closing the millennium gaps - undp country reports/viet nam...closing the millennium gaps is about...

UNITED

NATIONS

VIE

TN

AM

Millennium Development Goals

The United Nations

in Viet Nam

Closing the Millennium Gaps

MDG PROGRESS REPORT 2003

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Ha Noi, November 2003

UNITED NATIONS COUNTRY TEAM VIET NAM


Foreword

Viet Nam’s impressive advance towards the achievement of many of the MillenniumDevelopment Goals (MDGs) continues following the country’s ratification of the Millennium

Declaration together with 188 other nations at the United Nations Millennium Summit inSeptember 2000.

Poverty has been halved in Viet Nam since 1990, well ahead of the MDG schedule, andconsiderable progress has been achieved across a range of other MDG indicators reflectingsubstantial improvements in human well-being. At the same time, as highlighted in last year’sMDG report Bringing MDGs Closer to the People, a range of wide and in some cases vastsocio-economic disparities and gaps persist across Viet Nam’s 61 provinces and major urbanareas.1 Moreover, new preliminary data suggest that many of the poorest of the poor mayhave suffered an increase in food poverty and hunger over the past four years pointing to somemajor gaps and shortfalls in the inclusiveness of the development process.

Closing the Millennium Gaps is about further building upon the impressive progress achievedin improving human well-being in Viet Nam over the past decade, while at the same timebroadening the development process to include those being left behind, and reversing wideningsocio-economic disparities. In short, this report is about achieving the MDGs for all Vietnamesepeople, girls and boys, women and men, ethnic minorities and Kinh, and urban and ruralpeople.

Closing the millennium gaps will require substantial investments in capacity building at theprovincial and sub-provincial levels to enable effective decentralization of finance and decisionmaking authority. This strengthening of capacities for local solutions will be essential formeeting the real priorities of local communities in a sustainable manner while reaching thosein most need. For some of the most isolated poor provinces, there will also be a considerableneed in the foreseeable future for supplementing local efforts with a significant increase inequitable and efficient inter-provincial transfers from the central government.

In this context, equity and efficiency of such transfers would be greatly facilitated by an inter-provincial transfer formula anchored in objective needs-based criteria. The efficiency of suchtransfers needs to be supported by rational incentives that also strongly encourage localinitiatives to develop local income, employment and tax generating activities.

Like last year’s MDG report, this year’s report provides policy makers and decision takers arange of MDG progress indicators and indices by province. This breakdown aims to facilitateinter-provincial analysis and could be useful to help better target resource allocations. Asavailable data continue to improve, the intention is to further develop and refine such indices tohelp guide progress towards the full achievement of the MDGs.

This year’s MDG report is also about sustainability. The sad experience of the last fifty yearsis that many developing countries have experienced extended periods of rapid GDP growthfuelled by access to easy finance, which in turn supported temporary improvements in socialindicators, only to find themselves suddenly and unexpectedly destabilized and engulfed insocio-economic crisis, with major set backs to human well-being.

1 This report builds upon the 2002 MDG report Bringing MDGs Closer to the People, November 2002, UnitedNations Country Team (UNCT) in Viet Nam; the work of the Poverty Task Force Achieving the Viet NamDevelopment Goals, June 2002; and the seminal 2001 MDG report, IDT/MDG Progress, July 2001 UNCT,which was the first attempt to survey the MDG landscape in Viet Nam.

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In this context, recent socio-economic data also highlight the emerging challenges to thesustainability of Viet Nam’s development process. While economic growth appears to be pickingup in quantitative terms, the underlying quality of much of this growth is being called into questionby recent data and analysis reflecting a weakening quality of underlying public investments.

All of this also has direct implications for ODA effectiveness, especially given the general fungibilityof finance. Current attention and efforts at harmonization of ODA procedures are laudable andwill help rationalize and improve administrative efficiency of multiple donor procedures. However,as outlined in this report, the issue of allocative efficiency merits much greater attention in lightof the declining underlying quality of public investments where most ODA is ultimately investedeither directly or indirectly.

In sum, Viet Nam’s progress towards the MDGs over the past decade has truly been impressiveby most standards, but there are now a number of newly emerging challenges that will need to bemet. Judging from the record, Viet Nam will more than meet these challenges so that the country’sfuture will be even more impressive than its past with further substantial improvements in humanwell-being for all Vietnamese people.

Finally, this report is being issued as a Discussion Paper for several reasons. First, it aims tohelp generate useful discussion at the upcoming annual Consultative Group (CG) meeting inDecember 2003. Secondly, the policy implications and recommendations herein will be furtherenriched by a high level policy conference in January 2004. Thirdly, some of the underlying datafrom the Viet Nam Household Living Standards Survey (VHLSS) 2002 have not yet been finalizedby the General Statistical Office (GSO), and hence may still be subject to some change over thecoming few months.

In short, the consultative process for this report will be further deepened. In the meantime, wevery much welcome any comments and suggestions for further enriching the policyrecommendations in this report so as to better assist Viet Nam in the full achievement of all theMDGs and the further advancement of human well-being in the country.

Jordan D. RyanUN Resident Coordinator

Ha Noi, Viet NamNovember 2003


Acknowledgements

The United Nations Country Team (UNCT) in Viet Nam gratefully acknowledges thecontributions, advice and suggestions provided to earlier versions of this report from a

wide range of colleagues and partners in the Vietnamese Government, research institutionsand development community. The UNCT would like to offer special acknowledgement to CaoViet Sinh (MPI) for past invaluable support and advice on MDGs in Viet Nam and NguyenPhong (GSO) for invaluable support and advice on the underlying data.

Robert Glofcheski (UNDP), Juan Luis Gomez (UNDP), and Vu Quoc Ngu (UNDP) helpedcoordinate a broad based task force that researched and prepared the various sections of thereport.

The section on MDG 1 analyzing poverty in Viet Nam was prepared by Juan Luis Gomez(UNDP) with substantive contributions and advice from Guillemmette Jaffrin (ILO), JojannekeKraan (UNFPA), and Vu Quoc Ngu (UNDP) in consultations with Truong Thi Thuy Hang (Instituteof Human Studies), Nguyen Cao Duc (Institute of Economics), Nguyen Van Huan (Institute ofEconomics), Vu Quoc Huy (Institute of Economics), Pham Van So (MPI), Nguyen Tien Phong(UNDP) and Pham Thu Lan (UNDP).

Nalinee Nippita (UNICEF) and Erik Bentzen (UNICEF) prepared the section on MDG 2 coveringuniversal primary education with substantive contributions from Yayoi Segi-Vltchek (UNESCO)in consultations with Truong Thi Thuy Hang (Institute of Human Studies), Pham Van So (MPI),Tran Thi Thanh (MOET), Nguyen Quoc Chi (MOET), Hoang Van Sit (UNICEF), Ngo Kieu Lan(UNICEF), Vu Quoc Ngu (UNDP), Nguyen Cao Duc (Institute of Economics).

The section on gender equality, MDG 3, was prepared by Lisa Bow (UNDP) with substantivecontributions from various members of the UN’s Gender Working Group, particularly AidaMagrit Olkkonen (UNFPA), Yayoi Segi-Vitchek (UNESCO), Vu Ngoc Binh (UNICEF), MagaliRomedenne (UNFPA), Kristen Pratt (NCFAW-UNDP Project 01-015), Maaike Van Vliet (RoyalNetherlands Embassy) in consultation with Truong Thi Thuy Hang (Institute of Human Studies),Tran Thi Thanh (MOET), Do Thi Bich Loan (MOET), Pham Van So (MPI), and Mr. Nguyen CaoDuc (Institute of Economics).

Helenlouise Taylor (WHO) prepared the section on MDG 4 covering child mortality, withsubstantive contributions from Heather O’Donnell (WHO), Nguyen Anh Dung (IMCI), NguyenDuy Khe (Reproductive Health Department), Nguyen Thi Mai (World Bank) Maaike Van Vliet(Royal Netherlands Embassy), and Bruce Rasmussen (Save the Children US).

Aida Alkohonen (UNFPA) and Jojanneke Kraan (UNFPA) prepared the section on MDG 5 onMaternal Health, with contributions from Heather O’Donnell and Helenlouise Taylor (WHO) inconsultations with Seija Kasvi (UNICEF), Nguyen Thi Mai (World Bank), Nguyen Anh Dung(IMCI), Nguyen Duy Khe, Maaike Van Vliet, Bruce Rasmussen.

