| THE MINISTRY OF HEALTH | THE SOCIALIST REPUBLIC OF VIETNAM |
| No. 3451/QD-BYT | Hanoi, August 6, 2019 |
DECISION
ON APPROVAL FOR “CRITERIA AND GUIDELINES FOR EVALUATION OF RECOGNITION OF “HOSPITALS FOR EXCELLENCE IN BREASTFEEDING SUPPORT”
MINISTER OF HEALTH
Pursuant to Government's Decree No. 75/2017/ND-CP dated June 20, 2017 defining the functions, tasks, entitlements and organizational structure of the Ministry of Health;
Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers;
Circular No. 38/2016/TT-BYT dated October 31, 2016 of the Minister of Health on certain measures to promote breastfeeding at health facilities;
At the request of Director of Department of Pediatric and Maternal Health affiliated to the Ministry of Health,
HEREBY DECIDES:
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Article 2. “Criteria and guidelines for evaluation of recognition of hospitals for excellence in breastfeeding support” is the basis for health facilities specialized in obstetrics and gynecology to carry out the evaluation and recognition under guidance of the Ministry of Health.
Article 3. This Decision shall enter into force upon signing and promulgation.
Article 4. The Chief of the Ministry Office, Director of Department of Pediatric and Maternal Health, Director of Department of Medical Examination and Treatment Management; Heads of affiliates of the Ministry of Health; Directors of Department of Health of provinces and central-affiliated cities; Heads of relevant units shall implement this Decision./.
PP. MINISTER
DEPUTY MINISTER
Nguyen Viet Tien
CRITERIA AND GUIDELINES
EVALUATION OF RECOGNITION OF “HOSPITALS FOR EXCELLENCE IN BREASTFEEDING SUPPORT”
(Issued together with Decision No. 3451/QD-BYT dated August 6, 2019)
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- Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers.
- Circular No. 38/2016/TT-BYT dated October 31, 2016 of the Minister of Health on certain measures to promote breastfeeding at health facilities.
- Decision No. 4128/QD-BYT dated July 29, 2016 of the Minister of Health on approval for national guidelines for reproductive healthcare services.
- Decision No. 4673/QD-BYT dated November 10, 2014 of the Minister of Health on approval for guidance documents on early essential newborn care.
- Decision No. 6743/QD-BYT dated November 15, 2016 of the Minister of Health on approval for guidance documents on early essential newborn care in and right after caesarean sections.
- Decision No. 6858/QD-BYT dated November 18, 2016 of the Minister of Health on promulgation of the set of criteria for Vietnamese hospital quality assessment.
II. Criteria for recognition of “Hospitals for excellence in breastfeeding support”:
A hospital must meet 3 criteria below:
- Criterion 1: The hospital at least achieves level 4 (at least 1 year prior to the evaluation) of criterion E1.3 concerning breastfeeding under the set of criteria for Vietnamese hospital quality assessment.
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- Criterion 3: The hospital qualifies for exit interviews of postpartum mothers via cell phones.
III. Guidelines for evaluation of recognition:
1. Requests for evaluation of recognition:
- If the Criterion 1 is satisfied:
+ For hospitals affiliated to the Ministry of Health: send a written request to the Ministry of Health to establish an evaluation team.
+ For hospitals affiliated to the Department of Health: send a written request to the Department of Health to establish an evaluation team.
2. Evaluation:
2.1 Composition of evaluation team:
a) Evaluation team of the Ministry of Health:
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- Composition: Department of Pediatric and Maternal Health, experts of breastfeeding and EENC
b) Evaluation team of the Department of Health:
- Leading role: Department of Health
- Composition: Department of Health, Center for Disease Control (Department of Reproductive Healthcare) or equivalent units, staff with expertise in breastfeeding and EENC (Obstetrics/Obstetrics and Pediatrics Hospitals).
2.2 Evaluation of Criterion 2 (through checklists):
a) Evaluation:
- Interview 5 ≥ 7 month pregnant women at prenatal care rooms (Checklist 1).
- Evaluation of implementation of EENC (for breathing babies) through observation of at least 3 vaginal deliveries; observation of model-based practices in case of absence of vaginal delivery at the evaluation time (Checklist 2).
- Evaluation of implementation of EENC after caesarean sections (for breathing babies) through observation of at least 2 caesarean sections; observation of model-based practices in case of absence of caesarean sections at the evaluation time (Checklist 3).
