QUY T NH C A TH T N G CHNH PH S 136/2 000/ Q -T TG NGY 2 8 TH NG 11 N M 200 0 V VI C P H DU Y T "CHI N L C Q U C GI A V C H M SC S C KH O SINH S N GI AI O N 2001 -2 010"

T H T NG CH NH PH

- Cn c Lut T chc Chnh ph ngy 30/9/1992; - Cn c Lut Bo v sc kho nhn dn ngy 30/7/1989; - Theo ngh ca B trng B Y T,

QUY T NH:

i u 1. Ph duyt "Chin lc quc gia v chm sc sc kho sinh sn giai on 2001 - 2010" vi nhng ni dung ch yu sau y: 1. Cc mc tiu v chm sc sc kho sinh sn: a. Mc tiu chung: Bo m n nm 2010 tnh trng sc kho sinh sn c ci thin r rt v gim c s chnh lch gia cc vng v cc i tng bng cch p ng tt hn nhng nhu cu a dng v chm sc sc kho sinh sn (CSSKSS) ph hp vi iu kin ca cc cng ng tng a phng, c bit ch n cc vng v i tng c kh khn. b. Mc tiu c th: - To s chuyn bin r rt v nhn thc, cng nh s ng h v cam kt thc hin cc mc tiu v cc ni dung ca CSSKSS trong mi tng lp nhn dn, trc ht trong cn b lnh o cc cp, ngi ng u trong cc t chc, on th. - Duy tr vng chc xu th gim sinh. Bo m quyn sinh con v la chn cc bin php trnh thai c ch t lng ca ph n v cc cp v chng. Gim c thai ngoi mun v cc tai bin do no ht thai.

- Nng cao tnh trng sc kho ca ph n v cc b m, gim t l bnh tt, t vong m, t vong chu sinh v t vong tr em mt cch ng u hn gia cc vng v cc i tng, c bit ch cc vng kh khn v cc i tng chnh sch. - D phng c hiu qu lm gim s mc mi v iu tr tt cc bnh nhim khun ng sinh sn v cc bnh ly qua ng tnh dc, k c HIV/AIDS v tnh trng v sinh. - CSSKSS tt hn cho ngi cao tui, c bit l ph n cao tui, pht hin v iu tr sm cc trng hp ung th v v cc ung th khc c a ng sinh sn nam v n. - Ci thin tnh hnh sc kho sinh sn, sc kho tnh dc ca v thnh nin (VTN), thng qua vi c gio dc, t vn v cung cp cc dch v CSSKSS ph hp vi la tui. - Nng cao s hiu bit ca ph n v nam gii v gii tnh v tnh dc thc hin y quyn v trch nhim sinh sn, xy dng quan h tnh dc an ton, c trch nhi m, bnh ng v tn trng ln nhau nhm nng cao sc kho sinh sn v cht lng cuc sng. 2. Cc gii php v chnh sch ch yu: a. Tng cng thng tin - gio dc - truyn thng: S dng a dng v c hiu qu cc knh truyn thng v cc hnh thc thng tin, gio dc truyn thng khc, tip cn n mi i tng nng cao nhn thc, tri thc, hiu bit v cam kt thc hin cc mc tiu v ni dung ca CSSKSS. b. Kin ton h thng t chc v pht trin nhn lc cung cp dch v CSSKSS: Cng c, xc nh r chc nng, nhim v, mi quan h phi hp cng tc trong cc c s y t, cc c s bo v sc kho b m, tr em v k hoch ho gia nh k c khu vc Nh nc v t nhn; lng ghp vi cc chng trnh khc nh Dn s k hoch ho gia nh, Dinh dng, Phng chng HIV/AIDS; kin ton h thng t chc v o to bi dng cn b v CSSKSS, bo m cung cp y cc trang thit b, k c cc thit b thng tin lin lc, vn chuyn cp cu, phng tin gio dc truyn thng, thuc thc hin mt cch tt nht cc k thut chun on, d phng, cp cu, iu tr. c. Hon thin cc chnh sch v php lu t h tr cho Chin lc:

Nghin cu cc chnh sch v trnh cc c p c thm quyn ban hnh cc vn bn quy phm php lut v xy dng gia nh quy m nh, bnh ng gii, khuyn khch p dng cc bin php trnh thai hin i, khuyn khch cn b y t hc tp nng cao trnh nghip v, thu ht cn b y t phc v c s, nhng vng kh khn, xa xi, h o lnh. Nghin cu v ban hnh cc vn b n quy phm php lut v th thai trong ng nghim, mang thai h, chuyn gii tnh... d. X hi ho, hp tc lin ngnh v hp tc quc t: y mnh s hp tc gia cc B, ngnh, t chc x hi, huy ng s tham gia ca nhn dn, ca ton x hi, k c s tham gia ca khu vc y t t nhn vo vic thc hin cc hot ng CSSKSS, a dng ho cc hnh thc cung cp dch v t vn v SKSS cho cc i tng; m rng v nng cao hiu qu ca vic hp tc quc t song phng, a phng vi cc nc, cc t chc quc t, cc t chc phi Chnh ph trong lnh vc CSSKSS. . o to v nghin cu khoa hc: Tng cng o to cn b chuyn mn y t v CSSKSS, c bit l cn b y t tuyn c s. Ch trng o to thc hnh, rn luyn tay ngh vng chc, bi dng k nng truyn t, giao tip vi cc loi i tng v vi cng ng. Tp trung nghin cu vn v sinh, nui con bng sa m, cc bnh ca h thng sinh dc c bit l ung th cc c quan sinh sn, sc kho tnh dc v hnh vi tnh dc, sc kho sinh sn v thnh nin, sc kho sinh sn nam gii v kin thc, thi v thc hnh lin quan n SKSS v mt s vn khc c lin quan nng cao cht lng CSSKSS. e. Ngun kinh ph phc v cho CSSKSS: Ngun kinh ph phc v cho CSSKSS bao gm ngn sch nh nc, bo him y t, vin ph v dch v ph, cc ngun hp tc song phng v a phng ca cc t chc phi chnh ph v s ng gp ca cng ng; trong ngun ngn sch nh nc l ch yu v c b tr thnh mt khon ring trong mc lc ngn sch ca cc cp s dng ch yu cho vic tng cng nhn lc, o to b tc cn b, thng tin gio dc truyn thng, nghin cu v ng dng khoa hc k thut, b sung mt phn c s vt cht k thut, tng cng cng tc qun l, iu phi v h tr cc ban, ngnh trong cc ho t ng v SKSS. Ngun ngn sch nh nc b

tr theo k hoch. B Ti chnh cn i cc khon ny, b tr mt khon ring v ghi trong k hoch nh nc hng nm. g. V lnh o v qun l: Tng cng cng tc qun l v iu phi cc hot ng CSSKSS, trong c vic xy dng v hon thin h thng thng tin qun l y t, thng tin v CSSKSS. 3. T chc thc hin: Chin lc quc gia v chm sc sc kho sinh sn c thc hin thng qua cc hot ng c th theo 2 giai on: a. Giai on 1 (2001 - 2005) - Tip tc duy tr cc hot ng gio dc, tuyn truyn vn ng cng nh vic cung cp cc dch v sn c, xy dng v gn gi mt mi trng thun li cho cng tc CSSKSS. - Sa i, b sung cc chnh sch, ch , cc ti liu o to, cc vn bn quy nh v hng dn vic cung cp cc dch v; thc hin chin lc pht trin nhn lc, kin ton h thng qun l, gim st v chuyn mn nghip v cng nh v qun l ti chnh v ngun lc. - Tng bc lng ghp mt s thnh t mi ca SKSS vo gi dch v hin hnh. - Xy dng c ch phi hp vi cc i tc tham gia lnh vc SKSS trong vic thc hin nhng hot ng CSSKSS cc cp. - Xy dng h thng thng tin da trn cc ch s v gii v SKSS c chn la thc hin cc hot ng gim st v nh gi. - La chn cc nghin cu thc a v mt s u tin trong CSSKSS, xy dng thnh cng cc m hnh nhn rng trong c nc. - y mnh cc hot ng nhm p ng cc nhu cu CSSKSS ca v thnh nin v ng vin s tham gia ca nam gii trong lnh vc SKSS. - Tng cng thng tin v cung cp dch v cho vng su, vng xa v vng ng bo dn tc. b. Giai on 2 (2006 - 2010): - Tip tc cc hot ng bt u trong giai on 1. - Tp trung xy dng cc ch s tc ng ton din hn cng vi cc ch s gim st nhm p ng yu cu nng cao cht lng chm sc.

