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MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No. 2074/BYT-BM-TE

Re. commenting on the draft Guide to implementation of nutrition promotion actions specified in the National Target Program on Sustainable Poverty Reduction

Hanoi, April 25, 2022

 

To:

- Ministry of Labor, War Invalids and Social Affairs;
- Ministry of Education and Training;
- Ministry of Planning and Investment;
- Ministry of Finance;
- Ministry of Agriculture and Rural Development;
- Ministry of Information and Communications;
- Committee on Ethnic Minority Affairs;
- Central Committee of Vietnam Women’s Union;
- People’s Committees of provinces and centrally-affiliated cities.

On October 12, 2021, the Prime Minister issued the Decision No. 1705/QD-TTg, introducing the Plan to implement the Resolution No. 24/2021/QH15 dated July 28, 2021 of the National Assembly, approving the investment policy for implementation of the National Target Program on Sustainable Poverty Reduction for the 2021-2025 period, in which the Ministry of Health is assigned to take charge of and cooperate with the Ministry of Labor, War Invalids and Social Affairs and other relevant ministries, central and local authorities in promulgating the document directing and guiding the implementation of nutrition improvement content under the National Target Program on Sustainable Poverty Reduction in the 2021-2025 period;

On January 18, 2022, the Prime Minister issued the Decision No. 90/QD-TTg, approving the National Target Program on Sustainable Poverty Reduction in the 2021-2025 period, under which the Prime Minister assigned the Ministry of Health to take charge of, and cooperate with concerned ministries, central and local authorities in, implementing the Sub-project 2 - Nutrition promotion under the Project 3 – Support for production development and nutrition promotion.

Following the direction of the Prime Minister, the Ministry of Health has recently drafted the Guide to implementation of nutrition promotion actions of the National Target Program on Sustainable Poverty Reduction (Guide). During the drafting process, the Guide has received comments from nutritionists. Till now, the draft Guide is relatively complete.

In order to carry out the Poverty Reduction Program to ensure achievement of the specified objectives, effectiveness and efficiency, the Ministry of Health is sending you this Guide for your study and commentation. 

All of your written comments should be sent to the Ministry of Health (Department of Maternal and Child Health) by May 5, 2022 for its review, completion and issuance of the Guide.  Upon expiry of the aforesaid submission deadline, if there is none of comments received, the Ministry of Health could infer that you are agreed with the draft Guide.

Thanks.

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PP. MINISTER
DEPUTY MINISTER




Do Xuan Tuyen

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For all details, please contact:

- Doctor Hoang Anh Tuan - Department of Maternal and Child Health, Ministry of Health Mobile: 0913524408

 

MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No.           /QD-BYT

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DECISION

ISSUING THE GUIDE TO IMPLEMENTATION OF NUTRITION PROMOTION ACTIONS SPECIFIED IN THE NATIONAL TARGET PROGRAM ON SUSTAINABLE POVERTY REDUCTION DURING THE 2021-2025 PERIOD

MINISTER OF HEALTH

Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Government’s Decree No. 07/2021/ND-CP dated January 27, 2021, prescribing multidimensional poverty line for the 2021 – 2025 period;

Pursuant to the Government's Decree No. 27/2022/ND-CP dated April 19, 2022 on the mechanism for management and organization of implementation of national target programs;

Pursuant to the Prime Minister’s Decision No. 1705/QD-TTg dated October 12, 2021, issuing the Plan to implement the Plan to implement the National Assembly’s Resolution No. 24/2021/QH15 dated July 28, 2021 on approval of the investment policy for implementation of the National Target Program for Sustainable Poverty Reduction during the 2021-2025 period;

Pursuant to the Prime Minister’s Decision No. 90/QD-TTg dated January 18, 2022 on approval of the National Target Program for Sustainable Poverty Reduction for the 2021-2025 period;

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HEREIN DECIDES

Article 1. The guide to implementation of nutrition promotion actions specified in the National Target Program on Sustainable Poverty Reduction during the 2021-2025 period shall be enclosed herewith.

Article 2. This Decision shall enter into force from the signature date.

Article 3. Mr./Mrs. Director of the Department of Maternal and Child Health; Chief of the Ministry’s Office; the Ministry’s Chief Inspector; Directors or General Directors of Departments/Administrations/Authorities affiliated to the Ministry of Health; Directors of Departments of Health in provinces and centrally-controlled cities; Heads of Health Divisions of Ministries and central authorities; and Heads of other entities concerned, shall be responsible for implementing this Decision./.

 

 

PP. MINISTER
DEPUTY MINISTER




Do Xuan Tuyen

 

GUIDE

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I. PRELUDES TO THIS GUIDE

- National Assembly’s Resolution No. 40/2021/QH15 dated November 13, 2021 on the 2022 central budget allocations;

- Prime Minister’s Decision No. 90/QD-TTg dated January 18, 2022 on approval of the National Target Program for Sustainable Poverty Reduction for the 2021-2025 period;

- Prime Minister’s Decision No. 02/2022/QD-TTg dated January 18, 2022 on distribution principles, criteria and norms of central budget funds and proportions of counterpart funds of local budgets for implementation of National Target Program for Sustainable Poverty Reduction for 2021 – 2025 period;

- Prime Minister’s Decision No. 353/QD-TTg dated March 15, 2022 on approval of the list of poor districts, extremely disadvantaged communes of alluvial plains, coastal areas and islands during the 2021 - 2025 period.   

