Joint Circular No. 11/1998/TTLT/BYT-BTC-BVGCP guiding the management, distribution, use, and recovery mechanism for essential medicines under the National Health Support Project and the Population and Family Health Project.

JOINT CIRCULAR OF THE MINISTRY OF HEALTH - THE MINISTRY OF FINANCE - THE STATE PRICING BOARD

HGUIDING THE MANAGEMENT, DISTRIBUTION, USE AND RECOVERY MECHANISM FOR ESSENTIAL MEDICINES FUNDS

 UNDER THE NATIONAL HEALTH SUPPORT PROJECT AND POPULATION AND FAMILY HEALTH PROJECT

IMPLEMENTING THE GUIDANCE OF THE GOVERNMENT CHAIRMAN IN THE LETTER NO. 625/CP-QHQT ON JUNE 6, 1998 REGARDING THE MECHANISM FOR RECOVERING ESSENTIAL MEDICINES FUNDS OF THE TWO PROJECTS: THE NATIONAL HEALTH SUPPORT PROJECT OF THE MINISTRY OF HEALTH AND THE POPULATION AND FAMILY HEALTH PROJECT OF THE NATIONAL POPULATION AND FAMILY PLANNING COMMISSION, THE JOINT MINISTRIES: THE MINISTRY OF HEALTH - THE MINISTRY OF FINANCE - THE STATE PRICING BOARD ISSUE GUIDELINES FOR THE MANAGEMENT, DISTRIBUTION, USE AND RECOVERY MECHANISM FOR ESSENTIAL MEDICINES FUNDS OF THE TWO PROJECTS AS FOLLOWS:

I. GENERAL PROVISIONS

1.ALL FUNDS OF THE NATIONAL HEALTH SUPPORT PROJECT AND THE POPULATION AND FAMILY HEALTH PROJECT (REFERRED TO AS THE TWO PROJECTS) ALLOCATED FOR PURCHASING ESSENTIAL MEDICINES ARE GOVERNMENT BUDGET FUNDS PROVIDED TO SUPPORT THE IMPLEMENTATION OF THE NATIONAL HEALTH CARE STRATEGY AND THE POPULATION STRATEGY, FAMILY PLANNING.

2.THIS CIRCULAR APPLIES TO THE MANAGEMENT, DISTRIBUTION, USE OF ESSENTIAL MEDICINES AND THE RECOVERY MECHANISM FOR ESSENTIAL MEDICINES FUNDS OF THE TWO PROJECTS, WITH THE AIM OF MAINTAINING A MEDICINE FUND, ENSURING THAT THERE IS ALWAYS ENOUGH MEDICINE TO MEET THE NEEDS OF HEALTH SERVICES FOR THE PEOPLE AND NOT FOR PROFIT.

3.THE AMOUNT OF ESSENTIAL MEDICINES PURCHASED WITH FUNDS FROM THE TWO PROJECTS MUST BE USED FOR THE INTENDED PURPOSE AND MANAGED ACCORDING TO THE CURRENT REGIME OF THE STATE.

4.ESSENTIAL MEDICINES ARE DISTRIBUTED TO ALL CITIZENS IN THE PROVINCES OF THE TWO PROJECTS (WITH OR WITHOUT PAYMENT) THROUGH HEALTH SERVICES AT DISTRICT, COUNTY, CITY TOWN HEALTH CENTERS AND RURAL HEALTH STATIONS (REFERRED TO AS HEALTH SERVICE FACILITIES). IT IS STRICTLY PROHIBITED FOR HEALTH SERVICE FACILITIES AND HEALTH WORKERS TO SELL ESSENTIAL MEDICINES OF THE PROJECT IN ANY FORM.