Nancy Fee (UNAIDS), Duong Hoang Quyen (UNAIDS), Pascale Brudon, and Dominic Ricard(WHO), prepared the section on MDG 6 covering HIV/AIDS, with substantive contributionsfrom Marteen Bossman (WHO) on Tuberculosis and Tran Cong Dai (WHO) in the area ofMalaria following consultations with Aida Magrit Olkkonen (UNFPA), Jojanneke Evan Kraan(UNFPA), Le Duc Chinh (Sucecon against HIV/AIDS), Do Thanh Nhan (VWU), Dang Thi KhaoTrang (VYU), Nguyen Thien Huong (National TB Control Program), Quy Vinh (APP. USA),Nguyen Cuong Quoc (NIHE), Mai Huy Bong(MOET), Tran Minh Gioi (Ha Noi School of PublicHealth), Tran Tien Duc (Policy Project/Future Group international), David Stephens (Policy

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Project/Future Group international), Nguyen Thi Mai (World Bank), Seija Kasvi (UNICEF), HeatherO’Donnell (WHO), Mr. Tran Cong Dai (WHO), Tran Quoc Tuy (NIMPE), Vu Huy Nam (NIMPE),Nguyen Phu Trong (CEPHAD), Nguyen Thi Minh Chau (COHED), Dam Viet Cuong (CentralCommission of Science & Education.), Ly Ngoc Ha (MOH), Tran Thi Nga (SHAPC), Le DienHong (VICOMC), Nguyen Phuong Mai (UNDP), Jerome Bouyjou (UNDP) and Pham Thu Lan(UNDP).

Chanderpersad Badloe (UNICEF) and Dao Xuan Lai (UNDP) prepared the section on MDG 7covering Environmental Sustainability in consultation with Pham Van So (MPI), Nguyen Cao Duc(Institute of Economics), Pham Duc Nam (MARD), Ha Huy Ky (Institute of Occupational andEnvironmental Health), Le Kim Dung (MOET), Tran Minh Hien, Nguyen Thi Dao (WWF Indochina),Hoang Thanh Nhan (VEPA), Dang Huy Ram (MONRE), Guillemette Jaffrin (ILO) and Pham ThanhHang (UNDP).

Juan Luis Gomez prepared the section on MDG 8 on Developing a Partnership for Development,with contributions from Guillemmette Jaffrin (ILO), Sara Spant (ILO) and Elizabeth Morris (ILO) inthe area of Youth Employment, Lars Bestle (UNDP) on ITC and Swarnim Waggle (UNDP) in thearea of trade. In consultations with Vo Van Nhat (Viet Nam General Confederation of Labour),Truong Van Phuc (Centre for Information Statistics on Labour and Social Affairs), Truong Thi ThuyHang (Institute of Human Study), Nguyen Hai Anh (International Department National Committeeon Youth of Viet Nam.), Phan Minh Huu (General Department of Vocational Training), Tran LanAnh (SIYB/Bureau for Employees Activities), Ms. Pham Thi Thu Hang (SMEPC/VCCP), NguyenHoang Ha (ILO), Vu Quoc Ngu (UNDP), Murrey Gibbs (UNDP), and Swarnim Waggle (UNDP).

The section on Local Governance Challenges for the Achievement of the MDGs was prepared byJuan Luis Gomez, drawing extensively on the contributions of Nguyen Thuc Quyen, Nguyen TienDung, Trinh Tien Dung, Rab Nawaz and the Local Governance and Decentralization WorkingGroup at UNDP.


Table of Contents

Summary of Millennium Development Goals .......................................................................................... i

Overview and Summary ......................................................................................................................... iii

MDG Map .............................................................................................................................................. xiii

Millennium Development Goals: Progress to Date and Framework for Further Progress

Goal 1. Eradicate extreme poverty and hunger ................................................................................. 1

Goal 2. Achieve universal primary education .................................................................................. 10

Goal 3. Promote gender equality and empower women ..................................................................... 17

Goal 4. Reduce child mortality ...................................................................................................... 24

Goal 5. Improve maternal health ................................................................................................... 30

Goal 6. Combat HIV/AIDS, malaria and other diseases ................................................................... 37

Goal 7. Ensure environmental sustainability .................................................................................... 45

Goal 8. Develop a global partnership for development ...................................................................... 52

Local Governance Challenges in Achieving the MDGs ........................................................................... 60

Annex 1. Measuring Poverty in Viet Nam ............................................................................................... 69

Annex 2. MDG Index Calculation and Indicators .................................................................................... 70

Bibliography ......................................................................................................................................... 72

Key Viet Nam Development Goals (VDGs) for 2010 ................................................................................ 74

Main Acronyms ..................................................................................................................................... 76

List of Charts

1. Poverty Reduction in Viet Nam .............................................................................................................. 1

2. Poverty by Family Size ....................................................................................................................... 23. Share of Total Poverty by Region ........................................................................................................... 34. Poverty Rates by Ethnicity .................................................................................................................. 35. Primary Education Enrolment and Completion Rates ............................................................................ 106. Women and Men in People’s Committees .......................................................................................... 187. Share of Loans, by sex of borrower and source of loan, as a proportion of the total ................................... 198. IMR and U5MR (Deaths per 1000 live births) ......................................................................................... 249. IMR as a percentage of U5MR ............................................................................................................ 2410. IMR and U5MR by Educational Level .................................................................................................. 2511. Infant Mortality Rates by Ethnic Group of Mother .................................................................................. 2512. Cumulative Reported HIV Infections ..................................................................................................... 3713. Reported HIV Cases .......................................................................................................................... 3714. Trends in HIV Prevalence ................................................................................................................... 3715. HIV Infection among age group 15-24 .................................................................................................. 3816. HIV + TB Cases ................................................................................................................................ 3917. Forest Cover Recovering but Quality Weakened ................................................................................... 4518. Percentage of Water and Air-Quality Monitoring Stations Reporting Better

or Worse Results versus the 1995 Baseline Year .................................................................................. 4619. Annual ODA Disbursements (US$ Million) in Viet Nam .......................................................................... 5220. Urban Unemployment Rates by Age and Sex ....................................................................................... 58

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List of Tables

1. Poverty Rates: The Urban-Rural Gap ......................................................................... 1

2. Uneven Regional Patterns ......................................................................................... 2

3. Poverty Disparities at the Provincial Level ................................................................... 3

4. Increasing Inequality ................................................................................................ 5

5. Provincial Disparities in NER ................................................................................... 12

6. Net School Enrolment Rate by Education Level and Sex: 1993-2002 (%) ....................... 17

7. Proportion of Women Representatives on Governing Bodies ....................................... 18

8. Share of Female National Assembly Deputies per Province, 2002-2007 ....................... 20

9. Indicators for Maternal Health .................................................................................. 30

10. Maternal Mortality and Lifetime Risk by Province ....................................................... 31

11. Women Delivering at home Without trained Technical Assistance ............................... 32

12. Provincial Disparities in HIV Prevalence, TB, and Malaria ............................................ 40

13. The success of the Viet Nam’s Malaria Control Program 1991 to 2002 ........................ 42

14. Environmental Indicators ......................................................................................... 46

15. Access to water in rural areas ................................................................................. 47

16. Access to Proper Sanitation Facilities ....................................................................... 47

17. Commitment to Development Index .......................................................................... 54

18. Access to ICT by Region ........................................................................................ 58

19. Internet Penetration ................................................................................................ 59

20. Comparison National and International Poverty Lines ................................................. 70

List of Boxes

1. Community Contribution in Rural Infrastructure: Ownership or Burden for the Poor? ..........6

2. Targeting Credit for the Poor? The new Social Policy Bank ........................................... 7

3. Primary Education Salient Features ......................................................................... 10

4. Child Friendly Monitoring and Assessment System .................................................... 14

5. Child Mortality: Anecdotal Evidence of Underreporting and Low Local Capacity ............. 29

6. Working through Traditional Birth Attendants at the Local Level .................................. 31

7. Functioning at Minimum Capacity ............................................................................ 33

8. Recording of Maternal Death in Viet Nam: Looking Behind the Statistics ..................... 36

9. Risk Behaviour Patterns ......................................................................................... 38

10. HIV Prevention Among Injecting Drugs Users ............................................................. 44

11. Safe Water vs Clean Water ...................................................................................... 51

12. Measuring the Global Partnership: The Commitment to Development Index ................. 53

13. Fishy Lessons ....................................................................................................... 57

14. Conflicts from the Dual Supervision System ............................................................... 62

15. Ho Chi Minh City: Piloting Decentralization .............................................................. 63

16. Can communes Become Investment Owners in National Programs?The Case of Tuyen Quang ....................................................................................... 65


Summary of Millennium Development Goals

Overview of Millennium Declaration andMillennium Development Goals (MDGs)

The Millennium Declaration was ratified by 189 heads of state at the United Nations MillenniumSummit in September 2000. The Declaration sets the global agenda for the initial years ofthe 21st century so that globalization becomes a positive force for all the world’s people.The Declaration includes eight important Millennium Development Goals (MDGs). The MDGsrepresent a global commitment by all nations who signed the Declaration. The entire MDGframework is composed of eight broad goals, eighteen targets and forty-eight indicators.