- Government's Decree No. 27/2022/ND-CP dated April 19, 2022 on the mechanism for management and organization of implementation of national target programs;

- Decision No. 721/QD-BYT dated March 23, 2022 of the Ministry of Health, issuing the Plan of the Ministry of Health for implementation of the National Target Program for Sustainable Poverty Reduction for the 2021-2025 period;

- Decision No. 4121/QD-BYT dated October 28, 2009 of the Ministry of Health, issuing the Instruction Manual for treatment of diarrhoea in children.

- Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the national Guide to control and prevention of micronutrient deficiencies.

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- Decision No. 6437/QD-BYT dated October 25, 2018 of the Ministry of Health, issuing the Guide to intestinal deworming in the community.

- Official Dispatch No. 3598/BYT-BM-TE dated April 29, 2021 of the Ministry of Health on instructions about formulation and implementation of the Nutrition Care Program for the first 1000 days of life.

II. SUPPORTING PRINCIPLES, CONDITIONS AND METHODS

2.1. Supporting principles, conditions

Plan and organize the implementation of the National Target Program on Sustainable Poverty Reduction for the 2021-2025 period (hereinafter referred to as Program) according to the following principles:

- Ensure public accessibility, democracy, equality, fairness, local authorities’ participation and commitment during the process of designing and carrying out supporting activities.

- Agree with local socio-economic planning schemes and plans.

- Align with conditions, characteristics and demands of poor households, near-poor households and households newly escaping from poverty line.

- State budget grants are only accessible to poor households; employees newly escaping from the poverty line; households or healthcare establishments located in poor districts or extremely disadvantaged communes of alluvial plains, coastal areas and islands.

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- The nutrition promotion model must be developed and brought into operation according to the principles that such model helps to ensure household food security, and must be tailor-made and suitable for specific regions.

- When drawing up Plans to implement the Program for submission to People’s Committees of provinces/cities to seek their approval, Departments of Health must allow for types and details of budget expenditures provided in law in force, avoid using the Program’s funding for other purposes, and call for other funds for fulfillment of the tasks under the Prime Minister’s mandate, as well as integrate or coordinate these Plans with other nutrition-related investment programs or projects with the aim of providing against the overlapping situation that may arise during the process of distributing and allocating funds.        

2.2. Supporting methods

- Support that is given to enable mothers and children under five years to have access to direct interventions in preventing malnutrition and micronutrient deficiency (by providing counseling packages on nutrition, multi-micronutrients, nutritional products, etc., management of acute malnutrition in the community...).

- Support that is given to preschool children and students in extremely disadvantaged areas to help to improve school meals; provide children with multi-micronutrient milk; periodically monitor nutritional condition; provide specific nutritional advices and solutions for malnourished students; educate children on proper nutrition care, enhancement of physical activities, malnutrition prevention...

- Support that is given to help to improve awareness and behavior of beneficiaries by strengthening propagation, communication and counseling tasks on nutritional care for women and children aged 0-16.

- Support that is given to help to improve capacity of local health officers and health workers at rural villages; strengthen resources and interdisciplinary cooperation on improvement of nutritional care for women and children aged 0-16; monitor, supervise, evaluate, and report on the Program's performance.

III. SCOPE AND SUBJECTS OF APPLICATION

3.1. Scope of application:

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- Interventions against malnutrition and micronutrient deficiency in mothers and children aged 0-16 from poor households, near-poor households, households newly escaping from the poverty line and children living in poor districts and extremely disadvantaged areas of alluvial plains, coastal areas and islands (belonging to Subproject 2 -Project 3).

- Nutrition communication (belonging to Project 6).

- Performance monitoring, evaluation and reporting on child nutrition promotion activities (belonging to Project 7).

3.2. Scope of application:

- 63 provinces/cities nationwide.

3.3. Subjects of application:

- Ministries, ministerial agencies, provinces and centrally-affiliated cities participating in child nutrition promotion activities.

- Agencies, units, entities and persons carrying out and obtaining benefits from child nutrition promotion activities.

- Direct beneficiaries:

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+ Children under 16 years old from poor households, near-poor households, and households newly escaping from the poverty line under the province/city-level management (not in the areas mentioned above).

IV. OBJECTIVES AND TARGETS

4.1. General objectives: Improve nutritional condition, reduce stunting, provide health care, and promote the health and stature of children under 16 from poor households, near-poor households, households newly escaping from the poverty line and children living in poor districts and extremely disadvantaged communes in alluvial plains, coastal areas and islands.

4.2. Specific goals:

- Specific goal 1: Lowering the level of nutritional deficiency in mothers and children from poor households, near-poor households, households newly escaping from the poverty line and children living in poor districts and extremely disadvantaged communes of alluvial plains, coastal areas and islands.

Targets:

+ Reduce the malnutrition rate of stunted children under 5 living in poor districts and extremely disadvantaged communes of alluvial plains, coastal areas and islands to less than 34% by 2025.

+ Reduce the malnutrition rate of wasted children under 5 living in poor districts and extremely disadvantaged communes of alluvial plains, coastal areas and islands to less than 5% by 2025.

+ Reduce the malnutrition rate of stunted children aged 5-16 living in poor districts and extremely disadvantaged communes of alluvial plains, coastal areas and islands to less than 34% by 2025.

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- Specific goal 2: Mitigating micronutrient deficiencies in babies, juveniles and women of reproductive age from poor households, near-poor households, households newly escaping from the poverty line and children living in poor districts and extremely disadvantaged communes of alluvial plains, coastal areas and islands.