5.THE FUNDS RECOVERED FROM THE SALE OF ESSENTIAL MEDICINES WITH PAYMENT OF THE TWO PROJECTS ARE LEFT FOR HEALTH FACILITIES WITHIN THE SCOPE OF THE TWO PROJECTS TO ESTABLISH A MEDICINE REVOLVING FUND TO SUPPORT COMMUNITY HEALTH SERVICES. 6. THE MINISTRY OF HEALTH AND THE NATIONAL POPULATION AND FAMILY PLANNING COMMISSION ARE RESPONSIBLE FOR JOINING WITH THE PROVINCE PEOPLE'S COMMITTEES BELONGING TO THE TWO PROJECTS TO MONITOR AND SUPERVISE THE CORRECT IMPLEMENTATION OF THE CONTENT AND PURPOSE AGREED BETWEEN THE VIETNAMESE GOVERNMENT AND INTERNATIONAL ORGANIZATIONS.

II. SPECIFIC PROVISIONS

1.BUILDING A PLAN

BASED ON THE ANNUAL LOAN BUDGET APPROVED BY THE GOVERNMENT, THE PROCESS OF BUILDING THE ESSENTIAL MEDICINES PLAN OF THE TWO PROJECTS IS CONDUCTED IN THE FOLLOWING ORDER:

THE PROVINCIAL PROJECT MANAGEMENT BOARDS UNIFY WITH THE DEPARTMENT OF HEALTH TO DEVELOP THE ESTIMATED ESSENTIAL MEDICINES PLAN FOR EACH HEALTH SERVICE FACILITY AND SUBMIT IT TO THE CENTRAL PROJECT MANAGEMENT BOARD FOR APPROVAL AND AGGREGATION (THE NATIONAL HEALTH SUPPORT PROJECT FUNDS ARE SENT TO THE NATIONAL HEALTH SUPPORT PROJECT MANAGEMENT BOARD AT THE MINISTRY OF HEALTH; THE POPULATION AND FAMILY HEALTH PROJECT FUNDS ARE SENT TO THE NATIONAL POPULATION AND FAMILY HEALTH PROJECT MANAGEMENT BOARD AT THE NATIONAL POPULATION AND FAMILY PLANNING COMMISSION). THE CENTRAL PROJECT MANAGEMENT BOARDS ARE RESPONSIBLE FOR AGGREGATING THE ESTIMATED ESSENTIAL MEDICINES PLAN OF THE PROVINCES IN THE PROJECT AND CALCULATING THE VALUE BASED ON THE ANNUAL LOAN BUDGET APPROVED TO SUBMIT TO THE SUPERVISORY AUTHORITY. THE MINISTRY OF HEALTH AND THE NATIONAL POPULATION AND FAMILY PLANNING COMMISSION AGGREGATE THE PROJECT PLANS INTO THE ANNUAL LOAN BUDGET OF THE UNIT TO SEND TO THE MINISTRY OF FINANCE AND THE MINISTRY OF PLANNING AND INVESTMENT FOR AGGREGATION.

2.DISTRIBUTING MEDICINES TO HEALTH FACILITIES

2.1.MEDICINE HANDOVER.

AFTER COMPLETING THE PROCUREMENT PROCEDURES AT THE CENTRAL PROJECT MANAGEMENT BOARDS, THE TWO PROJECTS ARE RESPONSIBLE FOR HANDING OVER THE MEDICINES TO THE DEPARTMENT OF HEALTH THROUGH THE LOGISTICS SYSTEM OF THE TWO PROJECTS TO PROVIDE MEDICINES TO HEALTH SERVICE FACILITIES IN THE PROVINCES OF THE PROJECT ACCORDING TO THE APPROVED QUANTITY.

2.2.RECORD KEEPING, MONITORING, REPORTING.