The Millennium Development Goals

Goal 1: Eradicate extreme poverty and hungerHalve, between 1990 and 2015, the proportion of people whose income is less than onedollar a day, and the proportion of people who suffer from hunger

Goal 2: Achieve universal primary educationEnsure that, by 2015, children everywhere, boys and girls alike, will be able to complete afull course of primary schooling.

Goal 3: Promote gender equality and empower womenEliminate gender disparity in primary and secondary education preferably by 2005and to all levels of education no later than 2015.

Goal 4: Reduce child mortalityReduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

Goal 5: Improve maternal healthReduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

Goal 6: Combat HIV/AIDS, malaria and other diseasesHalt and reverse the spread of HIV/AIDS, malaria and other major diseases.

Goal 7: Ensure environmental sustainabilityIntegrate the principles of sustainable development into country policies and programmesand reverse the loss of environmental resources.

Goal 8: Develop a global partnership for developmentDevelop further an open, rules-based, predictable, non-discriminatory trading and financialsystem. Including a commitment to good governance, development, and poverty reduction –both nationally and internationally.

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Overview and Summary

Considerable Progress Achieved

Viet Nam’s impressive progress toward theachievement of many of the MDGs by 2015continues as confirmed by a new set of datasurveys. Similarly, progress towards a rangeof more localized Viet Nam Development Goals(VDGs) up to 2005 and 2010, which are helpingguide Viet Nam’s planning process towards theMDGs, has also been considerable and willhelp bring Viet Nam closer to the fullachievement of the MDGs by 2015.

Especially notable, poverty has been more thanhalved since 1990 and continues to decline,as do child mortality and maternal mortalityrates. Net primary school enrollment ratesalready exceed 90% and continue to rise, andlower and upper secondary enrollment rateshave increased dramatically in recent years.Net primary and lower secondary schoolenrollment rates are virtually gender balanced,and a number of new policies and laws havebeen put in place over the past few years that,once effectively implemented, offerconsiderable scope for further progress towardsgender equity. On the environmental front,access to clean water has been furtherwidened, as has forest cover.

In the area of effective governance, critical toachieving all of the MDGs, recent legislation instrengthening the role in budgetary oversightof the National Assembly and local People’sCouncils is a potentially significant steptowards increasing transparency and people’sparticipation in the development process, andhelping ensure effective use of availableresources.

“The Vietnamese Government guarantees that it will do its utmost to make the bestuse of your [ODA] assistance in the interest of the Vietnamese people, and to realizeViet Nam’s commitment to achieving the Millennium Development Goals [MDGs]).”2

2 His Excellency Deputy Prime Minister Vu Khoan,Head of the Government delegation at the annualConsultative Group (CG) donor conference inDecember 2002.

Doi Moi FundamentalsUnderlie Success

As was more fully analyzed in the 2002 MDGreport, Bringing MDGs Closer to the People,the main reason for this impressive progressin improving human well-being over the pastdecade and a half has been the country’sbroad-based policy and institutional reformprocess known as doi moi launched in 1986.3

The most impressive socio-economicdevelopment results have so far come from themore fundamental doi moi reforms in the late1980s and early 1990s including land reform,price liberalization, agricultural deregulationand in more recent years, the Enterprise Law.Growth in the agricultural and other ruralsectors throughout the 1990s fueled by suchfundamental reforms has had by far the greatestimpact on poverty reduction to date, and wasclearly the main reason for the dramaticreduction in poverty rates from well over 70%in the mid-1980s to some 29% today. Doi moihas successfully expanded people’s choices,further liberalized their creativity, and generateda substantial increase in domestic incomesand budgetary resources needed to supportthe related socio-economic achievements andprogress towards the MDGs.

Some Possible Setbacksand Emerging Challenges

At the same time, new preliminary data alsopoint to some possible set backs, wideninggaps in human well-being, and a number ofemerging challenges. Particularly notable,following steady improvements during 1993-98,

3 Bringing MDGs Closer to the People, November2002, United Nations Country Team in Viet Nam.

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food poverty and hunger among the poorest ofthe poor, mainly ethnic minorities, appears tohave worsened in most regions of the countryover the past four years. This is especially thecase in the North Central Coast, but also inthe Northern Uplands, Central Highlands, SouthCentral Coast and even in the Red River Delta.In the case of the South East, food povertyamong ethnic minorities improved over the pastfour years following a deterioration during 1993-98, but still remains above its level of 1993.Among the general population in the CentralHighlands, virtually no progress appears to havebeen made over the past ten years in reducingfood poverty, pointing to some serious shortfallsand gaps in the inclusiveness of the country’sdevelopment process. Whether these aretemporary set backs or more fundamental innature will require additional data and deeperanalysis, but would seem to call for urgentaction.

Widening Disparities in Human Well-being

In addition, most recent data indicate that arange of socio-economic disparities discernedduring the research of last year’s MDG reportare significantly wider than earlier estimatedand in some cases continue to widen. Variouscalculations of consumption and incomeinequality as measured by the country’s Ginicoefficient point to a widening gap betweenricher and poorer, particularly between urbanand rural areas, the latter being where the vastmajority of Vietnamese people live and work.Notably, the Gini coefficient measured inconsumption expenditure terms has risenfurther to some 0.37 in 2002, up from 0.35 in1998 and 0.33 in 1993.4 Measured in terms ofincome, the Gini coefficient has risen to around0.42, close to the same order as China’sincome-based Gini coefficient, but at a muchlower level of income per capita in the case ofViet Nam. Equally noteworthy, in terms of non-food expenditures, the Gini coefficient has risento some 0.49, reflecting much greaterinequality.

Moreover, newly calculated and updatedprovincial level indices covering a range of socialindicators relevant to the MDGs confirm thatdisparities in human well-being across VietNam’s 61 provinces and major urban areas

remain wide, and in the more isolated ruralprovinces, quite vast. On the extreme end, thepoverty rate in an isolated province like LaiChau is over 75% compared to an urban arealike Ho Chi Minh City, under 2%. Vietnamesepeople living in provinces like Son La, Bac Canor Gia Lai have a more than 40% likelihood ofsuffering from food poverty and hungerthroughout part of the year compared with onlya 1.6% chance for those fortunate enough tolive in the upper quintile of better off provinceslike Dong Nai, Bac Ninh or Quang Ninh.

Available data on infant mortality and maternalmortality rates also reflect wide disparities inbasic health conditions across the country. Thelikelihood of dying before one’s first birthday isat least 8 times higher if one is born in a provincelike Kon Tum in the Central Highlandscompared to an urban area like Ho Chi MinhCity. Even across rural provinces, the likelihoodof such early death is at least four times higherin provinces like Cao Bang, Gia Lai or Ha Giangthan in one of the better off provinces like VinhPhuc, Tay Ninh or Binh Phuoc.5 Similarly, thelikelihood of a mother dying because of birthrelated complications is ten times higher in aprovince like Cao Bang than in a province likeBinh Duong.

Wide disparities and gaps in human well-beingalso persist in other areas like child nutrition,maternal health, and access to clean water,despite significant progress in most of theseindicators at the national level. A compositeindex of such MDG indicators highlights thecontinued plight of the worst off quintile ofprovinces including Bac Lieu, Lao Cai, Dac Lac,Ninh Thuan, Binh Phuoc, Tra Vinh, Kon Tum,Ha Giang, Gia Lai, Soc Trang, Cao Bang, SonLa and Lai Chau.

In general, the slower rate of overall povertyreduction over the past four years comparedwith the 1993-98 period highlights the challengeof trying to reach many of the remaining poor,especially the poorest of the poor, who are oftenin the most remote parts of the country. Thesepoorest of the poor are typically suffering fromvarious forms of isolation, not just geographicisolation, but also linguistic and social isolation,as well as isolation from basic information andknowledge needed to improve their well-being.

5 Available data indicate 4 times greater likelihood, butgiven the higher frequency of unregistered infantbirths and deaths in the poorer and more isolatedprovinces, the probability is likely higher.

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4 A Gini coefficient of 0 would reflect perfect equalitywhile a coefficient of 1 would reflect extremeinequality.


Greater Distance to Some MDGs

In some cases, recent data also indicate thatthe distance remaining to the achievement ofsome MDGs is greater than previouslyestimated. For example, recently released dataindicate that the maternal mortality rate is 65%higher than earlier thought and hence meetingthe MDG goal on reducing maternal mortalityrates, while still achievable, will now requiremuch greater efforts.6 However, the relatedVDG targets to 2005 and 2010 may no longerbe realistic if recent data are confirmed.