Targets:

+ More than 80% of pregnant women living in poor districts, extremely disadvantaged communes, alluvial plains, coastal areas and islands are expected to have free access to multiple micronutrient supplements during the period starting on the pregnancy detection day and ending one month after giving birth by 2025.

+ Reduce the rate of anaemia in children under 5 who live in poor districts and extremely disadvantaged communes, alluvial plains, coastal areas and islands to less than 20% by 2025. Reduce the rate of anaemia in pregnant women and women of reproductive age who live in poor districts and extremely disadvantaged communes, alluvial plains, coastal areas and islands to less than 30% and 20%, respectively, by 2025.

+ Reduce the rate of zinc deficiency in children under 5 and pregnant women who live in poor districts, extremely disadvantaged communes, alluvial plains, coastal areas and islands to less than 60% and 70%, respectively, by 2025.

- Specific goal 3: Ensuring food security and nutritional response to emergency situations for children in poor districts, extremely disadvantaged communes, alluvial plains, coastal areas and islands.

Targets:

+ Increase the rate of entitlement to appropriate food supplements in adequate amounts of children aged 6-23 months living in poor districts, extremely disadvantaged communes, alluvial plains, coastal areas and islands to 50% by 2025.

+ Reduce the rate of households living both with severe household food insecurity and in poor districts, extremely disadvantaged communes, alluvial plains, coastal areas or islands to less than 25% by 2025.

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Items

2021 – 2025

2022

2023

2024

2025

Reduction in % of stunted children under 5 years of age

Below 34%

Collecting primary data in intervention districts or communes

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Decreasing % in 2023 by 2%

Decreasing % in 2024 by 2%

Reduction in % of wasted children under 5 years of age

Below 5%

Collecting primary data in intervention districts or communes

Decreasing % in 2022 by 1%

Decreasing % in 2023 by 1%

Decreasing % in 2024 by 1%

Reduction in % of stunted children under 5-16 years of age

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Collecting primary data in intervention districts or communes

Decreasing % in 2022 by 1%

Decreasing % in 2023 by 2%

Decreasing % in 2024 by 2%

Increase in % of children aged 6-23 months that eat appropriate food supplements in adequate amounts

Above 50%

Collecting primary data in intervention districts or communes

Increasing % in 2022 by 5%

Increasing % in 2023 by 7-10%

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Reduction in % of moderate and severe food insecure households

Below 25%

Collecting primary data in intervention districts or communes

Decreasing % in 2022 by 5%

Decreasing % in 2023 by 7-10%

Decreasing % in 2024 by 7-10%

V. BUDGET

The central budget funds shall be allocated to provinces under the Prime Minister’s Decision No. 02/2022/QD-TTg dated January 18, 2022 on distribution principles, criteria and norms of central budget funds and proportions of counterpart funds of local budgets for implementation of National Target Program for Sustainable Poverty Reduction for the 2021 – 2025 period.

VI. INSTRUCTIONS FOR IMPLEMENTATION OF ACTIONS

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6.1.1. At the central level

a) Develop technical and financial documents, and provide instructions for implementation of the Program's actions for local authorities.

Task completion process:  Based on the rate of child malnutrition and nutritional status of pregnant and pre-pregnancy women; local socio-economic situations, state of household food security; and according to the guidance of the Ministry of Health from the recommendations of the World Health Organization/ United Nations Children's Fund, develop and update professional documents, technical instructions issued by the Ministry of Health, and organize training or drilling courses on implementation thereof.

b) Provide health workers, child caregivers and guardians with instructions and counsels on identification of issues and problems related to the nutritional status of mothers, children, methods of assessing the nutritional status of children, nutritional, food safety and hygiene counseling and education skills.

Task completion process:  Comply with the instructions of the Ministry of Science and Technology, and the Ministry of Health. This action is carried out by providing seminars, conferences, training and drilling courses on programs, projects and professional activities needed for the Program's activities for health workers, poverty alleviation and other interdisciplinary officers at the provincial and district level. Training manuals will be designed, updated or revised, based on current local situations or proposals. 

c) Provide instructions on and assist in offering nutritious meals and nutritional education to semi-boarding/boarding students, and periodically monitoring the students' nutritional status; offer nutritional counsels on proper nutritional care and increased physical activity, prevention of malnutrition and micronutrient deficiencies.

Task completion process:  Depending on the characteristics of the region, ethnicity and age, design dietary menus and offer nutritious school meals to semi-boarding/boarding students; monitor nutritional status and provide nutritional counsels according to the guidelines of the Ministry of Health and the Ministry of Education and Training. Depending on the rate of malnutrition among school-age children, the local socio-economic situation and state of food security, set funding benchmarks for meals of school-age children, persons in charge of cooking, local regulators, teachers/childcare assistants in charge of preparing and dispensing meals and monitoring children. Apply financial support policies for kindergarten child meals at communes facing severe socio-economic disadvantages, extremely disadvantaged communes of coastal areas or islands (pursuant to Decree No. 57/2017/ND-CP, Decree No. 06/2018/ND-CP and Decree No. 105/2020/ND-CP) and other funds from local budgets, grants and private-sector contributions.

d) Develop guidelines and implement intervention models to improve nutritional status, ensuring food and nutrition security for specific regions.