DISTRICT, COUNTY, CITY TOWN HEALTH CENTERS, MOTHER AND CHILD HEALTH CENTERS - FAMILY PLANNING AND RURAL HEALTH STATIONS (REFERRED TO AS HEALTH FACILITIES) SHALL SEPARATELY TRACK THE AMOUNT OF MEDICINES ISSUED FROM THE TWO PROJECTS, MONTHLY AND QUARTERLY REPORTING TO THE DEPARTMENT OF HEALTH THE AMOUNT OF MEDICINES ISSUED AND THE FUNDS RECOVERED FROM THE ESSENTIAL MEDICINES SOURCE ACCORDING TO THE TABLE TEMPLATE ATTACHED TO THIS CIRCULAR.

2.3.PROCESSING SLOW-CIRCULATING MEDICINES.

FOR EACH SPECIFIC TYPE OF MEDICINE, IT MAY BE SLOWLY CIRCULATING IN ONE HEALTH SERVICE FACILITY BUT QUICKLY CIRCULATING IN ANOTHER. TO AVOID THE SITUATION WHERE SLOW-CIRCULATING MEDICINES ARE STOCKED LONG-TERM IN HEALTH SERVICE FACILITIES, AFFECTING THE QUALITY AND SHELF LIFE OF THE MEDICINES, BASED ON MONTHLY AND QUARTERLY REPORTS FROM HEALTH FACILITIES, DISTRICT, COUNTY, CITY TOWN HEALTH CENTERS IN THE PROJECT ARE ENTITLED TO TRANSFER SLOW-CIRCULATING PROJECT MEDICINES BETWEEN VILLAGES AND WARD IN THE DISTRICT, COUNTY, CITY TOWN. THE DEPARTMENT OF HEALTH OF THE PROVINCES OF THE TWO PROJECTS ARE ENTITLED TO TRANSFER SLOW-CIRCULATING MEDICINES BETWEEN DISTRICTS, COUNTIES, CITY TOWNS IN THE PROVINCE. THE TRANSFER OF SLOW-CIRCULATING MEDICINES IS BASED ON THE PRINCIPLE OF ASSET HANDOVER (MEDICINES AND THEIR EQUIVALENT VALUE). THE HANDOVER PARTY REDUCES THE FUNDS, THE RECEIVING PARTY INCREASES THE FUNDS. TRANSPORT FEES ARE AGREED UPON BY BOTH PARTIES.

3.METHODS OF DISTRIBUTING MEDICINES TO PATIENTS AND RECOVERING MEDICINE FEES.

3.1.METHODS OF DISTRIBUTING MEDICINES TO PATIENTS:

PATIENTS (IRRESPECTIVE OF WHETHER THEY NEED TO PAY FOR MEDICINES OR NOT, IN-PATIENT OR OUT-PATIENT TREATMENT) ARE ALL ISSUED ESSENTIAL MEDICINES ACCORDING TO THE TREATMENT PRESCRIPTION OF DOCTORS OR CLINICIANS.

3.2.SUBJECTS ELIGIBLE FOR FREE ESSENTIAL MEDICINES INCLUDE:

SUBJECTS DEFINED IN POINT B OF PART II OF JOINT CIRCULAR NUMBER 14/TTLB ON SEPTEMBER 30, 1995 OF THE JOINT MINISTRIES OF HEALTH - FINANCE - LABOR, WAR INVALIDS AND SOCIAL AFFAIRS - THE STATE PRICING BOARD "GUIDELINES FOR IMPLEMENTING THE COLLECTION OF A PORTION OF HOSPITAL FEES":

CHILDREN UNDER 6 YEARS OLD.

PERSONS SUFFERING FROM SCHIZOPHRENIA, EPILEPSY, LEPROSY, TUBERCULOSIS.

PERSONS SUFFERING FROM DISEASES IN VILLAGES RECOGNIZED AS HIGHLAND AREAS BY THE ETHNIC MINORITY AND MOUNTAINOUS REGION COMMITTEE.

ETHNIC GROUP MEMBERS ENGAGED IN CLEARING LAND, SETTLEMENT IN NEW ECONOMIC ZONES FOR A PERIOD OF 3 YEARS FROM THE DATE OF ARRIVAL.