Moreover, while progress in reducing infant andunder-five child mortality rates appears to beadvancing significantly, recent field work alsostrongly indicate that many infant births anddeaths still go unregistered and henceunreported, implying that their overall levelsmay be significantly higher than earlierestimated. Although birth and death registrationare required by law, registration fees arereportedly a major reason for such lack ofcompliance, particularly in the poorest partsof the country. Given the fundamentalimportance of birth and death registration formany different reasons, serious considerationshould be given to waiving birth and deathregistration fees for the poorest and ensuringstricter legal compliance on registration.

Quantitative AchievementsMask Qualitative Weaknesses

As indicated in previous MDG reports, anumber of quantitative achievements continueto mask significant short comings in quality.For example, primary school pupils spend lessthan half the normal school day in classcompared with many other countries in theregion and elsewhere. Moreover, a significantshare of teachers in the more remote areas ofthe country lack adequate qualifications andtraining. While primary school enrolment ratesare quite high, some 23% of pupils still fail tocomplete to grade 5. Similarly in the healthsector, a substantial share of staff in communehealth centres lack adequate training andequipment for treating patients. In theenvironmental area, forest cover continues toexpand, but the underlying quality of the newforest cover appears to be on the declinebecause of the introduction of non-native floralspecies and the associated loss of biodiversity.

6 Research on Maternal Mortality in Viet Nam, MOH2002

Persistent Gender Gaps

Significant gender gaps also persist in someimportant areas. The Law on Family andMarriage (2000) stipulates that Land UserCertificates (LUCs) for common land must listthe names of both husband and wife. Theinclusion of the wife’s name is especiallyimportant to gender equity because of itsimplications for production, income, access toformal credit, shared wealth ownership, and thesecurity of women and children. The financialcost of reissuing a LUC with both names isreportedly in the order of only 20,000-30,000VND.7 However, three years after the law waspassed, the Government Statistics Office(GSO) reports that only 2.3% of such LUCscarry both the husband’s and wife’s names.Recent revisions to the land law may acceleratesuch reissuing, but it is clearly an area withgreat scope for quickly helping to betterequalize the position of women in Viet Nam.

Another important issue relates to femalerepresentation in public office. While women’sparticipation in legislative bodies is high,executive decision-making bodies in Viet Namcount among their members a much lowershare of women. The share of femaleparticipation on representative bodies like theNational Assembly at 27% is relatively high(at least by regional standards). However, thenew Cabinet includes only three women out of30 members. Similarly, women’srepresentation on People’s Councils are in theorder of 20% on average at the provincial,district and commune levels. In contrast,however, female representation on the importantPeople’s Committees at the provincial, districtand commune levels is substantially lower inthe order of only 5%. Therefore, more targetedimplementation of public administration reformsalso appear urgent to redress such imbalancesand ensure that women are also part of thedecision making process in such executivedecision making bodies.

Emerging Risks to Sustainability

Recent data and analysis also highlight somepotentially serious emerging risks to thesustainability of Viet Nam’s developmentprocess. Challenges are emerging on theeconomic and financial front, as well as in thesocial and environmental areas.

7 Her Excellency Madam Ha Thi Khiet at the MonthlyDonor Group Forum, UNDP, November 2003.

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Economic and Financial Sustainabiltiy

Quality economic growth will be essential forgenerating the needed resources and financein a sustainable and non-destabilizing mannerto help achieve sustainable progress towardsthe MDGs. In this context, one particularlyworrisome recent finding discerned fromavailable data and analysis is that the country’sresources have been shifting increasinglytowards inefficient high cost, low returninvestments rather than towards more efficientlow cost, high return investments.8 As aconsequence, every year passing seems torequire a disproportionately higher value offinancial investment to generate a given levelof growth in Viet Nam. This is clearly notsustainable and is potentially destabilizing overthe longer term, judging from the painfulexperiences of so many other developingcountries over the past forty years. Hence, theunderlying quality of growth being generatedin recent years warrants a careful review bypolicy makers and decision takers who couldotherwise be led to complacency by theapparent quantitative economic achievements.

Especially notable, of the three major types ofinvestment, public investment, foreign directinvestment and domestic private investment,the latter appears to be generating by far thehighest returns in terms of new jobs, povertyreduction and reducing inequalities. Sincedomestic private investment is also the largestpotential source of future investment for VietNam, and tends to be more widely spreadthroughout the country, it offers by far thegreatest scope for generating the incomes, taxbase and sustainable finance needed tounderpin the achievement of the MDGs in asustainable manner, including much morebalanced and equitable growth anddevelopment across the country.

Available data and analysis also suggest thatthere is an urgent need for a much moredeliberate policy shift to free up resources,particularly from state owned banks and stateowned enterprises, for lower capital intensive,higher job creating industries in agriculturalprocessing, garments, shoes and lightmanufacturing, not more cement, steel,fertilizers and sugar which can be imported

8 Viet Nam’s Economy: Success Story or WeirdDualism? A special report prepared by David Dapicefor UNDP and the Prime Minister’s ResearchCommission, June 2003.

much more cheaply than Viet Nam is currentlyproducing. Similarly, the real value of somelarge show case public sector projects appearsto need more careful review in terms of theircontribution to the sustainable well being of VietNam and the Vietnamese people.

Safeguarding Social Sustainability

Ensuring longer-term social sustainability willcall for maintaining reasonable balance andequity across different regions and differentsocial groups, while reversing a number ofwidening socio-economic disparities that haveemerged in recent years. Socio-economicdisparities are particularly acute between urbanareas and rural areas. The labor force is growingannually by some 1.4 million new youngentrants mainly in rural areas, andunderemployment is already high and rising asavailable farm land cannot effectively absorbmore labor. Recent data indicate thatunderemployment in rural areas has reached56% in 2002 (MOLISA 2003), particularlyworrisome given the expected continued rapidgrowth in new young entrants to the labor forceover the next five to ten years.

Therefore, arresting and reversing growingsocio-economic disparities will require muchgreater attention to the development of ruralareas, and further improving the local enablingenvironment for domestic private investmentand domestic private business. This will beneeded to generate meaningful employment forViet Nam’s rapidly growing young labor force,and ensure that migration to urban areasremains manageable.

Social Gaps and the Migrant Poor

The social implications of growing migration tourban and industrializing areas is one of thebiggest development challenges facing urbanareas like HCMC and Ha Noi, and the morerapidly growing provinces like Binh Duong.Official projections based on current trendssuggest that by 2020, only 45% of thecountry’s population will live in rural areas welldown from more than 75% today, implyingsubstantial migration over the coming years anda national transition to more rapid urbanization.

While much better and more timely data needsto be collected in this area, all available evidenceindicates that most internal migration in recentyears has been driven by the desire to escapepoverty and the pursuit of a better life. In thiscontext, the plight of internal migrant workersand their families is in need of much greater

vi


attention by various levels of government andthe private companies that attract and benefitfrom migrant workers.

Many migrants typically lose access to basicsocial services when they leave their homeprovince because of lack of residency permits.Provinces like Binh Duong that attract largenumbers of migrant workers find localcapacities over stretched in basic housing,health services, education and other publicservices. Increased crime and public securityhave also become a significant concern of localgovernments, especially where migrants remainunemployed for extended periods of time. Theenvironmental impact including deforestationin provinces like Binh Phuoc have also beensubstantial in some areas.

Therefore, creative and equitable solutions areneeded to address these transitionalchallenges by both government and privatecompanies. Inter-provincial transfers need tobetter take into account this growing challenge.Allowing those provinces experiencingsubstantial inflows of migrants to retain a largershare of taxes collected in their respectiveprovinces would help ease the burden facedby local governments for providing adequatehousing and basic social services, includingbasic health and education for migrant children.Similarly, allowing private companies taxbreaks or other incentives for building qualitymigrant housing, and contributing to improvedsocial services for migrant families wouldfurther help. Migrant workers building housesshould be awarded residential certificates andtheir children allowed to join the publiceducation system even before such certificatesare issued.

The Evolving HIV/AIDS Threat

Increasingly worrisome is the evolution andpattern of HIV/AIDS in Viet Nam which pointsto a potentially explosive challenge ahead thatcould also threaten socio-economicsustainability. While the officially reportedinfection rate may appear low at 0.28%, HIV/AIDS is spreading rapidly with reportedinfections so far this year heading towards a25% growth rate for 2003. All 61 provinces andurban areas are now reporting cases of HIV/AIDS in contrast to only a few years ago wheninfections were largely confined to the majorurban areas and a small number of border andtourist areas. Moreover, since 1999, over 40%of new infections have been reported in the 15-24 age group, well up from just over 10% in1994. All of this points to the rapid infiltrationof HIV/AIDS into the general population, with

potentially major repercussions for increasedhuman suffering and a rising risk to socio-economic sustainability unless more broadbased urgent actions are soon taken.

