The Endeavours of Ministry of Health in Vietnam in Overcoming Subsequences from Chemical Poisons/Dioxin

I. THE DUTY OF MINISTRY OF HEALTH IN VIETNAM IS RECEIVED IN THE RECENTLY LEGAL DOCUMENTS ON VICTIMS OF CHEMCAL POISONS

1. Ordinance No. 04/2012/UBTVQH13, of July, the 16th, 2012 of Standing Committee of the 13th National Assembly amended and supplemented some articles of Ordinance to treat people having merits to the resolution. Ministry of Heath is assigned (Article 40).

a) The regulation about conditions, criteria and professional, technological regulations to ensure the certification, examination about heath of war invalids, diseased soldiers, resistance war activists infected with chemical poisons and biological children of them had deformities, malformations; to take care of and protect heath, heath insurance for people with meritorious services to the revolution.

b) To organize examination, expertise to war invalids, diseased soldiers, resistance war activist infected with chemical poisons and children of them had deformities, malformations.

2. Decree No 31/2O13/NĐ-CP of April 9th, 2013 of Government regulated details and guidance to practice some articles of Ordinance on treatment of people with meritorious services to the revolution (abbreviated Decree No 31/2013/NĐ-CP). At article No 72 of the Decree, Ministry of Heath is charged of Government.

a) To guide, looking after and protection of heath, heath insurance for people with meritorious services to the revolution.

b) To promulgate lists diseases, deformities, malformations caused by chemical toxins to confirm resistance war activists and their children infected chemical toxins.

c) To guide regulations on standards of injuries, diseases, deformities, malformations and organize examination, expertise to war invalids, diseased soldiers, resistance war activist infected with chemical poisons and children of them.

d) To guide the methods to synthesize percentage in examination, expertise percentage of working capacity decline.

3. The duty of Ministry of Heath is assigned in Decision No 651/QD-TTg of June, 1st, 2012 of the Prime Minister.

Decision No 651/QD-TTg of June, 1st, 2012 of the Prime Minister approved: “National action plan to overcome effects of chemical toxins used by US in the war in Vietnam until 2015 and orientation to 2020”, Ministry of Heath is assigned 4 duties:

3.1. Review the lists of diseases/disabilities and promulgate criteria to diagnosis diseases/disabilities related with chemical toxins.

3.2. Develop, implement treatment plans and heath care and cure diseases/disabilities for victims of chemical toxins.

3.3. Develop some early detective programs, consult about reproduction, detoxification, rehabilitation for victims of chemical toxins.

3.4. Coordinate with the Ministry of Finance to study and propose suitable heath insurance stature for victims.

3.5. Directive No. 43-CT/TW of May, the 14th, 2015 of the Secretariat of the Central Committee of the Communist Party of Vietnam on enhancing the leadership of Party for the work of dealing with the consequences of chemical toxins by the US used in the war in Vietnam.

II. RESULTS

2.1. To preside over and coordinate to promulgate some following documents

2.1.1. The Ministry of Heath coordinated with the Ministry of Finance and concerned ministries, sectors to study, amend, supplement some articles of the law on Heath insurance. At the 7th session, on the 13th of June, 2014, National Assembly passed the law No. 46/2014/QH13 amending and supplementing some articles of the law on heath insurance, including victims of chemical toxins.

2.1.2. Promulgating the joint circular No. 28/2013/TTLT-BYT-BLĐTBXH, on the 27th, September, 2013 of the Ministry of Heath, Ministry of Labour, War invalids and Social Affairs stipulated the rate of injury on physique caused by injuries, diseases/ disabilities and occupational diseases. This is an important legal document to medical examination based on the rate of injury on body so that Sector of Labour, War invalids and Social Affairs practices the policy regimes to people with meritorious services.

2.1.3. Promulgating the joint circular No. 41/2013/TTLT-BYT-BLĐTBXH, on the 18th, November, 2013 of the Ministry of Heath, Ministry of Labour, War invalids and Social Affairs about guiding examination, expertise diseases, disabilities, deformities and malformations concerned with exposure to chemical toxins of resistance activists and their children.