Task completion process:  Based on the rate of child malnutrition, local socio-economic situation and state of household food security, build and deploy a model to improve nutrition, ensuring household food security specific to regions; develop nutritional menus for children under 5 years old. Intervention models are brought into operation according to scientific research processes, tested, evaluated and their results are communicated for widespread application purposes.

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Task completion process:  Follow the instructions of the Ministry of Science and Technology, and the Ministry of Health. Including the construction of the central monitoring system for the whole country and at the intervention provinces, districts and communes; Formulation, dissemination and collection of annual monitoring indices at central and local levels; Data processing and reporting; Monitoring and supervision of support with the participating provinces.

6.1.2. At the local level

a) Provide nutritional counseling packages for mothers when they are pregnant and their child gets 2 years old.

Task completion process shall be subject to detailed instructions given in the Official Dispatch No. 3598/BYT-BM-TE dated April 29, 2021 of the Ministry of Health on instructions about formulation and implementation of the Nutrition Care Program for the first 1000 days of life of the Ministry of Health and Manual for nutritional counseling for the first 1000 days of life of the National Institute of Nutrition.

Nutritional counseling packages must be rendered at healthcare stations of communes involved in the project. Each mother from the time of pregnancy until the child reaches the age of 2 years old will be consulted (individually or in groups) by trained medical staff at least 9 times at the authorized appropriate time according to the standard procedures (e.g. pregnancy, breastfeeding and complementary feeding). Provide independent or integrated counseling services at the time of antenatal care and vaccination.

b) Provide multiple micronutrient supplements for pregnant women

The time length of provision of multiple micronutrient supplements for pregnant women must range from the time of pregnancy detection to 1 month postpartum. Amounts to be administered: At least 180 supplements/pregnant woman. Multiple micronutrient supplements must be prepared from ingredients specified in recommended formulations of the United Nations (United Nations Multiple Micronutrient Preparation - UNIMMAP). Ingredients: Retinol (800 RE), vitamin D (200 IU), vitamin E (10 mg), vitamin C (70 mg), vitamin B1 (1.4 mg), vitamin B2 (1.4 mg), vitamin B6 (1.9 mg), vitamin B12 (2.6 mcg), folic acid (400 mcg), niacin (18 mg), zinc (15 mg), copper (2 mg), iron (30 mg), iodine (150 mcg), selenium (65 mcg). The maximum allowance of supplements to be administered does not exceed the thresholds applied to Vietnamese people who are classified as beneficiaries thereof (Adopted under the Decision No. 2615/QD-BYT dated June 16, 2016).

Task completion process:  Comply with the detailed instructions given in the Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the National Guide to control and prevention of micronutrient deficiencies, and instructions of specialized divisions immediately subordinate to the Ministry of Health.

Annually, local authorities shall collect data on beneficiaries, plan and estimate purchase and tendering costs under applicable regulations to buy multiple micronutrient supplements (if they are not dispensed for free from the central level).  Local authorities must administer multiple micronutrients after purchase or receipt to commune-level healthcare stations and health establishments for further dispense. Instructions for use of medicines are given to beneficiaries, integrated with prenatal care of women or given through village medical staff. Regular counseling and communication activities should be done when providing multiple micronutrient supplements in order to enhance compliance. Local authorities shall carry out all-level supervision and statistical reporting under the Program’s regulations.

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c) Provide iron or multiple micronutrient supplements weekly for women of reproductive age and teenage girls.

Amounts to be administered: 15 supplements x two three-month intervals equal 30 supplements/woman of reproductive age/year in total. Iron/folic acid supplements need to supply 60 mg of iron and 2800 μg of folic acid.

Task completion process:  Comply with the detailed instructions given in the Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the National Guide to control and prevention of micronutrient deficiencies, and instructions of specialized divisions immediately subordinate to the Ministry of Health. This task is done in the same manner as multiple micronutrient supplements intended for pregnant women (subparagraph b), intended for women of reproductive age of 15-35 years (non-pregnant) on the list compiled by healthcare stations and managed in the community and at school (school-going adolescent girls).   For women of reproductive age in the community, iron supplements or multiple micronutrient supplements may be supplied on the micronutrient days (June and December); For school-going teenage girls, educational authorities can provide these supplements during the school year. 

d) Dispense Vitamin A capsules to children aged 6-60 years, non-breastfed children aged under 5 months, children aged under 5 years who are malnourished, suffer diarrhea, measles, acute respiratory infections and women within 1 month after birth

Amounts to be administered: Children aged from 6 to less than 12 months: 100,000 units/each; children aged 12-60 months: 200,000 units/each, two times per annum or on demand or on prescription.  Postpartum women: 200,000 units to be dispensed within one month after delivery.

Task completion process:  Comply with the detailed instructions given in the Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the National Guide to control and prevention of micronutrient deficiencies, and instructions of specialized divisions immediately subordinate to the Ministry of Health.

Depending on actual local demands, regulatory authorities of provinces can plan and procure Vitamin A capsules or propose them to be dispensed from central authorities (currently, Vitamin A are supplied for free nationwide). Distribution, management, dispensing, monitoring, supervision and reporting regimes must be the same as those specified in the current instructions of health authorities.

dd) Provide zinc supplements to children with acute diarrhoea:

- Supplementation amounts:  Taking 20 mg of zinc or zinc compound; 5ml syrup containing 10 mg zinc.

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+ Children ≥6 months: 1 supplement/day within 14 days (20mg) or 10 ml syrup.