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- Observe practices of 5 health workers giving counseling on breastfeeding (Checklist 6).
- Review hospital quality criteria (Checklist 7) and observe breastfeeding friendly environment (Checklist 8).
b) Results:
Checklist No.
Description
Notes
Checklist 1
Interview with ≥ 7 month pregnant women
“QUALIFIED” if 4 out of 5 pregnant women have a total score of ≥ 7/9 points
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Observation of implementation of EENC in vaginal deliveries (breathing babies)
“QUALIFIED” if 3 out of 3 vaginal deliveries have a total score of ≥ 72/80 points
Checklist 3
Observation of implementation of EENC in caesarean sections (breathing babies)
“QUALIFIED” if 2 out of 2 caesarean sections have a total score of ≥ 40/44 points
Checklist 4
Interviews with postpartum mothers with full-term birth
“QUALIFIED” if 8 out of 10 mothers have a total score of ≥ 15/18 points
Checklist 5
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“QUALIFIED” if 4 out of 5 mothers have a total score of ≥ 23/28 points
Checklist 6
Observation of health workers giving counseling on breastfeeding
“QUALIFIED” if 4 out of 5 health wokers have a total score of ≥ 26/28 points
Checklist 7
Hospital criteria for breastfeeding
“QUALIFIED” if all criteria are met
Checklist 8
Breastfeeding friendly environment
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2.3 Evaluation of Criterion 3
a) Units in charge of interviews via cell phones:
- The Ministry of Health shall conduct interviews at affiliated hospitals and Quang Ninh Obstetrics and Pediatrics Hospital, Da Nang Obstetrics and Pediatrics Hospital, Tu Du Hospital, Hung Vuong Hospital, Can Tho City Obstetrics Hospital (2019-2020).
- Department of Health shall conduct interviews at affiliated hospitals.
- The interview team is composed of staff with expertise in EENC and breastfeeding.
b) Organization of evaluation:
- Quarterly, hospitals shall send data on postpartum mothers discharged from hospitals in the quarters to the unit in charge of interview.
- The unit will conduct interviews with 100 random mothers/quarters/hospital (50 mothers with caesarean sections) in case of hospitals of provinces/cities and 50 mothers/quarter/hospital (25 mothers with caesarean sections) in case of hospitals of districts.
- The interview result shall be encrypted and entered into software for analysis.
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c) Evaluation results:
Question
Criteria
Was the baby placed in skin-to-skin contact with you right after birth?
“Qualified” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”.
How long did the baby remain in skin-to-skin contact with you?
“Qualified” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “more than 90 minutes”.
How long after birth did the baby lie with you?
“Qualified” if more than 95% of mothers with vaginal deliveries answer that her baby lied with her.
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or: While the baby lied on your breast, was the baby able to breastfeed?
“Qualified” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”.
During the hospital stay after birth, did you let the baby drink or eat infant formula?
“Qualified” if more than 90% of mothers with vaginal deliveries and caesarean sections answer “No”.
During the hospital stay, did health workers show you how to breastfeed?
“Qualified” if more than 80% of mothers with vaginal deliveries and caesarean sections answer “Yes”.
Did health workers counsel on feeding infant formula?
“Qualified” if 100% of mothers with vaginal deliveries and caesarean sections answer “No” (unless medically indicated).
Did you see any advertisement or marketing of infant formula?
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Conclusion:
The hospital qualifies for exit interviews with postpartum mothers via cell phones if it is “qualified” for all critiera mentioned above.
IV. Maintenance of “Hospitals for excellence in breastfeeding support”
After a hospital was recognized, it shall conduct annual self-evaluation according to the checklists mentioned above and send reports to the Ministry of Health (if it is affiliated to the Ministry of Health) or Department of Health (if it is affiliated to Department of Health). The validity period of the certificate of recognition of “hospital for excellence in breastfeeding support” is 5 years. 3 months before its expiry date, the hospital shall submit an application for extension to the Ministry of Health or Department of Health. The Ministry of Health/Department of Health shall conduct a re-evaluation and consider granting extension to the hospital.
APPENDIX 1.