After 3 years of implementation, both ministries received contributory opinions of voters, subjects adjusted in circular and contributory opinions of management agencies and 2 ministries amended, supplemented, finalized and promulgated the joint circular No. 20/2016/TTLT-BYT-BLĐTBXH, on the 30th, June, 2016 of both the Ministry of Heath and Ministry of Labour, War invalids and Social Affairs guiding examination, expertise diseases, disabilities, deformities and malformations concerned with exposure to chemical toxins of resistance activists and their children.

The Circular:

- Simplified some administrative procedures when the subjects create dossiers to exam, expertise at medical examination councils at levels (also accepting the summary of the outpatient’s treatment procedures of public hospitals from district level or higher or the summary of the outpatient’s treatment procedures of the Medical Examination Department of provincial/municipal Heath Services Committee for apparatchiks; the Certificates of deformity, congenital malformation of public heath establishments from at the commune, ward or township level or higher according to form provided in Appendix 6 that is accompanied with this Circular for subjects not having medical examination, treatment for deformities, malformations in Appendix 2 promulgated with this Circular)..

- Concretized the names of congenital malformations in offspring of resistance activist infected chemical toxins so that subjects and management agencies easily guide objects about creating and completing dossiers.

- Rearranged lists diseases/disabilities, deformities, malformations concerned with exposing chemical toxins of resistance activists and their offspring in order that Sector of Labour, War invalids and Social Affairs and subjects easily practice and contrast.

2.1.4. The Ministry of Heath built and promulgated Circular No. 18/2016/TT- BYT providing lists techniques and medical supplies, which are used in rehabilitation services paid by Heath insurance fund, to ensure rights for people with disabilities as well as victims of medical toxins when they want to treat and rehabilitate in heath examination, treat and rehabilitation establishments.

2.2. To review again lists diseases, disabilities, deformities, malformations concerned with exposure with chemical toxins.

In 2016, the Ministry of Heath founded a specialized council in order to review lists of diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/dioxin (hereinafter, it is abbreviated the lists of diseases). The specialized council researched internal and international documents, held a lot of meetings to review, amend, supplement lists of diseases and came to the conclusion: today, the specialized council haven’t enough scientific and practical bases to amend, supplement lists of diseases, disabilities, deformities, malformations promulgated; The rearrangement is more detailed than lists diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/dioxin. The Ministry of Heath assigns the Medical Assessment Institute, the Hanoi Medical University (the Department of Genetics and Biology) and the National hospital of Obstetrics and Gynecology to study and concretize lists of irregularities of reproduction for people took part in a war of resistance and lists of deformities, congenital malformations of offspring of resistance activists exposed with chemical toxins/dioxin.

Lists diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/dioxin have reviewed and consolidated by both ministries, at the joint circular No. 20/2016/TTLT-BYT-BLĐTBXH. The lists diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/dioxin contain 17 disease groups (instead of Decision No. 09/2008/QĐ-BYT).

The Ministry of Heath promulgated guidelines prognosis diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/dioxin, the detailed guidelines prognosis diseases, disabilities, deformities, malformations at Decision No. 3201/QĐ-BYT on the 29th, June, 2016 (replacing documents promulgated with Decision No. 1488/QĐ-BYT in 2012) to guide medical examiners, Medical Assessment Council’s members to expertise diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/ Dioxin. The documents are printed and issued to Medical Assessment Councils and Department of Heath, Vietnam Association for Victims of Agent Orange/ Dioxin.

Based on this guideline, The Ministry of Heath has finalized the content and promulgated the guidelines for medical examination and expertise for diseases, disabilities, deformities, malformations concerned with exposing chemical toxins/ Dioxin with Decision No. 3459/QĐ-BYT on the 31th, July, 2017 so that medical examiners practice.

2.3. Promulgating criteria for prognosis diseases/disabilities related to chemical toxins

American Academy of sciences recognized some diseases related to dioxin, such as: the sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, clor-cloracne acne and 7 diseases are considered to have evidence related to dioxin, containing: Respiratory cancers, prostate cancer, multiple myeloma, Spina Bifida, Cutanea Tarda, peripheral neuropathy and diabetes.

Epidemiological and clinical studies in Vietnam confirmed that there is a link between exposing dioxin and appearing some rare diseases (miscarriage, congenital malformations, cancer, especially soft tissue cancer, lymphoma...) in areas on which US sprayed chemical toxins/dioxin.