Task completion process:  Comply with the detailed instructions given in the Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the National Guide to control and prevention of micronutrient deficiencies, and the Decision No. 4121/QD-BYT dated October 28, 2009 of the Ministry of Health, issuing the Guide to child diarrhoea management.

Depending on the number of children under 5 years old with diarrhoea condition, the annual plans to supply and dispense drugs to healthcare establishments should be proposed.    This task is funded by health insurance schemes intended for children under 6 years old or the program.

e) Give nutritional products to malnourished children and in case of emergencies

- Distribute multi-micronutrient powder packets as supplements to flour/porridge meals to stunted children over 6 months to 23 months of age: Amounts to be administered: 60 packets/malnourished child/each dispensing period x 2 dispensing periods/year.   Multi-micronutrient powder must contain at least 3 micronutrients: Iron (12.5 mg elemental iron), Vitamin A (300 μg retinol), Zinc (5 mg elemental zinc). In addition, other necessary micronutrients can be added in the doses meeting currently recommended nutritional needs of specific target groups.

Task completion process: Comply with the detailed instructions given in the Decision No. 4944/QD-BYT dated November 27, 2014 of the Ministry of Health, issuing the National Guide to control and prevention of micronutrient deficiencies, and instructions of specialized divisions immediately subordinate to the Ministry of Health.

The list of stunted children aged 6 to 23 months must be compiled as a basis for regulatory authorities of provinces draw up the product purchase, distribution and management plans delegated to healthcare establishments and dispense these nutritional products to beneficiaries biannually (can be integrated with the annual Micronutrient Day). Provide home-based counsels and instruction for use of these products. Monitoring, supervision and reporting activities shall be carried out according to law.

- Dispense powder packets/micronutrient supplements to malnourished school-going children. Amounts to be administered: 60 packets (tablets/capsules)/malnourished child/each dispensing period x 2 dispensing periods/year. 

Task completion process:  Follow the instructions of specialized divisions under the Ministry of Health.

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- Administer nutritional powder/porridge to children over 6 months to under 5 years old in case of emergencies (e.g. natural disasters, crop failures, epidemics,...): Amounts to be administered: 1 dispensing period/year; 2 packets/child/day x 20 days. Task completion process: Follow the instructions of specialized divisions under the Ministry of Health.

Depending on the actual local situations, regulatory authorities of provinces shall make plans and budget estimates and procure reserve nutritional products (ensuring satisfaction of the nutritional needs of young children and limitation on ingredients not good for health; suitability for dispensing and processing of these administered items in case of emergencies at health authorities’ recommendations). In case of any emergency that occurs, these local authorities must conduct the fast assessment of demands, take charge of administering these products and providing directions for use to target beneficiaries.    Monitoring, supervision and reporting activities shall be carried out according to law. Plans for use or handling of these products in case of no emergency that occurs at localities under their management must be available for use.

g) Screen, treat and manage acute malnutrition in children in the community

Beneficiaries:   Children aged 0-72 months diagnosed with severe acute malnutrition.

Amount of products used for treating severe acute malnutrition: Each child with severe acute malnutrition will be treated with medical treatment preparations. Dosage: Average of 13.8kg RUTF (Ready to use therapeutic food)/child. Product specifications must follow the instructions of the Ministry of Health (Decision No. 4487/QD-BYT).

Task completion process:  Follow the detailed instruction of the Decision No. 4487/QD-BYT dated August 18, 2016 of the Ministry of Health, issuing the Guide to diagnosis and treatment of acute malnutrition in children aged 0 to 72 months, and the Decision No. 3779/QD-BYT dated August 26, 2019 of the Ministry of Health, issuing the Guide to practicing management of acute malnutrition in children aged 0 to 72 months, and the instructions of specialized divisions under the Ministry of Health.

In each commune, carry out the screening activities to detect the inclusion of severely malnourished children in the program. Medical facilities must take charge of management and treatment according to outpatient therapy programs, weekly re-examination and household visits according to professional indications. Implement procedures for receiving, tracking and transferring patients according to the guidance of the Ministry of Health. Therapeutical products must comply with the regulations of Decision 4487/QD-BYT. Regulatory authorities of provinces plan, procure and solicit bids for distribution of these products to healthcare establishments on the basis of the number of children with severe acute malnutrition which annually makes up 2% of the number of children under 5 years old at localities under their management. It is necessary to ensure a regular supply so that these products are always available at receiving healthcare establishments, avoiding supply chain disruptions affecting quality of medical treatment.

h) Enable children under 6 years of age, pregnant women and women of reproductive age to have access to regular deworming:

Amounts to be administered: 2 times/year for children aged from 2 to under 6 years and women of reproductive age. Pregnant women prescribed for deworming:  This task shall be scheduled for the second and third trimester of pregnancy.

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This task is performed in the same manner as the task of Vitamin A supplementation which may coincide with the deworming.

i) Plan and stockpile nutritional products to provide against natural disasters, calamities and epidemics with respect to the action involving the nutritional care for mothers and children. 

Amount of nutritional products: Available on actual local demand.

Task completion process must follow the technical Guide to nutritional preparation and response in case of emergencies and instructions of specialized divisions under the Ministry of Health.

