In recent years, the Party and the State of Viet Nam have always paid keen attention and attention to the disabled, step by step to ensure full access to services, infrastructure, medical examination facilities, etc. In particular, policies to ensure access to medical examination and treatment facilities for people with disabilities have been developed, promulgated, and adjusted from time to time in accordance with reality. In general, policies on establishing and developing a new grassroots health network are aimed at improving the supply capacity and quality of services of the grassroots health network, ensuring adequate provision of primary health care services, health care for individuals, ensuring fairness, and efficiency in protection, care and shift improvement people's health (including the disabled).
1. International conventions and laws of some countries on ensuring access to medical examination and treatment for people with disabilities
The International Convention on the Rights of Persons with Disabilities (CRPD) at point a, paragraph 1, Article 9 stipulates: “In order to enable persons with disabilities to live independently and fully participate in all aspects of life, States Parties Appropriate measures must be taken to ensure that persons with disabilities have equal access to the physical environment, traffic, communications…including detection and removal of impediments and obstacles to access, shall apply primarily to buildings, roads, traffic and other indoor and outdoor structures and facilities, including schools, housing, medical facilities, and workplaces”. Therefore, member states of CRPD, including Vietnam, need to actively develop appropriate policies to be compatible with CRPD regulations to ensure that persons with disabilities have access to medical facilities and healing on an equal basis with others.
Currently, numerous countries around the world have regulations on ensuring access to facilities for medical examination and treatment for the disabled, ensuring that persons with disabilities can use the best medical examination and treatment services. Typical examples include:
In the United States, to ensure that persons with disabilities can easily access the full range of services provided by a healthcare facility, the Americans with Disabilities Act (ADA) [1] standards of 1990 contain provisions. regulations requiring medical care and long-term care service facilities to meet the following conditions: (i) Arrangement and placement of beds, bedrooms, and toilets; (ii) Reasonable allocation of accessible bedrooms among patient care areas such as paediatrics, cardiovascular care, maternity, and other units [2].
In the Philippines, according to 4.1.1 IRR of BP 344[3] there are mandatory regulations in the space where the main services of the facility are provided and where facilities, parking spaces, entrances/exits of the facility must be secured for persons with disabilities. In addition, BP 344's IRR specifically stipulates minimum standards in the design, and construction of facilities and equipment corresponding to each type of disability to ensure accessibility, usability, and safety of the disabled, ensuring that all persons, whether or not they are persons with disabilities can use and enjoy services as well as access those facilities as much as possible.
In Singapore, Chapter 2 Code on accessibility in the built environment 2019[4] stipulates that hospitals, healthcare centres, clinics, and nursing homes with facilities must ensure that persons with disabilities can access, including: (i) Meeting toilet standards, sanitary facilities in the area or home for patients/residents must be provided in accordance with the requirements and needs of the patient hospital and the patient's family; (ii) Installation and supply of hearing enhancement systems; (iii) Braille signs are available for the blind; (iv) Arrange a wheelchair parking space suitable for persons with disabilities…
In China, Decree No. 622 Government of the People's Republic of China[5] has been issued, which requires the people's government at the county level to take responsibility. Prioritize the promotion of plans and implementation of construction and renovation of physical facilities, including medical facilities, rehabilitation clinics to ensure accessibility for persons with disabilities.
2. The current status of Vietnamese law on ensuring access to medical examination and treatment establishments for persons with disabilities
To fulfil its membership obligations of CRPD, like other nations, Vietnam has developed and promulgated regulations related to the issue of ensuring access to work in medical examination and treatment facilities for persons with disabilities. The goal is to guarantee that persons with disabilities have access to the finest medical assessment and treatment services available within the permitted scope. Medical examination and treatment facilities are recognised as "public works" under the 2010 Law on Persons with Disabilities (Articles 39 and 40). The provisions of the 2010 Law on Persons with Disabilities focused on the scope of national technical regulations on construction works to ensure access to public buildings and apartment buildings (both new and renovated). In addition, according to Clause 3, Article 4 of the Construction Law 2014 (Amendment, Supplement 2020) stipulates the basic principles of construction investment: "According to the standards, technical standards, and regulations of the law on the use of construction materials; ensure the need for access to facilities that are favourable to the disabled, elderly, and children...”. However, the 2009 Law on Medical Examination and Treatment – Law on Medical Examination and Treatment (current and under study revised and supplemented) and its implementation guidelines do not have clear provisions on ensuring access conditions for persons with disabilities in medical examination and treatment establishments (as of mid-November 2022). This has caused inconsistencies in the legal system and inevitably has implications for the implementation of the law on this issue.