To identify the object being victims of chemical toxins/dioxin, the most scientific and accurate W⁷ay is to take blood and fat samples of objects exposed with chemical toxins/dioxin in order to analyze and quantitate dioxin content that is existed in there. If results of quantitation have a few ppt dioxin in the sample, we can confirm that the object is a chemical toxin/dioxin victim, (because, only a few ppt dioxin can also cause disease to the object).

With conditions of Vietnam, the above tests are very difficult to practice. Today, technical facilities in our dioxin laboratories are very limited, furthermore, the cost of each quantitative test is very expensive (about 500 - 1,000 dollars), we can’t afford to do the test for all objects exposed with chemical toxin/dioxin.

In many case, blood tests haven’t dioxin (because dioxin in the infected human body displaced completely), but dioxin caused genetic mutations and deformities, congenital malformations for children and grandchildren generation.

The Ministry of Heath has repeatedly held meeting with ministries, departments, agencies to develop criterions to help identify victims of chemical toxins/dioxin used by US during the war in Vietnam, The minister of the Ministry of Heath promulgated Decision No. 1107/QĐ-BYT on the 6th, April, 2010 about establishing Committee of compiling criteria to identify victims of Agent Orange/Dioxin used by US during the war in Vietnam. The council includes 16 members, from the Government Office and related ministries, sectors: Justice, Labour, War invalids and Social Affairs, Ministry of National Defence, Ministry of Science and Technology, Ministry of Natural Resources and Environment, Association of Agent Orange/Dioxin victims, Scientific Council of Guidance Committee 33, Hanoi Medical University. The council met several times to draft criteria and the Ministry of Heath had missive to take opinions of relevant ministries, sectors for the Draft of Criteria and the Ministry of Heath completed the Draft Decision of the Prime Minister “promulgating Criteria to investigate, identify victims of chemical toxins/dioxin used by US during the war in Vietnam”.

On the 19th, August, 2011, the Ministry of Heath sent Report No. 696/TTr-BYT to the Prime Minister for the Draft Decision of the Prime Minister “promulgating Criteria to investigate, identify victims of chemical toxins/dioxin used by US during the war in Vietnam”.

2.4. Develop and implement plans to treat and take care of heath and cure diseases/disabilities, detoxify and rehabilitate for the victims of chemical toxins

In carrying out the above contents, the Ministry of Heath submitted to the Government and the Government agreed to assign the Ministry of Heath to preside and coordinate with the Ministry of Planning and Investment, the Ministry of Finance and Ministry of Natural Resources and Environment to consider, build, approve and assign the Hanoi School of Public Heath to implement the project “organize the rehabilitation in the community for victims of chemical toxins used by US during the war in Vietnam between 2008 and 2013 with the total cost of 20 billion”. The project is implemented in 3 provinces: Thai Binh, Quang Ngai, Dong Nai.

After 5 years of implementation, the Ministry of Heath organized independent evaluation missions to the localities and implement the project to review, evaluate output effects of the project comparison to targets proposed.

The results of the project have been recognized and highly appreciated by the Deputy Prime Minister Nguyen Xuan Phuc (the Prime Minister now), he directed the Sector of Heath to maintain and expand the scope of activities of the project.

Following the direction of the Deputy Prime Minister, the Ministry of Heath has coordinated with the Ministry of Planning and Investment, the Ministry of Finance, Ministry of Natural Resources and Environment, the Association of victims of agent Orange/Dioxin, Ministry of National Defence to develop and deploy phase 2 of this project. With the approval of the above-said ministries and branches, on the 4th, July, 2014, the Minister of Heath signed Decision No. 2246/QĐ-BYT about approving the phase 2 of this project from 2014 to 2016 with total budget of 20 billion from the state budget. The project has been implemented in all districts of 3 provinces: Thai Binh, Quang Ngai and Dong Nai (these provinces implemented phase 1) and some districts of Lao Cai, Quang Nam and Ben Tre (these provinces are deploying phase 2 of the project). So far, the project has finished and achieved the objectives.

The Ministry of Health has coordinated with the Association of Victims of Agent Orange/Dioxin and directed some health services to set up detoxification centers in some localities in the form of Association of Victims of Agent Orange/Dioxin in Thai Binh province of which has been deploying. Currently, the Victim's Association has deployed 2 detoxification centers in Thach That and Me Tri, Hanoi and many victims' associations in localities have implemented this detoxification model.