Annually, regulatory authorities of provinces need to successfully develop plans for nutritional response in case of emergency or integrate them into their own disaster response plans, including the task of having the reserve of nutritional products and procuring the reserve thereof before occurrence. Implement response activities and have the plan to put the product into use if no emergency occurs, and handle products in stock if they are not in use. Monitoring, supervision and reporting activities shall be carried out according to law.

k) Provide nutritional care during pregnancy and postnatal care for mothers/babies as part of the task of administering iron/folic acid - multi-micronutrient or vitamin A supplements to pregnant or breastfeeding women; breastfeeding and complementary feeding through direct communication, nutritional practice at commune and village-level health stations.

Task completion process:  Comply with the Decision No. 4128/QD-BYT dated July 29, 2016 of the Ministry of Health, introducing the National Guide to reproductive health care services, and the Official Dispatch No. 3598/BYT-BM-TE dated April 29, 2021 of the Ministry of Health, regarding instructions about formulation and implementation of the Nutrition Care Program for the first 1000 days of life of the Ministry of Health (and updated documents thereof, if any), as well as other instructions of specialized divisions under the Ministry of Health.

Regulatory authorities of provinces must provide training programs and guidance to local health authorities to deploy nutrition education communication models directly in the community in the form of individual counseling, group counseling, nutrition club, nutrition practice. Communication campaigns should focus on nutritional care in the first 1000 days, control and prevention of micronutrient deficiencies, nutrition for sick children, proper nutrition, food choice, combined with other agricultural farming models and projects located in localities under their management to ensure nutrition so that they can enhance the creation of safe, available and nutritious food sources. Consult effective nutrition communication models that have been made publicly available by the Institute of Nutrition. Host visits and field trips to models, conferences and seminars on promotion of effective models.

l) Ensure that nutritious meals and nutrition education courses are provided for semi-boarding/boarding students.

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Regulatory authorities of provinces must establish the cooperation between education and health regulatory authorities; plan and train project staff on provision of school meals, knowledge and skills in school nutrition education; promote the quality of the curricular and extracurricular nutrition education activities appropriate to specific localities’ circumstances. Health workers must play the role of participating in professional guidance and operational supervision for schools during the process of their provision of boarding meals and nutrition education at school in collaboration with nutrition education at home. Research and develop effective models for introduction and widespread use (such as the school-garden model). Combine with local food generation models on the spot in other Poverty Reduction Program’s component projects, if any, in order to find consumption markets for those projects, creating a harmonized connection of the food system.

m) Offer nutritional counsels on proper nutritional care and increased physical activity, control and prevention of malnutrition and micronutrient deficiencies at school.

Task completion process:  Follow the current instructions of health and education regulatory authorities.

Regulatory authorities of provinces must establish the cooperation between health and education regulatory authorities; plan and train project staff on proper nutrition and physical activity, knowledge and skills necessary for project execution. Health regulatory authorities must play their role as the professional instructor and operational supervisor. Educational institutions must use appropriate counseling forms, and integrate them with school medical care. Provide favorable physical amenities for students to practice proper nutrition and physical fitness.

n) Provide guidance on and organize the monitoring and assessment of the nutritional status of women and children under 16 years old on an annual and periodic basis according to the plan

Task completion process:  Follow the guidance of specialized divisions under the Ministry of Health (anthropometric measurements, blood tests, interviews about food portion, diets, food consumption habits, demographic interviews, feeding history, medical history, etc.)

Regulatory authorities of provinces must plan and provide local healthcare establishments with training courses on nutritional status assessment and agreed performance monitoring indicators (distinguishing between annual monitoring indicators and periodic or final evaluation indicators). Measure and assess nutritional status for children periodically: monthly for children under 2 years of age with malnutrition; quarterly for children under 2 years old; twice a year for children aged 0- under 5 years; once a year with children aged 5-16 years. Enter data and report on results in a timely manner for appropriate assessment and action.

p) Provide equipment to assess the nutritional status of children for healthcare establishments in provinces, districts, communes and villages, and provide medical supplies, supplementary food and documents to carry out interventions in the community.

Task completion process:  Implement bidding according to current regulations for procurement and supply thereof according to the needs and plans of specific regulatory authorities of provinces. The requirements concerning specifications of equipment standards and food supplements must be subject to the regulations of specialized divisions under the Ministry of Health and the guidance of the United Nations Children's Fund.

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q) Improve the capacity of local health workers, village health workers, school health workers, teachers and others on improving nutrition care for women and children aged 0-16 years

Including: Training for nutritionists at commune and village levels on professional guidelines and techniques for implementation of nutrition activities. Training for school health workers and school teachers at all levels on guidelines to support the implementation of nutrition activities at school. Host conferences and seminars on building of capacity of local health workers, village health workers, school health workers, teachers, poverty reduction officers, agricultural officers and women on improving nutritional care for women and children aged 0-16 years.

This task must be performed annually. Regulatory authorities of provinces must, based on actual needs, propose training plans approved to be included in the project, and training programs in the form of central trainers training staff members of regulatory authorities of provinces/districts who then train staff members of regulatory authorities of communes, villages and hamlets.

6.2. Nutrition communication actions

6.2.1. At the central level

- Provide essential information, documents and activities involved in maternal and child nutrition communication campaigns through the production and editing of communication information, materials, and digital contents which are related to control and prevention of malnutrition and micronutrient deficiencies in mothers and children aged 0-16 years, and suitable for ethnic groups and regions.

- Provide training courses on building of communication capacity for health and related staff at the provincial and district levels.

- Host conferences, seminars, campaigns and Opening Ceremony on nutrition.