CHECKLIST FOR SUPERVISION OF EVALUATION TEAM AT HOSPITAL
(CRITERION 2)
Checklist 1. INTERVIEW WITH ≥ 7 MONTH PREGNANT WOMEN
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Answer No/Wrong: 0 point
Description
Pregnant woman #1
Pregnant woman #2
Pregnant woman #3
Pregnant woman #4
Pregnant woman #5
Be counseled on breastfeeding during prenatal check-ups by health workers
1
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2
Harmful effects of baby bottles and infant formula
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3
The baby’s stomach size in the first 3 days of life
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Exclusive breastfeeding duration
5
Continued breastfeeding duration
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Able to list 3 benefits of breastfeeding
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Able to list correctly 3 benefits of breastfeeding
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Able to define exclusive breastfeeding
7
Right (no water, no honey, medicines presribed by doctors are acceptable)
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Right (exclusive breastfeeding for the first six months of life)
9
Right (continued breastfeeding until 24 months and beyond)
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Total score
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“QUALIFIED” if 4 out of 5 pregnant women have a total score of ≥ 7/9 points
Checklist 2. EARLY ESSENTIAL NEWBORN CARE IN AND IMMEDIATELY AFTER VAGINA DELIVERY (FOR BREATHING BABIES)
Adequate/proper performance (2 points); inadequate performance (1 point); none (0 point)
Observational checklists
Delivery #1
Delivery #2
Delivery #3
I. PRE-BIRTH PREPARATIONS:
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1. Checked room temperature, turned off fans
2. Washed hands (first of two handwashings)
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3. Placed dry cloth on mother’s abdomen
4. Prepared the resuscitation area, turned on heated bed (dry, clean and warm resuscitation bed)
5. Checked that bag and mask in newborn resuscitation area are functional
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6. Checked the vacuum extractor and vacuum pressure
7. Washed hands (second of two handwashings)
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8. Put on two pairs of clean gloves (if there is only 1 midwife)
9. Put forceps, cord clamp/ties in easy-to-use order
10. Checked if all conditions are met (the perineum is ballooning, the fetal head emerges) before initiating the delivery
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II. ASSISTING THE BIRTH:
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12. Used the fingers 2 and 3 of the other hand to pull down the occiput for the head down
13. When the occiput has come out of the vulva, a hand embraces the occiput upwards so that the forehead, eyes, nose, mouth and chin may come out. Told the mother to stop pushing when doing these actions
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14. The other hand still kept the perineum from tearing
15. Waited for the fetal head rotate itself, the midwife would help the head rotate so that the occiput rotate to one side (left transverse or right transverse)
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16. Check if the cord wraps around the neck. If yes, loosed it further. If the cord was tight around the neck, clamped the cord with two forceps, and cut the cord between the two clamps
17. Applied 2 hands to the temples of the fetus
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18. Gently pulled the fetus downwards to the foot of the midwife and instructed the mother to gently push until the anterior shoulder is delivered.
19. To assist the birth of posterior shoulder, one hand embraced the fetal head for the nape of the neck between fingers 1 and 2 to pull the head up.
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Birth of buttocks and limbs
21. Kept holding the nape of the neck when delivering the posterior shoulder, moved the hand keeping perineum along the abdomen, buttocks and lower limbs of the fetus
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22. When reaching the feet of the fetus, quickly catched it so that the foot is between fingers 2, 3, 4 supporting the buttocks. The baby was held in a transverse position.
III. IMMEDIATE POSTPARTUM/NEWBORN CARE
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24. Drying started within 5 seconds of birth
25. Dried the baby thoroughly (wiped the eyes, face, head, chest, abdomen, arms, legs, back, buttocks, and genitals) in 30 seconds
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26. Removed the wet cloth
27. Put baby in direct skin-to-skin contact with mother
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29. Checked for a second baby
30. Gave oxytocin to mother within 1 minute of delivery
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31. Removed outer pair of gloves
32. Checked cord pulsations before clamping, clamped after cord pulsations stopped (usually 1-3 min)
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34. Placed the second clamp at 3 cm from the first clamp/ties (or at 5 cm from umbilical base). Cut the cord near the first clamp using a sterile scissors.
35. Delivered placenta: One hand holded the clamp. One hand placed on the suprapublic abdomen, waited for the uterus to tighten and held and pushed the uterus towards the sternum.
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36. Pulled the umbilical cord with control, gently in the direction of the delivery while the hand on the mother’s abdomen pushed the uterus conversely
37. When the placenta reached the vulva, lifted the umbilical cord so that the weight of the placenta pulls the membranes. If the membranes did not slip out, lifted the placenta with both hands and twisted in one direction to allow the placenta to separate completely.