At present, the health sector has a system of general and specialized hospitals, there are rehabilitation hospitals, in general hospitals have Rehabilitation departments (or Department of Rehabilitation Physiotherapy). These hospitals are in charge of receiving, treating and rehabilitating all patients in general, including patients who are victims of chemical toxins, these hospitals are always overloaded.

Due to the limited budget, the health sector hasn’t hospitals or specialized centers for private treatment and care for agent orange/dioxin victims. In the coming time, it is expected that the Government will have adequate investment so that the health sector can build and operate specialized hospitals to look after specialized health for victims of chemical toxins.

2.5. Develop programs to detect early disabilities, reproductive counseling

- The Ministry of Health has developed and issued a set of documents: Guidelines for early detection and intervention for children with disabilities. This set of documents consists of 03 books: Vol. 01 for Health Professionals, Vol. 02 for Managers and Vol. 3 for Mothers and Families that have People with Disabilities (Nutrition Documents for children with disabilities). The Ministry of Health is printing this set of documents to give the Department of Health to transfer to health facilities in the province (from the commune health station upwards).

- The Ministry of Health has developed and issued a set of documents guidelines about rehabilitation for people with disabilities, including introduction exercises at home for some common forms of disability in the community;

Printing leaflets for kinds of disabilities, guiding early detection, intervention for disabilities and preventing disabilities, and transferred them to medical establishments from the commune level upwards so that the population can know how to prevent disabilities.

At the same time, the Ministry of Health has filmed and printed CDs of some types of disabilities (simple), which commonly appear in community, exercises, guidance exercise’s way, and rehabilitation techniques for types of simple disabilities, to provide for medical establishments to guide the practice and rehabilitation in the community.

- The Ministry of Health is carrying out the Project to Support people with disabilities (cost 01 billion) and implementing the Prime Minister's Decision No. 1208/2012/QD-TTg to implement Rehabilitation in the community at some communes of provinces (cost 2.5 billion): Ha Giang, Tuyen Quang, Ninh Binh, Hai Duong, Hoa Binh, Ha Tinh, Kon Turn, Ba Ria - Vung Tau and Ca Mau).

The Ministry of Health sent a document to the People's Committee of the provinces to request developing of a plan for the implementation of rehabilitation programs in the community for people with disabilities in general, including victims of chemical toxins.

" The Ministry of Health assigned the General Department of Population to implement the national target program on population and family planning for the period 2012 - 2015, including the objectives: prenatal and neonatal winnowing, to aim decline rate of disabilities of newborns in nationwide.

2.6. Develop a national plan of rehabilitation

On the 6^th, October, 2014, the Ministry of Heath promulgated Decision No. 4039/QĐ-BYT about approving the National Plan for Development of Rehabilitation for the period 2014 - 2020, to strengthen and develop the network rehabilitation establishments and improve the quality of rehabilitation services; to improve the prevention of disabilities, early detection, intervention and improvement of the quality of life of people with disabilities in all aspects so that people with disabilities can be integrated and participated equally in social activities. To develop maximum capacity of people with disabilities to contribute to the overall development of the community. Based on this plan, the Health Department of provinces assigned the units in the sector to implement to 2020, achieving the objectives set-out in the Plan.

2.7. Other guidance documents

The Ministry of Health has many documents to guide and sit on the examination and certification of diseases related to exposure with chemical toxins as well as documents sent to the chairman of the provincial People's Committee to suggest investing in the construction and strengthen the medical examination and treatment and rehabilitation establishments in the province to better meet the rehabilitation needs of subjects, including victims of agent orange. In the above documents, the Ministry of Health has directed:

- In the performance of professional duties daily, the clinician should carefully examine, appoint appropriate tests 'according to professional regulations, diagnose the correct disease, disability, especially, to attend to diseases, disabilities, malformations and deformities are listed in Article 2 of Joint Circular No. 41/2013/TTLT-BYT- BLDTBXH, especially, diseases such as: Acute and subacute peripheral neuropathy, type 2 diabetes and metal disorders. Doctors need to improve their professional capacity and political will, restrict referrals to higher levels, causing unnecessary overload for central hospitals.

- Cases of suspected or difficult to diagnose need to organize specialized consultation to determine each disease and concrete case and doctors are responsible in front of the law for the results of diagnosis of their disease.