- Pht trin vic cung cp y cc dch v CSSKSS theo quan ni m rng mi cp. - Th ch ho vic lp k hoch, kim tra v nh gi ca cc nh qun l trn c s s dng tt cc s liu c tin cy cao hn. - Tip tc thc hin cc hot ng o to, nghin cu, kim tra, nh gi v thng tin - gio dc - truyn thng c cht lng khng ngng cp nht k nng v trnh cho cn b. Trong qu trnh thc hin Chin lc, cn lun lun ch trng n vic pht trin nng lc i i vi vic xc nh phng hng u t cc ngun lc mt cch c hiu qu nht bo m s pht trin bn vng ca Chin lc.

i u 2. B Y t l c quan ch qun thc hin Chin lc, phi hp vi cc B, ngnh lin quan trong vic xy dng k hoch, hng dn kim tra, gim st v tng hp tnh hnh thc hin Chin lc hng nm bo co Th tng Chnh ph; t chc s kt thc hin Chin lc vo gia nm 2005 v tng kt vic thc hin Chin lc vo nm 2010.

i u 3. Quyt nh ny c hiu lc thi hnh sau 15 ngy k t ngy k.

i u 4. Cc B trng, Th trng c quan ngang B, Th trng c quan thuc Chnh ph, Ch tch U ban nhn dn cc tnh, thnh ph trc thuc Trung ng chu trch nhim thi hnh Quyt nh ny.

Ni dung SKSS: Cng tc chm sc SKSS giai o n 1991-2001

Trong thp k va qua, Vit Nam tch cc thc hin chnh sch i mi mt cch ton din. Chnh sch ny da trn ba yu t c bn l: chuyn i t c ch k hoch ho tp trung sang nn kinh t th trng theo nh hng x hi ch ngha; dn ch ha i sng x hi; tng cng s hp tc v quan h vi tt c cc nc. Mc d chu tc ng ca khng hong ti chnh trong khu vc, cng vi thin tai nghim trng lin tip my nm lin, trong 5 nm 1996-2000 nc ta vn t nhp tng trng GDP bnh qun 6,7%/nm; duy tr pht trin cc lnh vc vn ho, x hi. i sng cc tng lp nhn dn tng bc c ci thin, t l h i ngho gim t 30 % nm 1992 xung cn 11 % nm 2000. Trn 90 % s dn t 15 tui tr ln bit ch v t l ph n bit ch t 86,6 %. Nhng thnh tu ny tc ng tch cc n cng tc CSSKND, trong c CSSKSS. D- nh gi ca quc t v chng trnh SKSS Vit nam Qua tham kho cc ti liu nghin cu nh gi v xp loi ca mt s t chc quc t nhn chung cc ch s v SKSS ca Vit Nam thng c xp vo loi trung bnh hoc trn trung bnh, c th nh: 1- Theo bo co pht trin con ngi ca UNDP 2002 (HDR, 2002): * Trin vng sng khi sinh ca n l 70,6; nam 65,9 * T l bit ch ca n 91,4%; nam 95,5% 2- Theo nghin cu xp loi ca t chc Cu tr Nhi ng: * Ch s SK b m ca VitNam xp th 34/94 nc * Ch s ph n ca Vit Nam xp th 20/94 nc * T sut cht s sinh 18%o ngang vi cc nc Rumani, Braxin, Philippin (l cc n c c ch s HDI t 64 n 77, Vit Nam: 101). * Ch s v tr em Vit nam xp th 62/94 nc. 3- Theo nghin cu v xp loi ca T chc - Hnh ng Dn s Th gii (PAI): * Xp loi ch s nguy c v SKSS, Vit Nam xp th 49/133 nc. * Ch s im nguy c v SKSS ca VitNam l 25,4, nm trong s 35 quc gia c nh gi l nguy c thp (di 15 im l rt thp; t 15-29 l thp; 30-44 trung bnh; 45-59 cao; trn 60 l rt cao). phng hng cng tc BVSKBMTE/KHHG n 2010 Phng hng hot ng Tp trung thc hin cc ni dung ca Chin lc Quc gia v CSSKSS 2001-2010 v Chin lc Quc gia v Dinh dng, lng ghp thc hin Chin lc Dn s v K hoch hnh ng Quc gia v Tr em, nh vy h BVSKBMTE cng 1 lc ph i thc thi 4 chin lc ln ca Chnh ph. Cc ni dung hot ng chnh ca dch v chm sc SKSS. Lm m an ton (M v Con an ton): Bao g m Chm sc thai nghn: qun l thai nghn bng phiu TDSKBMTN, thm khm thai, dinh dng cho ph n c thai, tim phng.un vn an ton: sch, ti c s y t, do ngi c o to , s dng biu chuyn d