Environmental Treasure Chest Threatened

On the environmental front, the threats to VietNam’s environmental treasure chest are ofcontinued concern. Forest cover is expanding,but its quality is reportedly weak. The numberof rare and endangered species has risen from721 to 857 in recent years. Rapid urbanizationand industrial pollution threaten the quality ofair and water in urban areas. Therefore,integrating environmental sustainability criteriaand measures much more effectively intoinvestment planning has become critical.Greater transparency and public debate onmajor projects, and the involvement in thedecision making process of local communitiesimpacted by such projects, would help betterensure that important environmentalconsiderations are factored into the investmentdecision making process. In this context, therewill also be a growing need for the effectiveplanning of secondary cities to accommodaterapid urbanization and pressures on theenvironment.

Minimizing Corruption

All of the country’s senior leaders have raisedserious concerns about growing corruption. Inthis context, recent reports that infrastructureprojects experience 30% losses due to wasteand “administrative inefficiency” are of particularconcern. The best safeguards here areincreased transparency, reduced bureaucracy,open public debate and effective rule of law fromthe central to the local levels. Independentand reliable auditing capacity to support theoversight role of the National Assembly andPeople’s Councils combined with a greater roleof the local media in reporting on corruptionand encouraging accountability would alsoappear urgently needed. Such safeguardswould also help better ensure that statedirected investments, including from the nowvery large Development Assistance Fund(DAF), are most effective in terms ofsustainability and stability.

On a related issue, developing Viet Nam’sdomestic private business sector will beessential to achieving and sustaining most ofViet Nam’s socio-economic development goalsincluding the MDGs. However, as the privatesector develops, Viet Nam will need to avoidthe same grave mistakes made in a number ofother developing countries where the interests

vii


of the State and private sectors, at both theinstitutional and individual levels, became soblurred that they ultimately corrupted anddestabilized development. Publicadministration reforms that provide adequatesalaries through performance-basedremuneration, combined with the otheraforementioned safeguards, would greatly helpin minimizing this risk.

A Framework for Further Progressand Local Capacity Building

Last year’s MDG report offered a frameworkfor further progress towards the MDGs basedon the country’s so far highly successful doimoi reform process, supplemented with greaterefforts at reducing various forms of isolationand reaching those in most need.9 Within thedoi moi framework, the report called for well-targeted adjustments to policies, institutions,programmes and resource allocations at thelocal levels. This would need to be combinedwith a further decentralization of adequatefinance and decision making authority toenable local communities to meet localpriorities while identifying and reaching out tothe poorest of the poor.

Effective decentralization will require a greatdeal more investment in a range of localcapacities at the provincial and sub-provinciallevels including leadership, managerial,financial and technical capacities. These willbe needed to ensure that available financialresources are effectively invested so as toimprove the quality of social services and reachthose in most need.

Within this framework, recent data and analysishelp greatly in further defining possible prioritieswithin doi moi for further substantialimprovements in human well-being.

Considerable Scope for Further DevelopingLocal Productive and Financial Capacities

Achieving the MDGs will call for the generationand effective allocation of sustainable sourcesof finance and investment. Recent data andresearch indicate that considerable scopeexists for many more provinces to developsubstantially greater sources of employment,income and local tax bases through the effective

improvement of their local business andinvestment environments.10

Notably, the small number of provinces like BinhDuong that have so far implemented effectivepublic administration reforms for more businessfriendly local environments, created “one stopshops” for local investors, and effectivelyimplemented the Enterprise Law areexperiencing higher rates of domestic privateinvestment and enterprise creation, and morerapid rates of job creation and poverty reduction.Moreover, because domestic privatebusinesses and domestic private investmenttend to be much more widely distributedgeographically than other sources ofinvestment, they also offer the greatestpotential for supporting more balanceddevelopment across Viet Nam’s 61 provincesand major urban areas, and the greatest scopefor narrowing the large number of socio-economic disparities emerging in Viet Nam.

In short, much greater efforts and support toeffectively implementing such high returnreforms are needed in the majority of otherprovinces. Improving tax retention incentivesfacing provincial governments for developingtheir local economies and related tax basescould greatly help promote more resoluteprovincial government efforts at betterdeveloping their local economies and businessenvironments. Carefully structured taxincentives can be consistent with both higherprovincial tax retention for better off provincesand higher inter-provincial transfers to poorerprovinces.

Capacities for Equitable, Efficient andTransparent Public Finance

For some of the most isolated poor provinces,there will also be a considerable need in theforeseeable future for supplementing such localefforts with a significant increase in equitableand efficient inter-provincial transfers throughthe central government. In this context, equityand efficiency of such transfers would be greatlyfacilitated by an inter-provincial transfer formulaanchored in objective needs-based criteria byprovince. Again, the efficiency of such transfersneeds to be supported by rational incentivesthat also strongly encourage local initiativesfor developing local income and tax generatingactivities.

9 Bringing MDGs Closer to the People, November2002, United Nations Country Team in Viet Nam

viii

10 Viet Nam’s Economy: Success Story or WeirdDualism? A special report prepared by David Dapicefor UNDP and the Prime Minister’s ResearchCommission, June 2003.


Effectively generating and investing publicfinance for further poverty reduction and theachievement of the MDGs will require a rangeof local capacities, including innovative andflexible leadership, as well as managerial,financial, and technical capacities. Ensuringeffective use of finance will require increasedtransparency in public finance at the provincialand sub-provincial levels and the participationof local communities in helping set priorities.In this context, developing the capacities oflocal People’s Councils to effectively play theirbudgetary oversight role and represent theinterests of their local constituents will becritical. This will need to be underpinned byeffective financial planning and management,and accounting capacity which in turn wouldbe subject to review by independent and reliableauditing capacity.

In addition, much more resoluteimplementation of the Grassroots DemocracyDecree would help better ensure increasedtransparency, participation and accountabilityat the provincial, district and commune levels.Deeper public administration reform efforts aswell as capacity building for more effective andefficient local administrations and departmentswill be essential to ensure that availablefinancial resources are well invested and reachthose in most need. Priority areas includetraining in financial management, accountingand auditing.

Local Capacities for Higher Quality SocialServices

In order to deliver increased and higher qualitysocial services and achieve the MDGs, a rangeof much improved professional and technicalcapacities will also be essential.

For many poor people, health is their only asset.Maintaining and enriching this asset will becritical to improving human well-being andeconomic development in rural areas. Improvingthe availability and quality of health facilitiesand ensuring the presence of well trained staffwith adequate incentives to provide qualityservices will be essential to further progress.

Primary education, secondary education andvocational education relevant to the practicalneeds of people, especially in rural areas, areprerequisites to more balanced and equitablegrowth and development in rural areas.Education has to become more than just a wayout for rural people, but more importantly, a wayup within rural communities. Quality teacher

training, including in ethnic languages, andadequate incentives will be essential. TheEducation for All strategy provides acomprehensive framework for progress in thisarea.

In short, massive investments in humanresource development will be needed. This willalso be essential to improving Viet Nam’sinternational competitiveness and enabling VietNam to graduate to higher levels of value addedin global markets.

Better Data Urgently Needed

In addition, despite considerable progress inimproving the data situation in Viet Nam overthe past ten years, there is still clearly apressing need for much better and more reliabledata in a range of socio-economic andgovernance areas to better understand localsocio-economic challenges and target thosein most need. In this context, there is aparticularly urgent need for better data on HIV/AIDS, infant mortality rates, maternal mortalityrates, access to safe water, and migrant povertyamong others, ideally gender disaggregated.Strengthening the capacities of local statisticsdepartments will be needed to support thecollection of such essential data andinformation.

On the economic and financial front, muchbetter data on the performance of publicinvestments, state owned banks and stateowned enterprises through independent andreliable quality audits are also clearly neededto help better guide resource allocations andpublic investments.

Goal-by-Goal Progressand Challenges

Poverty Reduction

• Latest available data suggests povertyrates in Viet Nam have been reduced tosome 29% in 2002, down from well over60% in 1990. The share of families unableto meet a minimum level of dietary energyconsumption has also been furtherreduced over the last four years to some11% of households, down from anestimated 30% in 1990.

• The depth of poverty in Viet Nam has beenreduced from 18.5% of the poverty line in1993 to 7% in 2002. The depth of povertyis however 6 times higher for rural than for

ix


urban areas, and 7 times higher for ethnicminorities than for the Kinh/Hoa majority.

• Malnutrition levels, an important poverty-related indicator, have also been reducedsubstantially to some 30% in 2002, downfrom 50% in 1990.

• Some 95% of the remaining poor in VietNam live in rural areas.