- Only the heads of the units or their deputies will sign and affix the unit’s stamps on the hospital discharge papers or copies of medical records for the patients diagnosed

with diseases, disabilities, deformities, malformations listed on the list above-said diseases, disabilities, deformities and malformations (not authorized to subordinates) will be fully responsible in front of the law for the issuance of papers of discharge from hospitals or copies of medical records of their units.

- Medical examiners and members of medical examination councils of all levels, when practicing medical examinations, must strictly comply with procedures of examinations as well as professional guidance to examine the right subjects, identify the right diseases, disabilities and proper levels of diseases and disabilities of the examined subjects according to the regulations of law, ensuring fairness, accuracy and objectivity and take responsibility in front of the law for the conclusion of their examination. The chairman of the Medical Examination Council will be responsible in front of the law for the conclusions of the examination of the Council.

- Assign the I, II and III Central Medical Examination Councils according to their assigned geographical areas, have to guide and inspect and urge the provincial/municipal Medical Examination Councils to conduct the examination and expertise for the subjects in accordance with the provisions of law.

III. RESULTS OF THE PROGRAM No. 43

To implement the Directive No. 4'3-CT/TW dated 14/5/2015 of the Secretariat of the Central Party about enhancing the leadership of the Party in dealing with the consequences of chemical toxins used by the United States during the war in Vietnam; to continue implementing the Prime Minister's Decision No. 651/QD-TTg on June, the 1^st, 2012, approving “the national plan of action to basically overcome the consequences of chemical toxins used by the United States during the war in Vietnam to 2015 and orientation to 2020”, the Ministry of Health issued Decision No. 53O5/QĐ-BYT on November, the 24^th. 2017, approving the project “Health Care and Functional Rehabilitation with victims of chemical toxins/dioxin” period 2018 - 2021.

The project is approved with the overall objective of: Improving health and quality of life, helping victims of chemical toxins/dioxin and people with disabilities to gradually integrate into the community through early detection, intervention on health and disability issues, improving capacity and development of health care and rehabilitation networks for victims and people with disabilities at health facilities (community health) and community.

The project was implemented initially in 10 provinces: (1) Lao Cai, (2) Thai Nguyen (3) Quang Ninh (4) Hai Phong (5) Thanh Hoa (6) Nghe An (7) Quang Nam (8) Binh Dinh (9) Dong Thap (10) Ben Tre with total capital of the project is 72,300,000,000 (seventy two billion three hundred million) from the National Budget.

The Ministry of Health assigned the Agency of Medical Services Administration to coordinate with the concerned units to implement the project.

Due to the importance of the project and the need for care and rehabilitation for victims and people with disabilities increasingly, on the 2^nd, August, 2018, the Ministry of Health issued Decision No. 4762/QĐ-BYT to approve, amend Decision No. 5305/QĐ-BYT mentioned above, which added Ha Tinh province to participate in the project, increasing the number of provinces directly implementing the project is 11 provinces. The total amount of funds of the project raised 76,160,000,000 (seventy six billion, one hundred and sixty million).

IV. GENERAL COMMENTS

Some things have been done.

4.1. Implementing many activities to overcome the consequences of chemical toxins/dioxin on human health

Over the past years, under the leadership of the Party, the direct instruction of the Government, the Ministry of Health has implemented many activities to overcome the consequences of chemical toxins/dioxin on human health. Committees 10-80, medical units, medical scientists have done many studies about the effects of chemical toxins used in the Vietnam war for human health. At the same time, the Ministry of Health has also cooperated with many countries and international partners, including cooperation with US scientists to conduct research, exchange and workshop about the effects of toxic chemicals/dioxin used in the Vietnam War for human health. The results of the study are vivid proofs in order to suggest the US government, scientists and international organizations help the Vietnamese people accelerate the overcoming the effects of chemical toxins and improve their living environment and the health of the people living in the sprayed areas, especially the "hot spots" of dioxin exposure. Besides, there are measures to prevent the way of dioxin infiltration from the environment to people, affected human health and to ensure that children in these areas are bom and raised in clean environment, developed comprehensively physical and intellectual.

4.2. To develop documents, professional documents and examination

The Ministry of Health has coordinated with concerned ministries and branches to build, promulgate or submit to competent authorities for promulgation a number of documents regulating preferential regimes and policies on the care and protection of the health of people have contributed to the revolution in general, people infected with toxic chemicals/dioxin in particular.