DISABLED PERSONS, ORPHANS, ELDERLY WITHOUT SUPPORT AND POOR PATIENTS WHO ARE ISSUED A CERTIFICATE BY THE LABOR, WAR INVALIDS AND SOCIAL AFFAIRS DEPARTMENT OF THE DISTRICT OR COUNTY.

PERSONS ISSUED A "FREE HEALTH CARE CARD".

3.3.SUBJECTS REQUIRED TO PAY FOR ESSENTIAL MEDICINES:

INCLUDING ALL SUBJECTS NOT INCLUDED IN THE ABOVE MENTIONED SECTION 3.2.

3.4.METHODS OF RECOVERING ESSENTIAL MEDICINE FEES:

The recovery of essential medicine funds distributed to patients shall be carried out in accordance with current regulations on organizing the collection of part of hospital fees, specifically as follows:

Use invoices and receipts for hospital fee collections according to the model issued by the Ministry of Finance.

Forms of payment for medicines:

Patients without health insurance must pay directly to the healthcare facility.

Patients with health insurance will have their costs covered by the health insurance agency for the healthcare facility.

Healthcare facilities are not allowed to allocate 25-28% for rewards as stipulated in Point 2, Part V of Circular Joint No. 14/TTLB dated September 30, 1995, "guidelines for collecting part of hospital fees," from the recovered essential medicine funds of these two projects.

3.5.Price of essential medicines provided to patients:

Essential medicines supplied by the two projects are imported through international competitive bidding, thus the import price may be higher or lower than the market price of similar medicines currently sold in Vietnam. Therefore, the recovery price will be adjusted to align with local market prices and patient affordability, in accordance with Circular No. 06/TTLB dated July 10, 1993, jointly issued by the Government Price Control Board and the Ministry of Finance, regarding "management of goods and services subject to subsidized policies and orders from the state budget in the fields of culture, information, health, education, training, and sports." Pricing principles:

For types of essential medicines that are available on the local market, the recovery price of the project's medicines will be calculated based on the market price of the same type of medicine.

In cases where there are no comparable or similar items of essential medicines from the project on the market, the recovery price will be determined as follows:

Recovery price = CIF price (or EXW price) + 10%

(CIF price is the international competitive bidding price at the Vietnamese port, EXW price is the factory price at pharmaceutical establishments within Vietnam; 10% is calculated based on CIF or EXW price)

The People's Committee of the province establishes a Medicine Pricing Council comprising representatives from:

Provincial People's Committee

Health Department

Department of Finance and Prices

In cases where there are fluctuations in market prices exceeding 5% compared to the project's recovery price, healthcare facilities must promptly report to the Medicine Pricing Council for review and adjustment.

3.6.Management and use of recovered medicine funds:

The reflection of sources on the books of healthcare facilities is the value of medicines according to the CIF price, converted to Vietnamese Dong by the provincial Health Departments based on the exchange rate specified by the Ministry of Finance at the time of import. After the Medicine Pricing Council determines the price, the Health Department distributes medicines to healthcare facilities at the price decided by the Medicine Pricing Council. If the pricing council's price is higher than the project's announced price, the Health Department records an increase in the medicine fund; if it is lower, a decrease is recorded by the difference. Healthcare facilities can only recover money for medicines at the price announced by the local Medicine Pricing Council.

All recovered funds from essential medicines at healthcare facilities are retained at 90% to supplement operating funds and maintain the medical supply fund; 10% is allocated for transportation expenses, allowances for pharmacy supervisors, medical staff, and management work. (These expenditures are decided by the head of the healthcare facility). From the next cycle onwards, the Health Departments under the two Projects, Centers for Maternal and Child Health - Family Planning, Project Management Boards at the provincial level, and healthcare facilities will manage and implement steps as prescribed in this Circular. When planning, provinces under the two projects only plan to supplement essential medicines provided free of charge to certain groups as stipulated in Point 3.2 of this Circular. Healthcare facilities can still use 10% of the total recovered funds for transportation expenses, allowances for pharmacy supervisors, medical staff, and management work. The remaining 90% is supplemented to the revolving drug fund, which healthcare facilities purchase drugs to replenish their own funds, but they must comply with current national regulations on domestic trade.