• Enormous disparities in poverty areobserved across Viet Nam’s 61 provincesand major urban areas, as reflected bypoverty rates in HCMC at 1.8% and LaiChau at over 76%.

• Food poverty rates for the poorest 12provinces were on average 35%, comparedto an average food poverty rate of 1.6% forthe best off 12 provinces.

• Overall poverty rates for ethnic minoritygroups during 1998-2002 have decreasedat a substantially slower rate than during1993-98 and remain very high at 70% in2002, down from 75% in 1998.

• More worrisome, food poverty rates forethnic minorities appear to have increasedin most regions according to availabledata.

• Importantly, all standard indicators ofexpenditure and income inequality reportincreasing inequalities in both expenditureand income terms, especially importantfor a country with such a low level of percapita income. Preliminary data from theVHLSS 2002 would suggest the Ginicoefficient on consumption expenditurewas 0.37 in 2002, up from 0.33 in 1993.Whereas the richest quintile of thepopulation spent 4.6 times more than thepoorest in 1993, it spent some 6 timesmore in 2002.

• A significant number of households are stillvulnerable to falling back into poverty. Ifthe poverty line were increased by as littleas 10% (or the equivalent of one dollar permonth per person), overall poverty rateswould rise to some 36%, a nearly 25%rise.

Achieving Universal Primary Education

• In addition to impressive net enrolmentrates in primary education of over 90%,Viet Nam reports important progress oncompletion rates, currently placed atsome 77%. Net enrolment rates in juniorsecondary education continue to increase,with the current level at some 67%.Capitalizing on early investments inliteracy and basic education, much of

which predates the launching of doi moi,Viet Nam can today boast an adult literacyrate of some 91%, reflecting sustainedimprovements in human development.

• Achieving the 99% net enrolment rate inprimary education by 2010 will importantlyrequire the further integration of ethnicminority and disabled children into theformal education cycle. Net enrolmentrates for ethnic minority children in primaryeducation vary widely, ranging from 41.5%(Hmong) to 95% (Tay).

• Some 33% of disabled children have neverattended primary school and completionrates for disabled children are estimatedat some 15%.

• Viet Nam has virtually achieved genderbalance in net enrolment rates in primaryand lower secondary education. Achievinggender equity in primary education willhowever require further improvingcompletion rates. Available evidencesuggest girls stil l represent adisproportionate share of drop outs.

• Literacy rates for women below 40 yearsof age have reached an impressive 94%,reflecting improvements also for femalesfrom ethnic minorities, whose literacy ratesremain lower at some 75%.

• At the provincial level, the weakest 12provinces in the country report averagefemale literacy rates of some 82%,compared to 97.5% for the top 12provinces in the country.

Promoting gender equityand empowering women

• In addition to considerable progresstowards achieving gender equity in primaryeducation, Viet Nam is steadilyprogressing towards gender equity inaccess to secondary and tertiaryeducation. The share of girls to boys insecondary education increased from 86%to 93% between 1993 and 1998, whereasin tertiary education progress was evenmore visible, with rates increasing from56% to over 80% in the same period oftime.

• Female representation in the NationalAssembly stands at some 27%, rankingViet Nam among the leading countries inthis indicator in the Asia Pacific region.Figures are, however, importantly lower forPeople’s Councils at the provincial(22.5%), district (20.7%) and commune(16.6%) levels, and even lower if female

x


participation in People’s Committees isanalyzed, with around 5% on average atthe provincial, district and commune levels.

• The implementation of the law requiringboth the husband’s and wife’s name onLand Use Certificates (LUCs), critical toproviding equal access to credit andincreased security for women, appears tobe at a virtual standstill. The GeneralStatistics Office (GSO) reports that only2.3% of all LUCs have been issued in boththe names of husband and wife. Landallocation policy based on age andavailable labor force also puts women at adisadvantage. As a result, total farmlandfor female-headed farms is, on average,only 54% that of male-headed farms.

• Some preliminary evidence appears toindicate a relationship between domesticviolence and the changing role of womenin the transition to a market economy. Anational scale survey is required to gaindeeper understanding of domestic violencein Viet Nam so as to improve the nationalpolicy framework.

Reducing Child Mortality

• While available official data suggestconsistent improvements in infant mortalityrates (IMR) and under five child mortalityrates (U5MR), the apparent significantnumber of unregistered and henceunreported births and deaths (especiallywithin the first month after birth) wouldsuggest caution in interpreting availabledata for these indicators.

• Estimates of IMR have come downconsiderably from the 1990 estimate of44.4 deaths per 1000 live births to a levelbetween 35-30 deaths in 2002, whereasU5MR is estimated at some 40 deathsper 1000 births, down from an estimated58 in 1990.

• Available data suggest some 68% ofdeaths under-one year occur in the firstmonth of life (neonatal mortality). However,the neonatal mortality rate is not yet anational indicator and data are poor andincomplete.

• The likelihood of a child dying before hisor her first birthday is at least 6 timesgreater in the weakest 12 provinces of thecountry than in the 12 provinces andurban areas reporting the lowest IMRs.

• Importantly, IMR for newborns frommothers having completed uppersecondary education are nearly 5 times

lower than those for mothers who neverattended formal education. Depending onthe ethnic origin of the mother, rates canrange from 70 deaths per 1000 for the Gia-Rai or 30 for Khmer.

Improving Maternal Health

• Newly available data on maternal mortalitysuggests national rates are around some165 deaths per 100,000 births, althoughas stated in the National Plan on SafeMotherhood, this is just the best availableestimate.

• Provincial maternal mortality rates can be10 times higher in isolated provinces thanin urban and industrial centres. The MoHreported maternal mortality rates of 411in Cao Bang compared to 45 in theSoutheastern province of Binh Duong.

• The National Health Survey 2002 reportsthat in Hanoi, Ha Tay, Hai Duong, Da Nangand Vinh Long, all birth deliveries wereattended by skilled birth attendants. Thetop 12 provinces reported an average of74% of deliveries attended by skilled birthattendants, while for the bottom 12provinces the average rate was reportedto be at around 43%. In three NorthernUplands provinces of Cao Bang, Ha Giangand Lai Chau, more than 70% of deliveriesat home were not assisted by skilled birthattendants. Lai Chau was an exceptionalcase where the proportion was 86%.

• While differences between urban and ruralareas have decreased in the past 5 years,still only three-fourths of rural children aredelivered at a health facility compared toalmost all children in urban areas.

Combating HIV/AIDSand Other Communicable Diseases

• Confirming the important upward trend ofthe last 10 years, Viet Nam officiallyreported total cumulative cases of HIV/AIDS at some 70,000 in 2003, up 25%from the previous year. However, this wasstill less than half the Ministry of Healthestimate of 160,000 cumulative cases.Viet Nam’s official prevalence rate istherefore reported at 0.28%, lower thanmany neighboring countries. However, theevolution and pattern of HIV/AIDS in VietNam make it one of the potentially mostserious threats to the country’s humanwell-being and socio-economicdevelopment.

xi


• Some 45 people get infected with HIV/AIDS every day in Viet Nam. Amongreported cases, there is a noticeable trendtowards a younger average infection age.In 1994, just over 10% of new infectionswere among people aged 15-24. However,since 1999, over 40% of newly reportedcases have been among this age group.

• In contrast to a few years ago, all provincesin the country are reporting HIV cases.Several provinces have reached the 1%prevalence rate, and nine cities andprovinces reported more than 100 HIVcases per 100 000 people. Quang Ninh(572.5) and Hai Phong (331.9) led theranking in number of reported infections,whereas Quang Binh, Quang Tri, QuangNgai, and Ha Giang appear as the leastaffected provinces in the country in lightof available data.

Ensuring Environmental Sustainability

• Preliminary data from different governmentsources confirm the important increase inaccess to clean water in Viet Nam inrecent years, although data is wide andvaried. Based on an average estimate,around 50% of Vietnamese householdshave access to clean water.

• Stark provincial disparities are observed,however, with the top 12 provinces reportingaverage rates of over 97% of householdswith access to clean water and the bottom12 reporting an average rate of 32%.

• The twelve weakest provinces in Viet Namreported an average rate of 12.4% ofhouseholds with access to propersanitation facilities, in comparison to 75%for the top quintile of provinces on thisindicator.

• In 2002, only Ha Noi, Ho Chi Minh cityand Da Nang reported access to garbagedisposal rates over 60%. For the bottomquintile of provinces only 3.5% ofhousehold on average had access togarbage disposal services.

• Government official data suggests forestcover has increased to some 36% inrecent years, although the overall qualityof forest may be decreasing due to naturalforest destruction and loss of biodiversity

associated with the introduction of non-native flora species. Habitat loss has ledto a rise in the number of threatenedspecies over the last five years. Thenumber endangered species hasincreased from 365 fauna species and 356flora species in 2000 to 407 fauna speciesand 450 flora species in 2002.