On the other hand, the current Vietnamese legal system also has a set of national technical standards that are mandatory for healthcare facilities to follow, including national technical standards such as Construction Regulations for Construction of Construction Projects for Persons with Disabilities 10:2014/BXD; Vietnam Construction Regulation 05:2008/BXD on Housing and Public Works - Life and Health Safety; Vietnam Construction Regulations 06:2021/BXD on Fire Safety for Houses and Buildings… However, the implementation of these policies is limited, difficult and challenging due to various reasons. In which, at the policy level of the law, as of now, the Law on Examination and Treatment of Diseases in 2009 has no specific provisions on ensuring access to the disabled in healthcare facilities, which is seen as a policy vacuum leading to practical difficulties.
In addition, according to the public works improvement roadmap stipulated in the Law on Persons with Disabilities in 2010 and Decree 28/2012/ND-CP guiding the Law on Persons with Disabilities, by 2015 at least 50% of facilities will ensure access to the disabled, and by 2017 at least 75% of facilities will guarantee access to persons with disabilities [6]. However, according to the 2016 National Survey Report on Persons with Disabilities, only 16.9% of health stations are designed following accessibility standards for people with disabilities. In which, only 22.4% of health stations have toilets designed suitable for persons with disabilities, and about 41.7% of medical stations have walkways and ramps for persons with disabilities. There are differences between regions, for example: While the Northern Midlands and mountains have only 7.8 per cent of designated health centres for the disabled, this ratio is 27.4 per cent and 26.0 per cent in the Southeast and the Mekong Delta, respectively. The Southeast region has the highest proportion of customized sanitation works for the disabled, with 34.1 per cent. Urban areas are a little better when there are roads and ramps for the disabled, but the rate is still lower than 50% [7].
Next, according to Decision 1019/QD-TTg in 2012 approved the 2012-2020 Project for Support for the Disabled, issued by the Prime Minister on 5/08/2012, the roadmap for 2016-2020, 100% of the facilities for medical examination and treatment ensure access conditions for the persons with disabilities. However, by the end of 2020, only 80% of new construction health works ensure access for persons with disabilities. The restoration and renovation of medical examination and treatment establishments to ensure access for people with disabilities has been carried out very slowly [8]. Even in Viet Nam, according to statistics from the Independent Report on the Implementation of the UN Convention on the Rights of Persons with Disabilities, Viet Nam has only 22.6 per cent of all health facilities guaranteed access to persons with disabilities[9].
With the above situation, it can be seen that the renovation and construction of new medical examination and treatment facilities to ensure access for persons with disabilities has not yet achieved the set roadmap. Failure to ensure access to medical examination and treatment facilities for persons with disabilities can be considered one of the reasons for limiting their right to medical examination and treatment.
3. Recommendations
Based on the above analysis, it is shown that: To be compatible with the CRPD's regulations, to approach the laws of advanced countries in the world as well as to ensure the synchronization in the domestic legal system (first of all, the accordance with the provisions of Clause 3, Article 4 of the Law on Construction 2014 (amended and supplemented in 2020) and Articles 39 and 40 of the Law on People with Disabilities in 2010), and at the same time to overcome practical difficulties and limitations. mentioned above, it is proposed to add provisions to the Draft Law on Medical Examination and Treatment or the Draft Decree detailing and implementing measures to the Law on Medical Examination and Treatment on what medical examination and treatment establishments must: "Ensure the conditions for radiation safety, fire prevention and fighting, environmental sanitation, national standards on construction to ensure access to use by persons with disabilities following the law".
In addition, to ensure the achievement of the Prime Minister's goals set out in Decision 1190/QD-TTg in 2020 on approving the Program to assist people with disabilities in the 2021-2030 period, issued on August 5, 2020. 2020: “By 2030, 100% of new construction works and 50% of old works will be medical examination and treatment facilities ensuring accessibility conditions for people with disabilities”, a master plan clearly stating responsibilities is needed. by ministries, local branches, and health facilities to strengthen the renovation and upgrade of infrastructure under national standards and strengthen inspection and supervision, ensuring conditions for persons with disabilities to access and use. works suitable for each type of disability at medical examination and treatment establishments.
Note that the above solutions are only an extension of the overall solutions that we have to implement shortly. The addition of "hard" regulations on ensuring access to facilities for disability and disability facilities within the Examination and Treatment Act is seen as a solution to the objectives of policies to ensure the rights, promotion, and support of persons with disabilities to receive comprehensive medical examination and treatment. As a result, contribute to improving the physical and mental health of the disabled, aiming to improve the quality of medical examinations and rehabilitation for persons with disabilities./