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39. Examined placenta: when the uterus was well contracted and no sign of bleeding was found, examined the placenta
40. Counselled mother on feeding cues (drooling, mouth opening, tonguing/licking, biting hand, crawling). Explained that the baby will be placed skin-to-skin with the mother continuously in at least 90 minutes and complete the first breast-feeding before being separated to weigh and receive other care
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Total score
“QUALIFIED” if 3 out of 3 vaginal deliveries have a total score of ≥ 72/80 points
Adequate/proper performance (2 points); inadequate performance (1 point); none (0 point)
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C-section #1
C-section #2
I. PRE-BIRTH PREPARATIONS:
1. Checked room temperature, turned off fans
2. Nurse/midwife washed hands
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3. Prepared the newborn resuscitation area, turned on heated bed
4. Checked that bag, mask and vacuum extractor are functional
5. Washed hands before surgery, wore sterile clothes, wore gloves (surgeons and midwife picking up the baby)
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6. Prepared cord clamp/ties
7. Placed a sterile cloth over the woman's thighs below the incision at the time of caesarean section
II. IMMEDIATE POSTPARTUM/NEWBORN CARE
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9. Placed dry cloth on mother’s thigh.
10. Drying started within 5 seconds of birth
11. Dried the baby thoroughly in order (wiped the eyes, face, head, chest, abdomen, arms, legs, back, buttocks, and genitals) in 30 seconds
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12. Removed the wet cloth, covered baby’s body with cloth and the head with a hat
13. Checked for a second baby
14. Gave oxytocin to mother within 1 minute of delivery
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15. Checked cord pulsations before clamping, clamped after cord pulsations stopped (usually 1-3 min)
16. Placed the first clamp at 2 cm from umbilical base, push the blook in the cord towards the mother.
17. Placed the second clamp at 3 cm from the first clamp (or at 5 cm from umbilical base). Cut the cord near the first clamp using a sterile scissors.
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19. Put baby prone on the mother’s breast in direct skin-to-skin contact
20. Covered baby’s back with dry cloth
22. Counselled mother on feeding cues (drooling, mouth opening, tonguing/licking, biting hand, crawling) and support the baby to attach well to the breast. Explained that the baby will be placed skin-to-skin with the mother continuously in at least 90 minutes and complete the first breast-feeding before being separated to weigh and receive other care
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Total score:
“QUALIFIED” if 2 out of 2 ceasarean sections have a total score of ≥ 40/44 points
Checklist 4. INTERVIEWS WITH POSTPARTUM MOTHERS WITH FULL-TERM BIRTH
Question
Mother with vaginal delivery
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#1
#2
#3
#4
#5
#1
#2
#3
#4
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1. Did anyone push down on the mother’s belly? (Yes = 1 point, No = 0 point)
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2. Was the baby placed in direct skin-to-skin contact with mother right after birth? (Yes = 1 point, No = 0 point)
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3. How long did the baby remain in uninterrupted skin-to-skin contact? (≥ 90 min = 1 point; < 90 min = 0 point)
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4. How long after birth did the baby first breastfeed? (15-90 min = 1 point; other = 0 point)
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5. How long after birth was the baby bathed? (≥ 24 h = 1 point; < 24 h = 0 point)
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6. Did the baby stay with the mother during the entire hospital stay (rooming in)? (Yes = 1 point, No = 0 point)
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7. Since delivery, was the baby fed anything other than breast-milk? (Yes = 1 point, No = 0 point)
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8. Did the baby use baby bottles and pacifiers? (Yes = 1 point, No = 0 point)
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9. Was anything applied to the cord stump and was the umbilical cord tape placed? (Both no = 1 point; yes in one or both cases = 0 point)
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11. Did the mother get medical advice from health workers at the hospital about the benefits of breastfeeding? (Yes = 1 point, No = 0 point)
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12. Was mother counselled on feeding cues by health workers at the hospital? (Yes = 1 point, No = 0 point)
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13. Was mother counselled on how to place the baby in the breast by health workers at the hospital? (Yes = 1 point, No = 0 point)
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14. Was mother counselled on how to help the baby to attach to the breast by health workers at the hospital? (Yes = 1 point, No = 0 point)
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15. Was mother counselled on signs of baby’s proper attachment to the breast by health workers at the hospital? (Yes = 1 point, No = 0 point)
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16. Did mother tell exactly that the baby has breastfeeded 8-12 times in 24 hours or on demand? (Yes = 1 point, No = 0 point)
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17. Did mother tell correctly size of the baby’s stomach in the first 3 days of life? (Yes = 1 point, No = 0 point)
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18. Was the baby given Vitamin K1 after 90 minutes of first breastfeeding and skin-to-skin contract? (Yes = 1 point, No = 0 point)
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Total score:
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Checklist 5. OBSERVATION OF BREASTFEEDING
Adequate/proper performance (2 points); inadequate performance (1 point); none (0 point)
Activity
Mother #1
Mother #2
Mother #3
Mother #4
Mother #5
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1.
