Joint Circular No. 06/2010/TTLT-BYT-BNV-BTC guiding the implementation of Government Decree No. 64/2009/NĐ-CP dated July 30, 2009 on policies for medical staff working in areas with particularly difficult economic and social conditions.

Article 1. Scope of Regulation and Applicability

1. These joint circulars stipulate the preferential allowances; attraction allowances; travel, study, and professional training subsidies; and water purchase and transportation subsidies for civil servants, contractual employees, and military health personnel directly engaged in medical work who have been classified under the salary system pursuant to Decree No. 204/2004/ND-CP dated December 14, 2004 of the Government on the salary system for civil servants, public officials, civil servants, and armed forces personnel (hereinafter referred to as Decree No. 204/2004/ND-CP) at state-owned healthcare facilities located in areas with particularly difficult socio-economic conditions.

2. Civil servants, contractual employees (including those health workers temporarily assigned, rotated, or dispatched for at least one month continuously) directly engaged in medical work (hereinafter collectively referred to as health civil servants) at state-owned healthcare facilities, including: commune health stations, ward health stations, town health stations; health stations of agencies and schools; regional multi-specialty clinics; maternity homes; district health centers; hospitals; and other state-owned healthcare facilities located in areas with particularly difficult socio-economic conditions.

3. Officers, professional military personnel, defense civil servants who are doctors, pharmacists, medical technicians, nurses, medical technical assistants, and pharmacy assistants (hereinafter collectively referred to as military health personnel) directly engaged in medical work at state-owned healthcare facilities, including: military-civilian health stations, military-civilian health clinics, military-civilian multi-specialty clinics, military-civilian health stations according to decisions of competent authorities, communes without health stations where military units have approved combined military-civilian health programs, and military health personnel regularly assigned to directly care for the health of people in areas with particularly difficult socio-economic conditions.

4. Health civil servants and military health personnel directly engaged in medical work include the following tasks: examining, treating, caring for, and serving patients; laboratory testing for medical purposes; diagnostic imaging and functional examinations; pharmaceutical compounding and distribution: drugs, vaccines, biological products, chemicals, culture media; disease prevention and control; occupational medicine and environmental hygiene; supervising lower-level facilities; health education, population and family planning; border quarantine, inspection, testing, and appraisal; research in medical and pharmaceutical techniques; corpse preservation and mortuary management; medical equipment repair; sterilization of medical instruments, and ambulance driving.

5. Areas with particularly difficult socio-economic conditions shall be implemented in accordance with the provisions of the following documents:

a) Decision No. 106/2004/QĐ-TTg dated June 11, 2004 of the Prime Minister approving the list of particularly difficult communes in coastal and island areas;

b) Decision No. 164/2006/QD-TTg dated July 11, 2006 of the Prime Minister approving the list of particularly difficult communes, border communes, and safe area communes for investment under the Socio-Economic Development Program for Particularly Difficult Communes of Ethnic Minorities and Mountainous Regions for the period 2006-2010 (Program 135 Phase II);

c) Decision No. 113/2007/QD-TTg dated July 20, 2007 of the Prime Minister approving the list of communes that have completed the objectives of the Socio-Economic Development Program for Ethnic Minority and Mountainous Communes, Border Communes, and Remote Areas for the period 1995-2005, supplementing communes, villages, and hamlets for investment under Program 135 Phase II, and coastal and island communes for investment under the National Target Program to Reduce Poverty for the period 2006-2010;

d) Decision No. 69/2008/QD-TTg dated May 28, 2008 of the Prime Minister approving the supplementary list of particularly difficult communes, border communes, and safe area communes for investment under Program 135 Phase II, and the list of communes removed from investment under Program 135 Phase II;

đ) Other decisions of the Prime Minister regarding the supplementation and modification of the list of communes with particularly difficult socio-economic conditions (if any).

6. Civil servants and military health personnel as specified in Clause 2 and Clause 3 of this Article working in communes within poor districts (excluding communes specified in Clause 5 of this Article) according to Resolution No. 30a/2008/NQ-CP dated December 27, 2008 of the Government on the Program to Support Rapid and Sustainable Poverty Reduction in 61 Poor Districts shall apply the allowances and subsidies stipulated in these joint circulars.