Chm sc sau : theo di, x tr Chm sc tr s sinh. Tng cng tip cn v nng cao cht lng dch v KHHG: nhm gim t l tht bi trong cc bin php trnh thai v gim t sut sinh th, ng gp tch c c vo chin lc dn s 2001-2010. y mnh hot ng Mc tiu PCSDDTE: vi phng chm d phng l chnh v tp trung chm sc u tin vo tr di 2 tui. Hng dn s dng thc n ti ch. Chm sc sc kho tr em, tp trung vo tim chng m rng, chm sc tr em lnh mnh, cp cu s sinh. Gim no ht thai v no ht thai an ton Cc bnh nhim khun c quan sinh sn v cc bnh ly truyn qua ng tnh dc (RTIs v STDs, bao gm c HIV/AIDS): thc y hn na trong pht hin v iu tr. Tng cng chm sc sc kho v thnh nin: Tng cng d phng v iu tr v sinh Thng tin, gio dc, truyn thng v sc kho sinh sn v Gio dc tnh dc hc: cho c nam v n, huy ng nam gii c trch nhim trong hnh vi tnh dc v sinh sn. Cc bnh ung th c quan sinh s n v sc kho sinh sn ngi ln tui Cc gii php thc hin cc chin lc ca ngnh v k hoch hnh ng quc gia, h BVSKBMTE/ KHHG ang m ng mt trng trch rt ln, i hi s h tr n lc c gng ca ton h thng. Cn thc hin ng b cc gii php t lnh o, t chc thc hin, chnh sch ch n thng tin gio dc truyn thng v cung cp cc dch v CSSKSS, tip tc duy tr cc hot ng gio dc, tuyn truyn vn ng cng nh vic cung cp cc dch v sn c, xy dng v gn gi mt mi trng thun li cho cng tc CSSKSS. Cc ho t ng phi hng vo nng cao cht lng ca dch v CSSKSS, ly ngui s dng dch v l Trung tm v l mc tiu ca cc hot ng CSSKSS. Cc gii php sau y cn c u tin thc hin: Lng ghp cc dch v KHHG vi CSKBMTE theo cch ti p cn v SKSS. Tng bc lng ghp mt s thnh t mi ca SKSS vo gi dch v hin hnh. Xy dng h thng qun l bng cng ngh thng tin da trn cc ch s v gii v SKSS c chn la thc hin cc hot ng gim st v nh gi. Sa i, b sung cc chnh sch, ch , cc ti liu o to, cp nht cc vn bn quy nh v hng dn vic cung cp cc dch v; thc hin chin lc pht trin nhn lc, kin ton h thng qun l, gim st v chuyn mn nghip v cng nh v qun l ti chnh v ngun lc. Gn thng tin, gio dc, truyn thng vi nng cao cht lng dch v CSSKSS. Tng cng t vn v phng chng nhim khun, nhim HIV/AIDS v cc bnh ly truyn qua ng tnh dc khc trong cc c s cung cp dch v CSSKSS. Gim t l no ht thai v m bo ph thai an ton. Tng cng cng tc Lm m an ton. Cc b m c thai c khm thai t nht 3 ln pht hin sm v phng cc tai bin sn khoa. Thc hin sch, an ton, khng sang chn, nhn bit, x tr kp thi cc tai bin sn khoa, t chc tt vic chm sc sau i vi tt c cc sn ph v tr s sinh, k c cc trng hp ti nh hay ti c s y t. T vn, khuyn khch nui con bng sa m v dinh dng hp l. Tng cng o to v o to li N h sinh, phn u n nm 2010, 100% s x c h sinh trung hc. i mi gio trnh o to theo hng cp nht, tng cng kin thc v k nng v cc k thut thch hp, c bit l v cc lnh vc t vn, phng chng nhim khun, x l cp cu sn v nhi khoa.