Task completion process:  Organize the Vitamin A supplementation campaign twice a year (in June and December) under the guidance of the Ministry of Health. Organize the Opening Ceremony of Micronutrient Day, Nutrition and Development Week, etc. according to the guidance of the Ministry of Health.6.2.1. At the local level

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- Train health and interdisciplinary staff working in maternal and child nutrition care at district/commune/village level in communication skills. Task completion process:  Local regulatory authorities shall register the needs for training in communication skills for maternal and child nutrition care staff at districts/communes/villages with provincial in-charge agencies. Based on actual needs, regulatory authorities of provinces must prepare the annual training plan. Training courses can be provided whether offline or online, depending on current local situations and significance of each of these training courses.

- Organize public gatherings at villages/hamlets during World Breastfeeding Week, Nutrition and Development Week, Micronutrients Day or Immunization Day.

Task completion process:  Directly meet people at villages/communes during World Breastfeeding Week, Nutrition and Development Week, Micronutrients Day or Immunization Day, etc., depending on local infrastructure and plans, and in conformity with annual written guides of the Ministry of Health.

6.3. Nutrition monitoring and surveillance action

6.3.1. At the central level

- Monitoring and surveillance of performance in implementation of maternal and child nutrition action: Central authorities must carry out the annual and irregular monitoring, inspection and supervision, and the close surveillance of the implementation of nutrition activities from the central to local level. Conduct monitoring and surveillance according to the annual plans.

+ Conduct sampling investigation nationwide with the aim of measuring annual performance indicators with respect to Specific Goal 1 and 3.

+ Gather report data corresponding to indicators specified in Appendix 3 from 32 provinces according to the Decision 353/QD-TTG.

+ Measure all indicators of sub-projects located within intervention localities in 2025 at the end of the period of implementation of the program.

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- Local regulatory authorities of provinces and districts shall monitor, inspect and supervise implementation of nutrition-related tasks at communes, wards and villages. Conduct monitoring and surveillance according to the annual plans.

- Formulate the plan to collect information for input assessment for intervention districts or communes (according to the Decision 353/QD-TTg) in 2022: 5 performance evaluation indicators referred to in Section I of Appendix 3. Annual re-assessment shall be required.

- Monitor implementation of tasks and actions, and submit reports, including data on performance indicators (Section II of Appendix 3), to central authorities.

- Report on funds received, called for and utilized in the program.

VII. PROGRAM MANAGEMENT AND IMPLEMENTATION INSTRUCTIONS

7.1. Steps in carrying out local child nutrition improvement actions:

7.1.1. Conducting the survey on and identification of tasks and activities involved in the action- Determine the necessity and legal basis for implementation of the local child nutrition improvement action. Based on information obtained from local nutrition and health assessment, importance of nutrition for sustainable poverty reduction, and legal documents issued by relevant competent authorities,

- Determine the scope, scale and beneficiaries of the action.

+ For districts and communes referred to in the Prime Minister’s Decision No. 353/QD-TTg dated March 15, 2022 on approval of the list of poor districts and extremely disadvantaged communes in the alluvial plains, coastal areas and islands in the period of 2021 - 2025: All children aged 0-16 years in these districts and communes will be beneficiaries of the action.

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- Analyze and evaluate factors related to the nutritional status of children aged 0-16 years from poor households, near-poor households or households newly escaping the poverty line and children living in poor districts or extremely disadvantaged communes in the alluvial plains, coastal areas and islands to determine and propose objectives, details, budgets, solutions and methods for implementation of the action at localities.

7.1.2. Developing the local implementation plans

- Annual and entire-period plans for implementation of the maternal and child nutrition improvement action are deemed as part of the plan for implementation of the National Target Program on Sustainable Poverty Reduction for the 2021-2025 period (Forms used for developing local plans that are given in Appendix 2).

- Maternal and child nutrition improvement activities must be conformable to the local planning schemes, projects and plans approved by competent authorities and must be on the list of activities included in local socio-economic development plans.

- Develop budget plans for implementation of the action of maternal and child nutrition improvement according to state budget’s annual funding, periods of time, including expectations about possibilities of receiving other resources.

- Departments of Health must gather these budget plans for submission to provincial People’s Committees for their approval.

7.1.3. Assessing implementation of these actions at localities

- Assess the scopes, scales, beneficiaries, tasks or activities involved, solutions and processes for implementation of these actions at localities.

- Assess impacts of these actions on socio-economic development performance, sustainable development and gender impacts.

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Annually, based on funding plans of the central budget, counterpart funds of local budgets and principles, criteria and quotas on allocation of funds to provinces, People’s Committees of provinces shall take charge of and direct Departments of Health to cooperate with relevant subordinates in developing plans for allocation of capital development funds and non-business expenditures to districts and communes for submission to competent regulatory authorities for their approval in accordance with regulations in force.

7.1.5. Carrying out these actions at localities

- Departments of Health shall report to provincial People’s Committees for cooperation with relevant authorities on instructing districts to review and synthesize counsels on allocation of funds for implementation of these actions; preferably, communes of poor districts, extremely disadvantaged communes of alluvial plains, coastal areas and islands.

- For provinces and centrally-affiliated cities carrying out these actions by using local budget funds, People’s Committees of provinces must provide adequate funding for implementation of these actions, subject to the minimum requirement that such funding must be equal to quotas on investment funds of the Central Budget.  

- Departments of Health/People’s Committees of districts must cooperate with relevant agencies in consulting People's Committees of provinces on integrating implementation of these actions with implementation of the other ones so that they take place at the same time in localities under their management. 