• In general terms, air in almost all citiesand industrial areas throughout Viet Namis severely polluted. The dustcontamination is 1.3 to 3 times exceedingpermitted levels in areas surroundingfactories, even 10 times around someroads. Some progress may have beenachieved after a period of worsening air andwater quality, with 64% of Water and Air-Quality Monitoring Stations reportingbetter results than in the 1995 baselineyear.

Developing a GlobalPartnership for Development

• The eighth MDG involves important jointpartnership responsibilities betweendeveloped and developing countries in theareas of trade, ODA effectiveness, debtsustainability, and access to newtechnologies.

• The collapse of the Cancun Summit inSeptember 2003 has setback progresstowards the further opening of agriculturalmarkets in developed countries, critical toimproving the development prospects offarmers from developing countries whocomprise most of the world’s poor.

• A new Commitment to Development Index,developed by the Center for GlobalDevelopment and Foreign PolicyMagazine, ranks the Netherlands andDenmark as top donors according to avariety of criteria.

• ODA harmonization will help improveadministrative efficiency of ODAprocedures. However, much morefundamental to ODA effectiveness isallocative efficiency. In this regard, recentdata and analysis have raised concernsabout the allocative efficiency and qualityof public investments in Viet Nam, a criticalarea in need of urgent government review.

xii

MDG PROGRESS REPORT 2003 xiii

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1993 2002 2010 t

Popu la tionbelowIn terna tionalPoverty L ine

Popu la tionbelow theNationa lPoverty L ine

Chart 1. Poverty Reduction in Viet Nam

Source : G SO, VLS S 93, VLSS 98, p relim inary data from VHLSS 2002, M OLISA 2003(1) O ld National Poverty L ine defin ition

Poverty levels

Following a dramatic reduction during the1990s, Viet Nam’s has continued to bring downpoverty rates significantly over the last fouryears, albeit at a slower pace. The country hasmet well ahead of schedule the MDG target ofhalving poverty rates between 1990 and 2015,and is well on track to meet the national targetof further reducing the share of householdsbelow the poverty line to some 20% by 2010.In spite of the remarkable progress achievedat the national level, preliminary data from thenew Viet Nam’s Household Living StandardsSurvey (VHLSS) 2002 would suggest that thebroad-based pattern of poverty reductionobserved between 1993 and1998 may haveturned into a less equitable one. Significantdisparities in poverty reduction dynamics areobserved at the provincial level, and betweenthe Kinh majority and ethnic minority groups,which appear to have benefited little from overallprogress in poverty reduction over the last fouryears.

Estimates from the VHLSS 2002 suggest thatpoverty rates declined in Viet Nam from around37% in 1998 to some 29% in 2002. A reductionof some eight percentage points over the last4 years, in itself a significant achievement,reflects a slowing of progress compared to theremarkable reduction of more than twentypercentage points between 1993 and 1998.

The slower pace in poverty reduction since 1998is more perceptible when the situation of themost vulnerable households is analysed. The

Table 1. Poverty Rates: Urban and Rural Gap

1993 1998 2002

National poverty rate (% )Urban poverty rate (% )

Rural poverty ra te (% )

58

2566

379

45

29

6

35

Source : G SO , VLS S 9 3, VLS S 9 8 , p relim inary da ta from VH LSS 20 02

food poverty rate, estimated at 15% in 1998,has been reduced by some 4 percentage pointsover the last four years and stands now atapproximately 11% in 2002.

In line with Viet Nam’s traditional povertyfeatures, substantial differences are observedin the distribution and poverty reduction trendsbetween rural and urban areas.

Preliminary data suggest poverty rates in urbanareas have been reduced by around 30% (from9% to 6%), while the share of rural householdsbelow the poverty line have declined from 45%to 35% (a reduction of 22% over the 1998levels).

The poverty gap, which measures the depth ofpoverty, declined slightly from 9.5% to 7%between 1998 and 2002. This indicator is theaverage gap between poor people’sconsumption expenditure and the poverty line,expressed as a percentage of the poverty line.The reduction of the poverty gap in Viet Namincreases the potential poverty-reductionimpact of well-targeted policies and pro-poorbudget mechanisms in assistance of the mostvulnerable. Although progress has beenachieved across the country, the depth ofpoverty is still some six times higher in ruralareas than in urban centres, and seven times

I. Progress towards the achievement of the goal

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Q ua n g N a m

K o n T u m

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MDG 1 - Eradicate Extreme Poverty and Hunger

2 UNITED NATIONS COUNTRY TEAM VIET NAM

higher for ethnic minorities than for the Kinh/Chinese majority.

Around 95% of all poor in Viet Nam live in ruralareas, a higher share than in 1998, as it was tobe expected from the country’s economicgrowth dynamics, with manufacturing andservices activities concentrating in major urbanareas and their neighbouring provinces. Poorhouseholds in Viet Nam are traditionallyemployed in the primary sector, with agriculture,fisheries and forestry being reported as theprimary occupation of 84% of all poorhouseholds in 2002.

Low educational attainments, closely correlatedwith the expenditure levels of households, arean important determinant of poverty in VietNam. Poverty rates among those havingcompleted lower secondary education arealmost half those of individuals who did not

II. Provincial and Social Disparities

Progress in poverty reduction has however beenquite uneven at the regional and provinciallevels. The broad-based poverty reduction trendacross all regions in the country over the lastdecade appears to have become less even andthere may be preliminary indications of stallingin poverty reduction in some regions wherepoverty levels appear not to have improved atall.

The Mekong delta region has led povertyreduction in Viet Nam over the last four years,reducing poverty rates by 40%. The preliminaryresults from the VHLSS 2002 may howeverhave been importantly affected by high riceprices at the time of the survey. This in turnappears to have been due to a combination offactors. First of all a change in the diversificationof rice crops produced in the Mekong region

has increased the quality of rice produced(which for the first time is generating betterprices than that of Thailand for the same qualitylevels). Secondly, generally higher internationalprices have also contributed to improve income

Table 2. Uneven Regional Patterns

Region

Northern Uplands

Red River Delta

North Central

South Central Coast

Central Highlands

South East

Mekong Delta

1993

81.5

62.7

74.5

47.2

70.0

37.0

47.1

1998

64.2

29.3

48.1

34.5

52.4

12.2

36.9

2002

43.9

22.4

43.9

25.2

51.8

10.6

23.4

Source: GSO (2003), based on Viet Nam HouseholdLiving Standard Survey 2002

0

20

40

60

80

100

0 1 2 3 4 5+

FoodP overtyR ates

P overtyR ates

Number of Child ren

Chart 2. Poverty by Fam ily Size

Source : G SO (2003), based on V iet Nam Household L iving Standard Survey 2002

complete the primary education cycle. In acountry in which almost 25% of children dropout of the primary education cycle, this is amatter of grave concern. Related to this, thepoverty reduction impact of investment invocational training would seem to be a promisingpolicy alternative.

Another common characteristic of the poor inViet Nam is large family size. In 2002, povertyrates for families with five or more children werewell over 70%. Average family size has declinedimportantly since 1993 for each expenditurequintile in Viet Nam.

Malnutrition levels

Viet Nam reports steady declines in malnutritionrates of children under-five years of age. TheNational Institute of Nutrition reportsunderweight children (low weight for age)prevalence rates of some 30% in 2002, althoughdata from the recently released National HealthSurvey 2002 would suggest furtherimprovements and places current levels at22.5%. Underweight prevalence is stronglycorrelated with the educational attainment ofthe mother, with rates up to 40% for childrenwhose mothers are illiterate, and only 10% forchildren whose mother have completed highereducation. In addition, expenditure levels andethnic origin are critical determinants ofunderweight prevalence, with the pooresthouseholds reporting prevalence rates 3 timeshigher than the richest.


1998

Northern M ounta ins25%

M ekong De lta21%

Red R iverDe lta18%North Centra l Coast

18%

South East5%

CentralH ighlands

5%South

Central Coast8%

Chart 3. Share of total Poverty, by region

2002

Northern M ounta ins23%

Red R iverDe lta17%

North Centra l Coast21%

SouthCentral Coast

7%

CentralH ighlands

10%

South East5%

M ekong De lta17%

1 Data, however, needs to be treated with cautiondue to the small number of observations.

levels. The northern part of Viet Nam has notbeen able to benefit from this favourableinternational situation due the generally lowerquality of the soil, which limits the scope forproducing quality rice for export.