m bo v nng cao cht lng chm sc sc kho ban u cho ph n v tr em. Ch phng chng cc bnh ph khoa, pht hin sm v iu tr kp thi ung th c t cung v ung th v ph n. Nng cao cht lng v hiu qu phng chng suy dinh dng tr em di 5 tui. Thc hin tt chng trnh thanh ton cc bnh x hi v bnh dch nguy him. Tng bc pht trin iu tr v sinh theo hng k thut cao v theo 7 vng sinh thi. y mnh cc hot ng nhm p ng nhu cu CSSKSS ca v thnh nin v ng vin s tham gia ca nam gii trong lnh vc SKSS. Huy ng ngun lc: trung ng, a phng, hp tc quc t y mnh x hi ho CSSKSS, xy dng c ch phi hp cc i tc tham gia tham gia lnh vc SKSS trong vic thc hin nhng hot ng CSSKSS cc cp. Kt hp hot ng vi cc ban ngnh: Dn s, Tr em, Ph n, on thanh nin, t chc Quc t, cc t chc phi chnh ph ch trng hp tc vi cc hi nh: Hi KHHG, hi Sn ph khoa, hi N h sinh... Nghin cu khoa hc: Cc vn bc xc nh t vong m, th nghim cc BPTT mi, gim no ht thai, dinh dng tr em... Tng cng thng tin v cung cp dch v cho vng su, vng xa v vng ng bo dn tc. Mt s ch tiu CSSKSS n 2010 Ch s T sut cht m/100.000 tr sng T l cht tr em < 1 tui ( %0) T l t vong chu sinh ( %0) T l tr s sinh < 2500 g ( % ) T l tr em suy dinh dng di 5 tui Gim mc TBSK cn so vi 1999 (%) Gim cht do TBSK cn so vi 1999 (%) T l ph n no ht thai trn 100 tr sng T l ph n khm thai trc sinh (%) T l ph n khm thai > 3 ln (%) T l ph n c CSSS > 1 ln (%) Trung bnh chm sc sau sinh (ln) T l tim UV > 2 mi trc sinh T l ti c s y t ( %) T l do cn b chuyn mn gip (%) T l cp v chng s dng BPTT (%) T l s dng BPTT hin i (%) 66 (98) 28 (98) 30 1 67 (00) 62 (97) 70 (00) 74 (00) 56 (00) 80 50 40 1,5 80 70 85 76 65 thc hin 95 (00) 36,7 (99) 22,2 (98) 7,3 33,8 [66 % so 95] [53 % so 95] 6,5 25 80 70 Ch tiu 2005 80 30 Ch tiu 2010 70 25 18 6 20 65 60 25% 90 60 60 2 90 80 97 78 70

Tng t sut sinh (con) Gim mc lu, giang mai so 1999 (%) S ln khm ph khoa so vi 1999 (%) S ln cha ph khoa so vi 1999 (%) Thng 11 nm 2003

2,3 (99) [80 % so 95] [117 % so 96] [121 % so 96]

2,1 80 120 130

2 70 140 150