Article 2. Preferential Allowance

1. Level of allowance: Medical civil servants, military medical officers working at state healthcare facilities in areas with particularly difficult socio-economic conditions shall be entitled to a preferential allowance equal to 70% of their current salary grade level or rank plus leadership position allowance and seniority allowance exceeding the standard range (if applicable).

2. Medical civil servants entitled to preferential allowances under this Joint Circular shall not be entitled to preferential allowances stipulated in Joint Circular No. 02/2006/TTLT-BYT-BNV-BTC dated January 23, 2006 issued by the Ministry of Health, the Ministry of Home Affairs, and the Ministry of Finance guiding the implementation of Decision No. 276/2005/QĐ-TTg dated November 1, 2005 of the Prime Minister on preferential allowance systems for certain professions for officials and civil servants working at state healthcare facilities (hereinafter referred to as Joint Circular No. 02/2006/TTLT-BYT-BNV-BTC).

3. The amount of monthly preferential allowance shall be calculated according to the following formula:

Example 1: Ms. Nguyen Thi H, a village health station head nurse in Village M located in an area with particularly difficult socio-economic conditions, has a salary coefficient of 3.46 - grade 9 nurse, and enjoys a leadership position allowance coefficient of 0.2. Ms. H's preferential allowance for October 2009 is as follows:

Ms. H's preferential allowance for October 2009 = 650,000 VND x (3.46 + 0.2) x 70% = 1,665,300 VND.

Ms. H has been entitled to preferential allowances under this Joint Circular, so she will no longer be entitled to preferential allowances under the profession-based system stipulated in Joint Circular No. 02/2006/TTLT-BYT-BNV-BTC.

Example 2: Lieutenant Nguyen Van A, a doctor with a salary coefficient of 4.2 for officer rank, was assigned by the competent authority to work at a combined military-civilian health station in an area with particularly difficult socio-economic conditions starting from October 1, 2009. Lieutenant A's preferential allowance for October 2009 is as follows:

Lieutenant A's preferential allowance for October 2009 = 650,000 VND x 4.2 x 70% = 1,911,000 VND.

4. Medical civil servants, military medical officers shall not be entitled to preferential allowances stipulated in Clause 1 of this Article during the following periods:

a) Time spent on overseas assignments, work, or study receiving 40% of their salary as stipulated in Clause 4, Article 8 of Decree No. 204/2004/NĐ-CP;

b) Time spent on domestic assignments or study not directly related to medical work for more than three consecutive months (except for cases involving medical specialization training);

c) Time off without pay continuously for one month or more;

d) Time off due to illness or maternity leave exceeding the prescribed period by the State;

đ) Time when they are suspended from work or suspended from performing medical duties.

Article 3. Attraction Allowance

1. Level of allowance: Medical civil servants, military medical officers currently working or transferred to work (including newly graduated individuals recruited by the competent authority) at state healthcare facilities in areas with particularly difficult socio-economic conditions shall be entitled to an attraction allowance equal to 70% of their current salary grade level or rank plus leadership position allowance and seniority allowance exceeding the standard range (if applicable).

2. The amount of monthly attraction allowance shall be calculated according to the following formula:

3. Duration of entitlement:

a) Attraction allowance shall be paid for the actual working time of medical officials and staff, and military medical officers at state healthcare facilities in areas with particularly difficult socio-economic conditions, but the duration of entitlement to attraction allowance shall not exceed five years.

b) Medical civil servants, military medical officers shall not be entitled to attraction allowances during the periods specified in Clause 4, Article 2 of this Joint Circular.

4. Entitlement date:

a) Medical civil servants, military medical officers who have a decision to transfer to work (including newly graduated individuals recruited by the competent authority) at state healthcare facilities in areas with particularly difficult socio-economic conditions from September 15, 2009 onwards shall be entitled to attraction allowance from the date they start working at the healthcare facility.

Example 3: Mr. Nguyen Van B, a doctor, was assigned by the competent authority to work at a village health station in an area with particularly difficult socio-economic conditions from January 1, 2010. Mr. B is entitled to attraction allowance from January 1, 2010.

b) Medical civil servants, military medical officers who have been working at state healthcare facilities in areas with particularly difficult socio-economic conditions before September 15, 2009 and continue to work there shall be entitled to attraction allowance from September 15, 2009.

