Background information

In Viet Nam, traditional medicine can be divided into two categories: Vietnamese traditional medicine, which is influenced by Chinese traditional medicine, and oriental medicine. In the countryside and in remote and mountainous areas, Vietnamese traditional medicine is more commonly used. In the delta, lowlands, and cities, patients more commonly use a combination of Vietnamese traditional medicine and oriental medicine.

Both Vietnamese traditional medicine and oriental medicine form an integral part of the national health care system in Viet Nam and have an important role in promoting the health of the Vietnamese people, particularly in difficult cases, geriatric diseases, and primary health care at the commune level. Allopathic doctors who have graduated from medical universities and who have been trained in traditional medicine have become some of the most outspoken supporters of traditional medicine. They are actively engaged in promoting the rational use of traditional medicine in their institutes and hospitals (272).

Statistics

According to Ministry of Health statistics, about 30% of patients receive treatment with traditional medicine. Treatment is provided by traditional medicine practitioners (who have not received any formal education) and by traditional medical doctors (who have graduated from a department of traditional medicine at one of the medical universities in Hanoi, Ho Chi Minh City, or Haiphong). There are about 1000 traditional medicine practitioners, 5000 traditional medical doctors, 2000 assistant traditional medical doctors, and 209 traditional medicine pharmacists (272). Additionally, there are approximately 8000 private practitioners of traditional medicine. Of this number, about 1400 are acupuncturists.

The Viet Nam Association of Traditional Medicine Practitioners has 24 000 members. Of this number, 461 work in public hospitals. The Viet Nam National Association of Acupuncture has 18 000 members, 4500 of whom work in public hospitals (272).

A Traditional Medicine Hospital of the Ministry of Interior Affairs was inaugurated at the end of 1996 (273). Additionally, there are 286 departments of traditional medicine in general hospitals, 45 provincial hospitals of traditional medicine, and four institutes of traditional medicine in Viet Nam (274). There are three medical colleges that have a faculty of traditional medicine, two pharmaceutical colleges, two secondary schools of traditional medicine, two State pharmaceutical companies, two State pharmaceutical manufacturers of herbal medicine, and three national research institutes for traditional medicine (219).

An Army Institute of Traditional Medicine was established in 1978, with a staff of 100 doctors and pharmacists. The tasks of the Institute include clinical work, research, training, and the manufacture of herbal products. It serves about 20 000 outpatients and 2500 inpatients each year.

The Viet Nam Acupuncture Institute operates under the authority of the Ministry of Health. The Institute is responsible for giving nationwide guidance on acupuncture and other medical therapies that reduce or avoid the use of drugs in treatment. It has 350 beds and serves approximately 2500 inpatients and 8500 outpatients each year.

Regulatory situation

The Government supports public-sector facilities for traditional medicine and encourages people to mobilize resources for the development of traditional medicine, especially for primary health care. Government programmes include training health workers at the community level in using traditional medical methods to treat common and recently defined diseases and encouraging people to plant medicinal vegetables, ornamental plants, and fruit trees. These three groups of plants are intended for use in treating common diseases in the community as well as improving family incomes. This model has become a countrywide programme.

A number of official documents indicate clear support for traditional medicine. There is official recognition for a number of traditional therapies, including medications made from plants and animals, massage, acupuncture, acupressure, moxibustion, vital preservation, cupping, and thread embedding.

Article 39 of the Constitution of the Socialist Republic of Viet Nam outlines State undertakings to develop and integrate allopathic and traditional medical and pharmaceutical practices as well as to develop and integrate official health care, traditional medicine, and private medical care. More detailed provisions on traditional medicine can be found in a 1989 public health law (275) and 1991 regulations made under it (276).

Among the objectives of health care, Section 2 of the 1989 law lists the development of official Vietnamese medicine on the basis of traditional medicine and pharmacy and the integration of allopathic and traditional medicine. The promotion of these objectives is the shared responsibility of the Ministry of Health, the Vietnamese Traditional Medicine Association, and the Viet Nam General Union of Medicine and Pharmacy. Under Section 34.1, these organizations are additionally charged with ensuring conditions for the operation of all major hospitals and institutes of traditional medicine. Section 34.2 provides that the medical services and the people's committees at all levels are to consolidate and broaden the health-care network using traditional medicine. Section 35 permits licensed traditional medicine practitioners to practise in any State, collective, or private health care institution. This includes acupuncturists who have been trained, who have attended courses in traditional medicine, or whose knowledge of traditional medicine was passed down to them through their family. Traditional medicine practitioners may examine and treat patients as well as offer preventive advice. However, before new treatment methods can be used, they must be approved by the Ministry of Health or provincial health office and the Traditional Medicine Association. Superstitious practice is forbidden by Section 36. Private practice of traditional medicine is subject to management by the Government and the Ministry of Health.

The 1991 regulations specify required qualifications for traditional medicine practitioners as well as the permitted range of procedures practitioners may use. A breach of any of these rules that results in serious harm to life or health of another person is punishable under the Criminal Code by imprisonment (277).

The 1993 Vietnamese Ordinance on Private Medical and Pharmaceutical Practice (278) includes detailed provisions on the private practice of traditional medicine. The Ordinance permits certified practitioners of traditional medicine to privately practise the range of activities for which they are certified, provided they have a permit to do so and subject to State overview. Article 5 lists permitted activities as including practice in a traditional medical hospital or clinic and providing traditional forms of treatment such as acupuncture, massage, acupressure, and herbal saunas. Article 7 requires traditional practitioners to hold a diploma of Doctor of Medicine or Assistant Doctor Specialising in Traditional Medicine and to have practised traditional medicine for a minimum period that varies between two and five years.

A number of measures are included in the Ordinance to further safeguard patients' interests. Under Article 17, practitioners must put up a name board that sets out the activities they are permitted to practice. Private practitioners must obtain the permission of the Ministry of Health to use novel treatment techniques or drugs. Superstitious practices are not permitted according to Article 19. Private practice without a certificate or practice that exceeds the range of permitted activities is subject to administrative, disciplinary, or criminal sanctions under Article 34.

The Government entrusts the health service system with issuing licences to traditional practitioners through an assessing committee. Anyone who has 13 certificates issued by an assessing committee and the Ministry of Health can privately practise traditional medicine. In the area of acupuncture, the regulatory qualifications of practitioners include Professor, Associate Professor, PhD, Acupuncture Speciality Doctor Level I, Acupuncture Speciality Doctor Level II, and Acupuncture-Oriented Doctor.

The Ministry of Health advocates socialization and diversification of traditional medicine.

Education and training

There is no college or university of traditional medicine in Viet Nam. Although Hanoi Medical University has a department of traditional medicine, it does not meet the needs of developing traditional medicine in Viet Nam. Two secondary schools are the main seats of learning in traditional medicine. There is strong support for a facility of higher education in traditional medicine, and the Government is planning to create a university of traditional medicine to provide programmes for secondary, undergraduate, and postgraduate study (278, 279).

Insurance coverage

Health insurance covers costs for both allopathic and traditional medicine (218); however, this is not on an equal basis in all areas because of differential access to care.