The mother holds the baby so that the baby’s belly is close to the mother’s belly
2.
The mother supports the baby’s whole body, not just the neck and shoulders
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3.
Ensure the baby’s ears, shoulders and hips are in a straight line
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4.
The baby faces the breast, with nose opposite nipple
Attachment to the breast
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Touch the baby’s lips with the nipple
6.
Wait until the baby’s mouth is opended wide
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7.
Move the baby onto the mother’s breast, aiming the lower lip well below the nipple
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Signs of good attachment to the breast
8.
The baby’s chin touching breast
9.
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Lower lip turned outwards
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11.
More areola is visible above the baby’s mouth than below
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12.
Baby feeds with slow deep sucks
13.
Occasional short pauses in sucking are normal; no sucking sounds should be heard
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14.
The mother feels empty after feeding (feed on both sides one after one)
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Total score:
“QUALIFIED” if 4 out of 5 mothers have a total score of ≥ 23/28 points
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Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Activity
#1
#2
#3
#4
#5
Shows the mother how to position the baby
1.
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2.
Support the baby’s whole body, not just neck and shoulders
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3.
Ensure the baby’s ears, shoulders and hips are in a straight line
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Ensure that the baby’s face looks forwards breast, with nose opposite nipple
Shows the mother how to help baby attach to the breast
5.
Touch baby’s lips with her nipples
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6.
Wait for baby’s mouth to open wide
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7.
Move the baby onto the mother’s breast, aiming the lower lip well below the nipple
Shows the mother how to help baby attach to the breast
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Baby’s chin is touching the breast
9.
Baby’s mouth is wide open, puffed cheeks
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10.
Baby’s lower lip is curled out/downwards
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11.
More areola is visible above the baby’s mouth than below
Discusses with the mother signs of good breastfeeding
12.
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13.
Occasional short pauses in sucking are normal; no sucking sounds should be heard
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14.
The mother feels empty after feeding (feed on both sides one after one)
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“QUALIFIED” if 4 out of 5 health workers have a total score of ≥ 26/28 points
* Health workers should avoid touching the baby but showing the mother how to breastfeed herself.
Checklist 7. HOSPITAL CRITERIA
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Source of information authentication
Standard achieved
1- At least 95% of obstetrics and neonatal staff are trained on counseling and support for mothers to breastfeed
Certification/certificate of training for breastfeeding
At least 95%
2- % of breastfeeding counselor staff participating in training course in breastfeeding and obtaining certifications/certificates
Hospital’s decision to assign staff to undertake counseling of breastfeeding.
Certification
At least 95%
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Decision to establish the group “Breastfeeding support” (list of members, action plan)
Yes
4- At least 80% of vaginal deliveries are fully performed with EENC
EENC data of the hospital
At least 80%
There is a system of birth register and software
5- At least 50% of caesarean sections are fully performed with EENC out of eligible cases
EENC data of the hospital
At least 50%
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6- No violation of marketing of substitutes for breast-milk in hospital as prescribed in Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers, including:
• No case in which a health worker prescribes a breast-milk substitute for babies in unnecessary cases
• No display and sale of breast-milk substitutes in hospital canteens.
• No breast-milk substitutes, baby bottles, pacifiers in recovery rooms (in case of vaginal deliveries).
Observation at hospital
No violation
Checklist 8. ENVIRONMENT SUPPORTING BREASTFEEDING
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Delivery room(s)
Recovery room(s)
Neonatal care unit
Qualified
1. Is there a board of breastfeeding regulations: with adequate regulations of WHO on ten steps to successful breastfeeding.