Example 4: Ms. Tran Thanh C, a nurse, was assigned by the competent authority to work at a village health station in an area with particularly difficult socio-economic conditions from January 1, 2007 and has continued working there since then. Ms. C is entitled to attraction allowance from September 15, 2009. According to this Joint Circular, Ms. C can enjoy attraction allowance for a maximum of five years (until September 14, 2014 if she continues working in the village in an area with particularly difficult socio-economic conditions until 2014).

If Ms. C is transferred or requests to change her job to a healthcare facility not in an area with particularly difficult socio-economic conditions from January 1, 2012 or if the village completes its socio-economic development program targets (exiting the Program 135 investment scope) from January 1, 2012, Ms. C will no longer be entitled to attraction allowance from January 1, 2012.

Article 4. Subsidies for sightseeing, study, and professional training

1. Medical civil servants, military medical officers working at state-owned healthcare facilities in areas with particularly difficult socio-economic conditions who are dispatched by competent authorities to attend training on professional skills and foreign languages at public training institutions shall be supported as follows:

a) Costs for purchasing study materials (excluding reference materials);

b) 100% tuition fees according to invoices or receipts issued by the training institution;

c) Travel expenses from their workplace to the training location (one round trip; holidays and Tet);

d) Partial support for food expenses during concentrated training periods;

đ) Rent for accommodation during concentrated training days at the training institution (in cases where the training institution confirms that accommodation cannot be provided);

These expenditures shall not exceed the limits specified in Circular No. 51/2008/TT-BTC dated June 16, 2008, issued by the Ministry of Finance, guiding the management and use of training and professional development funds for state officials and civil servants.

2. Medical civil servants, military medical officers working at state-owned healthcare facilities in areas with particularly difficult socio-economic conditions who excel in their duties based on annual performance evaluations by competent authorities may organize one domestic sightseeing and learning exchange trip per year, not exceeding 15 days, and shall be reimbursed for train and bus tickets, accommodation rental fees, and travel allowances according to current travel expense regulations, along with any additional costs incurred from organizing practical visits, provided there are valid receipts and within the approved budget.

3. Medical civil servants, military medical officers working in ethnic minority regions in areas with particularly difficult socio-economic conditions who self-study and become proficient in local ethnic minority languages (including self-study of other ethnic minority languages) to serve medical examination, treatment, and health care services, and are certified by competent authorities, shall be supported once for the cost of purchasing study materials and a subsidy for self-study of ethnic minority languages and scripts. The specific amount is decided by the provincial People's Committee but shall not exceed VND 3,000,000 per person for studying one script and ethnic minority language, and not more than VND 5,000,000 per person for studying two scripts and ethnic minority languages.

Article 5. Subsidies for purchasing and transporting clean water

1. Medical civil servants, military medical officers working and living in areas with particularly difficult socio-economic conditions experiencing seasonal shortages of clean water (referred to collectively as water-scarce areas) shall be subsidized for the purchase and transportation of clean water to meet daily living needs after deducting the portion of clean water costs already included in their salaries.

2. Seasonal water-scarce areas are those where natural conditions do not provide sufficient water for daily living for at least one continuous month in a year.

3. Subsidies for purchasing and transporting clean water:

a) The basis for calculating subsidies for purchasing and transporting clean water for one person includes:

Standard consumption rate: 6 cubic meters/person/month (a);

The actual number of months without clean water in a year (b);

The cost of purchasing and transporting one cubic meter of clean water to the residence and workplace of medical civil servants and military medical officers, as stipulated by the provincial People's Committee (c);

The price of clean water included in the salary, which is the business price of one cubic meter of domestic water as prescribed by the competent authority at the local level (d).

b) Calculation Method:

The monthly subsidy amount is: a x (c - d).

The amount of subsidy received for one year is: a x (c - d) x b.

4. The provincial People's Committee shall base its determination of water-scarce areas, duration, and subsidy amounts for purchasing and transporting clean water on the specific conditions of communes in areas with particularly difficult socio-economic conditions under its jurisdiction, ensuring appropriateness.

Article 6. Sources of funds and methods of payment

1. The sources of funds for implementing the supplementary allowance and subsidy regimes stipulated in this Joint Circular shall be guaranteed from the state budget according to the current budget classification, income from healthcare facilities' public service activities as prescribed, and other lawful sources of funding.