- After allocating funds and assigning budget plans to districts or communes, Departments of Health must prepare the review reports on performance of districts and communes for submission to People's Committees of provinces.

7.2. Implementation duties and responsibilities

7.2.1. Central authorities:

a) Ministry of Health

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Review these allocated funds available at specific localities and activities involved in the National Target Program on socio-economic development of ethnic minority and mountainous areas to prevent any overlapping situation.  Prefer to carry out direct interventions (the Sub-project on offering nutritional products to mothers and children) funded by the budget of this Sub-project.

- Department of Financial Planning: Take charge of cooperating with the Department of Maternal and Child Health, the Institute of Nutrition and relevant units, based on the plan of actions approved by the Ministry of Health's leadership, and allocated funds, on carrying out the assessment of annual budget estimates for submission to the Ministry's leadership to seek their approval of these estimates for implementation in accordance with regulations in force.

- Institute of Nutrition: Act as the agency leading the Sub-project 2. Develop the plan and ensure that the plan is actualized; synthesize and propose targets, objectives, funding sources and plans to allocate the five-year period’s and each year’s central budget funds for implementation of the Projects and Sub-projects of the program to central authorities and local authorities, and submit them to the Ministry of Health (via Department of Maternal and Child Health) in order for it to review them before seeking approval from competent regulatory authorities.   Develop the plan and instruct local authorities on how to implement the program; practice the professional supervision in accordance with regulations in force. Survey, assess, study, design the program’s documents and carry out activities involved in the program; provide training courses on enhancement of capacity of central authorities and local authorities of districts and provinces; carry out the monitoring and evaluation of performance and reporting of performance of nutrition improvement actions of provinces, and integrate them into the review report for submission to the Ministry of Health. 

- Concerned agencies: According to their assigned duties and delegated powers, actively cooperate with the Department of Maternal and Child Health in carrying out activities involved in the program according to the approved plan of actions.

- Regional Institutes designated by the Ministry of Health to give professional support related to nutrition issues: Duly manage all-level authorities in charge of implementing the actions of the program; provide technical support for inferior authorities so that they can enable their nutritional staff to have access to training courses on updated knowledge.

b) Ministry of Labor, War Invalids and Social Affairs; Office of the Poverty Reduction Program

Cooperate with the Ministry of Health in ensuring the implementation of the program and assignments of the Ministry of Health in order to ensure effectiveness, fulfillment of predetermined goals and objectives and prevention of any overlapping situation; promote communication to get more people involved in and gaining benefits from the program, especially those who are beneficiaries of the Sub-project 2 - Nutrition improvement; collaborate with the Ministry of Health and other relevant agencies in supervision, inspection and evaluation of performance of actions of the program implemented by the Ministry of Health.

c) Ministry of Education and Training

Cooperate with the Ministry of Health in the program’s actions at the central level; direct the local education system to carry out actions of sub-projects at school (e.g. school meals; monitoring and surveillance of nutrition; nutritional education; nutritional product counseling and support)

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d) Other relevant ministries/central authorities and regulatory authorities:  Cooperate on ensuring effective implementation of actions, depending on their assigned duties, delegated powers and related activities of projects and sub-projects of the program.

7.2.2. Local authorities:

- People’s Committees of centrally-affiliated cities and provinces:  Direct the implementation of tasks and actions falling within their remit, ensuring the right beneficiaries and strict conformance to regulations on principles and criteria for allocation of central budget funds and provision of counterpart funds of local budgets, and actively call for other funds for implementation of these tasks and actions on their part. Inspect, supervise, assess and compile regular and irregular reports on performance.

- Departments of Health in cities/provinces: Based on the nutritional status and actual local condition as well as orientation of the program’s tasks and actions, develop action plans to implement the program’s tasks and actions, and submit them to the People's Committees of provinces or centrally-run cities to seek their approval. Direct inferior medical units (provincial centers for disease control, health centers of districts, health stations of communes) to implement nutrition-related activities under the assigned sub-projects. Cooperate with other relevant Departments and units in integrating and calling for resources from other programs.

+ Procure or seek bids for provision of equipment, nutritional products, print leaflets; manage and distribute them to local recipients.   Local health authorities shall receive and distribute nutritional products and leaflets.

+ Edit information used for communication purposes.

+ Undertake the monitoring and assessment of the nutritional status and nutritional counseling.

+ Undertake nutrition communication and education activities at the community and school.

+ Organize training and coaching courses on improvement of capacity intended for nutrition public workers of provinces, districts and communes; school medical staff, kindergarten teachers and interdisciplinary officers.

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VIII. AMENDMENTS OR SUPPLEMENTS

8.1. Action plan

Based on the current progress in implementation of the plan, issues and problems of central and local authorities:

- Subordinate units of the Ministry of Health shall submit recommendations about necessary amendments or supplements to the plan to the Ministry of Health (via Department of Maternal and Child Health) in order to seek approval from the Ministry's leadership.

- Local authorities shall seek consent to any necessary amendment or supplement from provincial People’s Committees and report on such amendment and supplement to the Ministry of Health.

8.2. Professional guidance

Based on the actual progress in implementation of the program, central and local authorities’ issues and problems, all feedback and suggestions of relevant agencies about the Program implementation process must be sent to the Ministry of Health (through the Department of Maternal and Child Health) to report to the Ministry's Leadership for to seek its decision on appropriate amendments or supplements to this Guide.