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2. Does the hospital prohibit using infant formula and other linkages with milk formula publicly?
Yes
3. Are there any pictures encouraging breastfeeding?
Yes
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Yes
5. Does the hospital encourage the use of cups and spoons instead of using baby bottles when babies are not breastfed directly?
Yes
6. Are posters, video, pictures, etc. of milk formula companies visible in the hospital? (including infant formula companies which advertise pregnant woman formula).
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No
7. Is there a breastfeeding couseling program for mothers at the hospital?
Yes
8. Is there a breast-milk storage refrigerator?
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Available at neonatal care unit
* Is there a separate and clean area with full of supporting materials for mothers: nutrition when breastfeeding, proper feeding position, breast massage, milking by hand of by machine.
Qualified when specified criteria are met
APPENDIX 2.
EXIT INTERVIEWS WITH POSTPARTUM MOTHERS VIA CELL PHONES
(CRITERION 3)
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No.
Question
Answer
1
How many months old is your youngest child?
(Record the number of months)
2
Is he/she currently breastfed?
1) Yes (Go to question 2a)
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2a
In addition to breastfeeding, do you let him/her eat or drink anything else?
a) Exclusive breastfeeding (breast-milk of natural mother or others)
2) Breastfeeding and formula
3) Breastfeeding and water
3
Did you experience vaginal delivery or caesarean section?
1) Vaginal delivery
2) Caesarean section
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Was the baby placed in skin-to-skin contact with you right after birth?
1) Yes (Go to question 5a)
0) No (Go to question 5b)
8) No answer
9) Do not know/Do not remember
5a
How long did the baby remain in skin-to-skin contact with you?
1) Under 90 minutes
2) Over 90 minutes
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5b
How long after birth did the baby lie with you?
1) Right after birth or less than 1 hour
2) From 1 to 6 hours
3) After 6 hours
9) Do not know/Do not remember
6
Was the baby breastfed within 90 minutes after birth?
1) Yes
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8) No answer
9) Do not know/Do not remember
7
During the hospital stay after birth, did you let the baby drink or eat infant formula?
1) Yes
0) No
8) No answer
9) Do not know/Do not remember
8
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1) Yes
0) No
8) No answer
9) Do not know/Do not remember
9
Did doctors and nurses counsel on using infant formula for babies under 24 months old?
1) Yes (Go to question 9a)
0) No
8) No answer
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9a
Why was you given counseling for using infant formula from doctors or nurses?
1) Less milk, no milk
2) Caesarean section
3) The mother is unable to breastfeed because of maternal illness
4) The baby is unable to be breastfed because of illness or premature birth
5) The mother wants to feed the baby infant formula
6) No answer
7) Do not know/Do not remember
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Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital?
1) Are there any poster, pictures or promotional materials of infant formula for babies under 24 months old
2) Are there any marketing staff of infant formula for babies under 24 months old in the area of hospital
3) Did the hospital display or health workers market or sell infant formula for babies under 24 months old
4) Someone called the mother (when she was at the hospital and after leaving the hospital) and advised on formula for babies under 24 months old, baby bottles, pacifiers
5) There are advertisements of pregnant woman formula, formula for postpartum mothers
6) There are advertisements and display of baby bottles, pacifiers
9) Other forms of advertisement and marketing of infant formula for babies under 24 months old (description)
0) None of the above.
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Do you have any suggestions for the hospital to do well or help with breastfeeding?
(Record suggestions)
If the mothers have more time and are interested, more time should be spent on advising on breastfeeding. If not, say thanks and end the interview.
File gốc của Decision No. 3451/QD-BYT dated August 6, 2019 on approval for “criteria and guidelines for evaluation of recognition of “hospitals for excellence in breastfeeding support” đang được cập nhật.
Decision No. 3451/QD-BYT dated August 6, 2019 on approval for “criteria and guidelines for evaluation of recognition of “hospitals for excellence in breastfeeding support”
Tóm tắt
| Cơ quan ban hành | Bộ Y tế |
| Số hiệu | 3451/QD-BYT |
| Loại văn bản | Quyết định |
| Người ký | Nguyễn Viết Tiến |
| Ngày ban hành | 2019-08-06 |
| Ngày hiệu lực | 2019-08-06 |
| Lĩnh vực | Thể thao - Y tế |
| Tình trạng | Hết hiệu lực |