2. For the years 2009 and 2010, additional funds for implementing policies towards medical staff, military medical officers working in areas with particularly difficult socio-economic conditions as stipulated in this Joint Circular shall be handled as follows:

a) For Ministries and central agencies: The Central Budget will supplement according to the proposals of the Ministries and central agencies.

b) For localities: To be consolidated into the demand for salary reform and processed from the salary reform expenditure source as prescribed.

3. Methods of payment:

a) The preferential supplementary allowances and attraction supplementary allowances stipulated in this Joint Circular shall be paid together with monthly salaries; the subsidy regimes shall be paid once a year.

b) The supplementary allowances and subsidies stipulated in this Joint Circular shall not be used to calculate contributions or benefits under social insurance, health insurance, unemployment insurance, and trade union fees.

c) The units directly managing and paying salaries to medical staff and military medical officers shall be responsible for disbursing the supplementary allowances and subsidies stipulated in this Joint Circular.

Article 7. Budget preparation, execution, and settlement work

1. The work of preparing budgets, executing budgets, and settling accounts for funds implementing the supplementary allowance and subsidy regimes as stipulated in this Joint Circular shall be carried out in accordance with the current provisions of the State Budget Law, Accounting Law, and other guiding documents currently in force.

2. The supplementary allowances and subsidies stipulated in this Joint Circular shall be recorded under corresponding Chapters, types, and Clauses, and the following items and sub-items:

a) Preferential allowances shall be recorded under Item 6.100, Sub-item 6.112;

b) Attraction supplementary allowances shall be recorded under Item 6.100, Sub-item 6.103;

c) The subsidies:

Tuition support for officials attending training shall be recorded under Item 6.150, Sub-item 6.155;

Housing rental support shall be recorded under Item 6.700, Sub-item 6.703;

Travel allowance support shall be recorded under Item 6.700, Sub-item 6.701;

Support for purchasing study materials shall be recorded under Item 7.000, Sub-item 7.003;

Support for purchasing materials and self-study language subsidies shall be recorded under Item 6.150, Sub-item 6.155;

Subsidies for purchasing and transporting fresh water shall be recorded under Item 6.250, Sub-item 6.299.

Article 8. Implementation organization

1. For localities:

a) Units directly managing and paying salaries to medical staff and military medical officers shall be responsible for reviewing and preparing budgets for the beneficiaries according to Tables 1a, 1b, 2a, and 2b issued along with this Joint Circular and submitting them to the immediate superior administrative body according to the current budget classification (hereinafter referred to as the immediate superior administrative body).

b) The immediate superior administrative body shall review and consolidate the increased financial needs of healthcare facilities according to Tables 3, 4, and 5 issued along with this Joint Circular and submit them to the Department of Finance.

c) The Department of Finance shall be responsible for reviewing and consolidating the increased financial needs according to Tables 3, 4, and 5 issued along with this Joint Circular and presenting them to the People's Committee of the province or centrally-administered city for decision.

d) The People's Committee of the province or centrally-administered city shall consolidate and prepare reports according to Tables 3, 4, and 5 issued along with this Joint Circular and submit them to the Ministry of Finance for consideration and resolution according to regulations.

2. For Ministries, agencies at the ministerial level, and government agencies:

a) Units directly managing and paying salaries to medical staff and military medical officers shall implement the provisions set forth in point a, Clause 1, Article 1 of this Joint Circular.

b) The immediate superior administrative body shall review and consolidate the increased financial needs according to Tables 3, 4, and 5 issued along with this Joint Circular and submit them to the higher-level management body up to the Ministry, agency at the ministerial level, or government agency.

c) The Ministry, agency at the ministerial level, or government agency shall be responsible for reviewing, consolidating, and preparing reports according to Tables 3, 4, and 5 issued along with this Joint Circular and submitting them to the Ministry of Finance for consideration and resolution according to regulations.

Article 9. Implementation Provisions

1. This Joint Circular takes effect from May 15, 2010.

2. The regimes stipulated in this Joint Circular shall be calculated from September 15, 2009.

During implementation, if there are any difficulties, the Ministries, sectors, and localities shall report to the Ministry of Health for coordination with the Ministry of Home Affairs and the Ministry of Finance to study and resolve the issues.