4.Accounting, reporting, and settlement:

The entire value of essential medicines provided by the two Projects to healthcare facilities is considered as assets transferred by the Projects to the localities for management and use in accordance with the content and objectives approved by the Government. When transferring medicines to the Health Departments under the Projects, the Ministry of Health and the National Population and Family Planning Commission are responsible for settling accounts with the Ministry of Finance.

The Health Department is the coordinating body working with the Project Management Boards at the provincial level, urging healthcare facilities to report monthly on the operation of the medicine fund, including:

Quantity and value of medicines provided free of charge.

Value of recovered medicine funds.

Inventory status (with quality analysis and expiration date) and slow turnover of medicines.

Management and use of 10% for administrative and service costs.

Every quarter, the Health Department reviews and evaluates the implementation of the project management and project execution at the local level, draws lessons, and formulates plans for the next quarter.

5.Supervision and inspection:

5.1.The Central Project Management Board and the Health Departments, along with the Project Management Boards at the provincial level, are responsible for coordinating with the Provincial Departments of Finance and Prices to regularly or unexpectedly inspect and supervise the distribution, use of essential medicines, and the recovery of medicine funds at healthcare facilities under the Projects.

5.2.The Joint Ministry of Health - Ministry of Finance - Government Price Control Board will conduct regular or unexpected inspections on the management, distribution, and use of essential medicines at facilities under the two Projects.

III. IMPLEMENTATION PROVISIONS

This Circular takes effect fifteen days after its issuance date. During implementation, if there are any difficulties, the Central Project Management Boards, Provincial Departments of Finance and Prices, and Provincial Health Departments should report to the Joint Ministries for timely supplementation and amendment.

ANNEX
signing and implementing AgreementsIssued pursuant to Circular Joint No. 11/1998/TTLT/YT-TC-VGCP dated August 15, 1998
of the Ministry of Health - Ministry of Finance - Government Price Control Board

REPORT ON THE RESULTS OF MEDICINE FUND ROTATION ACTIVITY

Name of the Project:

Month:

Commune Health Station:              County:            Province:

1.Beginning period balance (Drug value):                                     VND

2.Added during the period:                                                        VND

3.Extracted during the period                                                          VND

c) The Reorganization Enterprise Fund at the state-owned holding corporation level is centralized in a separate account of the state-owned holding corporation, managed by the Board of Directors, to support the reorganization and ownership conversion of enterprises under the state-owned holding corporation as stipulated in Article 2 of this Decision and is responsible for settling accounts with the Ministry

3a.Direct extraction (with payment received)                                                 VND

3b.Extraction without payment (exemption for certain subjects)              VND

3c.Extraction with payment through the Health Insurance Agency:                                     VND

Amount collected:                                                                                VND

Amount still to be collected:                                                                           VND

4.Ending inventory balance:                                                                 VND

Of which: Slow-moving drugs

(Detailed list attached)                                                 VND

5.Set aside 90% of the amount collected to supplement the drug fund:                        VND

6.Set aside 10% of the amount collected for expenses, services...                         VND

Recommendation:

Suggest the project to supplement the drug fund

Measures to handle slow-moving drugs

Other management measures for the drug fund

...Date...                                               Director of the Commune Health Station

Chairman of the People's Committee of the Commune...                                              Station Chief

of the People's Committee of the commune, ward, town where the minor who commits a crime temporarily resides to coordinate in supervising and educating.                                                           (Signature, stamp)

(Signature, stamp)