Basically until now, the Ministry of Health has coordinated with the Ministry of Labour - Invalids and Social Affairs completed the system of legal documents related to resolving policy regimes for resistance activists infected toxic chemicals and their offspring, contributing to the good implementation of the preferential regime of the Party and the state for people have contributed to the revolution.

The Ministry of Health has issued relevant professional documents and directed the Central Medical Evaluation Council and the Medical Evaluation Councils of the provinces and cities to conduct the examination to determine the people have contributed to the revolution, victims of toxic chemicals/dioxin used by the United States during the war in Vietnam in accordance with regulations, the people are very welcome, acknowledging, showing the responsibility and gratitude of the following generations to the previous generations, who sacrificed blood, health for the cause of struggle for independence, national unification of our nation.

4.3. Some difficulties

- Diseases, disabilities, deformities and deformities associated with exposure to toxic chemicals/dioxin have no specific signs, so far in the actual situation in our country the diagnosis identified a person with diseases, disabilities, deformities, malformations caused by dioxin are very difficult, expensive, not feasible. Therefore, the identification of chemical toxins/dioxin victims in a scientific way is very difficult, appearing some negative gaps in the identification of chemical toxins/dioxin victims, easily lead to abuse the policy of the Party and the State is destabilizing social security.

- In some localities, the units also have some improper awareness apparatchiks about the policy of gratitude, which put pressure on the medical examiner, the sector of examination and poses a potential negative potential. Some medical workers have abused diagnosis diseases and disabilities associated with exposure to toxic chemicals. Some diseases are easy to abuse in diagnosis such as: mental disorders, peripheral neuropathy, type 2 diabetes.

- Some victims do not really cooperate in the examination, sometimes over­reacting to medical workers, causing difficulties and putting pressure on the examiners.

- Lack of human resources to carry out the state management of the settlement of policies for resistance war activists infected with chemical toxins and the work of overcoming the consequences of chemical war on human health. At the Agency of Medical Services Administration - Ministry of Health assigned new 01 leader of the Department and 01 staff of this job should affect the work in general.

- The inspection and examination is not regular, close to timely detect and prevent negative occurrence in the examination, certification and medical examination for resistance activist infected chemical toxins.

- Some recommendations, suggestions:

+ In order to ensure the proper implementing of the Party and State's policies towards resistance war activists infected with toxic chemicals and their biological children, policies should be considered with caution, consistency and uniformity among ministries, Departments and branches to ensure that policies are properly implemented, minimizing negative impacts.

+ Continuing to complete the preferential guidelines and policies of the Party and State for the resistance war activists infected with toxic chemicals/dioxin used by the US during the war in Vietnam.

+ To intensify the examination and inspection work for the examination and expertise to identify the resistance war activists, who are victims of chemical toxins in the localities.

+ Considering revising policies and guidelines in order to be able to make a one­time payment (number of months, years) of exposure with toxic chemicals/dioxin used by the United States during the war in Vietnam for resistance war activists and their offspring instead of current medical examinations.

+ The victims of agent orange belong to the third generation and their relatives are facing many difficulties in their life. It is necessary to have policies and support from the Party and the State to partly relieve take the pain orange. This work, the Heath sector can’t determine, must be institutionalized by the Party’s directive documents, concretized by the state’s legal documents. The health sector continues to implement when the Party and State assign.

+ The above activities of the health sector have contributed to overcome the consequences of chemical toxins/dioxin on human health, helping victims of chemical toxins/dioxin be protected, health care, integrated and reintegrated into the community, improved the quality of life. At the same time, contributing to the implementation of preferential regime of the Party and State for people have contributed to the revolution be victims of toxic chemicals/dioxin used by the US during the war in Vietnam. However, dealing with the effects of toxic chemicals/dioxin used by the United States during the war in Vietnam on human health is a big issue, requiring close government’s guidance and having coordination of many ministries, sectors and international cooperation, it need more time, more money.

- In the coming time, the Ministry of Health will continue to coordinate with the ministries, branches and Association of Agent Orange victims to continue to promote the guidance some regulations of the Ordinance about treatment for people, who have contributed to the revolution. The responsibility of the health sector, the protection and health care for chemical toxins/dioxin victims is more effective and practical.