Poverty reduction in the Northern Uplands,however, has also been significant, although itwould seem to have concentrated in theNorthwest part of the region (the Northeast sub-region reports a poverty rate of around 70%,with hardly any improvements in rural areas,where rates are still close to 80%1). Moreover,virtually no progress in poverty reductionseems to have been achieved in the CentralHighlands, where rates remained at some 52%of households, and where food poverty rateswould appear not to have improved since 1993.The Central Highlands presents the oppositepicture to the Mekong delta region, withdepressed coffee prices that importantlyaffected income and expenditure. In addition,important migration of farmers from theNorthern Uplands region towards the CentralHighlands, in search of arable land may alsobe behind the stalled poverty levels in the region.

86

54 58

75

31 37

70

23 29

0

20

40

60

80

100

Ethnic Minority Kinh Total

1993 1998 2002

Chart 4. Poverty Rates by Ethnicity

Provincial disparities in poverty rates asreported by the VHLSS 2002 preliminary dataare dramatic. Ha Noi, Ho Chi Minh and Da Nangreport poverty rates of 5% or less, whereasrates for Lai Chau, Ha Giang, and Bac Can areplaced at some 70% or over.

Poverty and Ethnic Origin

Ranking high among the more worrisomefindings discerned from the preliminary datafrom the VHLSS 2002 is the slow progressobserved in poverty reduction among ethnicminorities in Viet Nam. Poverty rates for ethnicminorities declined from 75% in 1998 to some70% in 2002. In contrast, 23% of Kinh/Chinesehouseholds were reported below the povertyline, a level three times lower than that of ethnicminorities. As a result, the difference in povertyrates between the Kinh/Chinese majority andthe remaining ethnic groups, measured inpercentage points, continues to increase andis now close to 50 percentage points.

Table 3. Povert Disparities at the Provincial Level

Top 12 Provinces Bottom 12 Provinces

International Poverty Line

Ho Chi Minh CityDa NangHa NoiBa Ria Vung TauQuang NinhBinh DuongKhanh HoaDong NaiBac NinhHai PhongAn GiangBen Tre

1.83.55.06.97.28.49.19.9

11.512.014.414.7

Kon TumHa TinhThanh HoaDac LacLao CaiCao BangGia LaiSon LaHoa BinhBac CanHa GiangLai Chau

45.348.048.854.359.461.763.363.966.168.870.576.6

Source: GSO (2003), based on Viet Nam HouseholdLiving Standard Survey 2002


Especially worrisome following steadyimprovements during 1993-98, food poverty andhunger among the poorest of the poor, mainlyethnic minorities, appears to have worsened inmost regions of the country over the past fouryears, particularly in the Northern Uplands (from36.3% in 1998 to 37.3% in 2002), CentralHighlands (from 58.4% to 59.2%), North CentralCoast (22.7% to 42.5%), South Central Coast(79.4% to 82.2%) and even in the Red RiverDelta (from 36.5% to 44.4% in 2002). Amongthe general population in the Central Highlands,virtually no progress appears to have beenmade over the past ten years in reducing foodpoverty and hunger. Of the remaining tworegions, the Southeast reported higher foodpoverty rates for ethnic minorities2 in 2002 thanin 1993, while the Mekong reported a modestdecline (from 25.1% in 1998 to 22.6% in 2002).All of this highlights the challenge of trying toreach the remaining poor, especially the poorestof the poor, who are often in the most remoteparts of the country. These poorest of the poorare typically suffering from various forms ofisolation, not just geographic isolation, but alsolinguistic and social isolation, as well asisolation from basic information and knowledgeneeded to improve their well-being.

Gender distribution of Poverty

As was the case in 1998, female-headedhouseholds reported poverty rates considerablylower than male headed ones. In particular,female-headed households reported povertyrates of 20% in 2002 (down from 28% in 1998)whereas male-headed ones reported povertyrates of 31% (down from 40% in 1998). Thisfinding needs to be interpreted with somecaution, however, since there are importantdifficulties at establishing who is the householdhead, and data is not disaggregated betweenmarried female-headed households andunmarried ones, an area for further developmentin forthcoming surveys.

Moreover, many married female-headedhouseholds are recipients of large remittancesfrom their migrant husbands working elsewherein the country or overseas. In addition, female-headed households tend to have a smallersize, an important determinant of poverty levels.The further gender disaggregation of data fromthe living standards surveys is a critical need

2 The Southeast region reports a decline of 53% infood poverty for ethnic minorities, but data from1998 is based on only 6 observations of ethnicminority households and would seem hardlyrepresentative.

to evaluate in depth the relative situation ofwomen in Viet Nam.

Challenges to further progress in PovertyReduction

Vulnerability

Poverty estimates in Viet Nam must beinterpreted with some caution. The definitionof a poverty line is a technically complex andsomewhat subjective process and the povertyrates obtained on its basis should be taken assimply the best possible estimates within abroad range. The sustainability of povertyreduction in some regions is still at stake andmany households might still be vulnerable tofalling back into poverty for different reasons.As an indication, if the poverty line were to beincreased by 10% (or around 200,000 VND peryear, or a bit more than one dollar per monthper person) overall poverty rates would bebrought up to 35.6%, a nearly 25% rise.

Another available alternative to assess thedegree of vulnerability of households to fall backinto poverty is to measure the distance betweenmean per capita expenditure and the povertyline. As the distance to the poverty lineincreases, the general vulnerability of non-poorhouseholds to fall into poverty is reduced (WorldBank 2002a), although this line of reasoningmay be based on the assumption of areasonably even distribution of income. In VietNam, mean expenditure has increasedconsistently in absolute terms since 1993,albeit with huge disparities between expenditurequintiles and ethnic groups. However, as apercent of the poverty line, mean expenditurehas increased only slightly from to 167% in1993 to 168.5% in 2002 (after fall ingsubstantially to 154% in 1998), pointing atmodest improvements in the vulnerability ofnon-poor households to falling back into povertymeasured by this indicator.

On an important related issue it is estimatedthat some 1 million people annually needemergency relief in Viet Nam due to naturalcalamities, bringing new households below thepoverty line. In addition, an important numberof households are still very vulnerable to fallingback into poverty due to long-term illnessesand the relatively high cost of medical treatment.

Increasing Inequality

The rising trend in expenditure inequalityperceived in 1998 might have been confirmedaccording to preliminary estimates from the


Table 4. Increasing Inequality

Gini Coefficient

Food Expenditure

Non-Food Expenditure

1993

0.33

0.256

0.474

1998

0.35

0.256

0.484

2002

0.37

0.274

0.49

Source: GSO, VLSS 93, VLSS 98, based on Viet NamHousehold Living Standard Survey 2002

III. Financing, Decentralization, and Local Governance Issues

Financing Development at the Local Level

Amendments to the State Budget Law, whichshould help better define the roles andresponsibilities of government agencies andlegislative bodies in budget preparation,approval, implementation and monitoring werepassed by the National Assembly in January2003. The amendments will affect thepreparation of the 2004 national and localbudgets.

Out of the main amendments approved, theincreased responsibility of Provincial People’sCouncils to decide on district level allocationshas legally endowed provincial administrationswith important discretion in the use of publicfunds. In theory, this flexibility should allowprovincial Government’s to reallocate funds topro-poor, employment-generating initiatives andsocial services. In practice, annual provincialallocations are hardly enough to cover for basicsocial needs. It is not expected therefore thatsubstantial pro-poor modifications to provincialbudget allocations will occur. Expenditurepriorities in the form of minimum standardswould need to be defined in a binding way, andit is expected that the formulation of sectoralMedium Term Expenditure Frameworks wouldassist the earmarking of additional resourcesfor priority sectors. (In this regard, theEducation For All Plan is a good start, definingeffectively both quantitative and qualitativeminimum standards for the country’sprovinces.)

In addition to low management capacity at thelocal level, the lack of spending flexibility(including lack of revenue raising powers) oflocal administrations is the main administrativeconstraint for the effective targeting of localdevelopment issues by provincial and districtadministrations. Increased decentralization ofexpenditure capacity will need to be balancedagainst the continued need to safeguard thefiscal stability Viet Nam has achieved over thepast decade.

Targeting the Poor

In addition to broad-based socio-economicdevelopment policies, the Government of VietNam is allocating an important amount ofresources to poverty reduction through a seriesof targeted mechanisms. The assessment ofthe success of national poverty reductionprogrammes in reaching the poor may provideinteresting insights for the administration of theprogrammes.

A UNDP (2003b) study on the process for theallocation of State Budget resources to theHunger Eradication and Poverty Reduction andJob Creation Programme (HEPR) andProgramme 135, found that despite thesignificant amount of resources committed toboth programmes (almost US$60 million forHEPR and nearly US$95 million for Programme135 in 2003), important budget managementshortcomings might be hindering theprogrammes’ impact on the poor.

VHLSS 2002 data. Every major traditionalindicator of inequality suggests increasessince 1998, with a Gini coefficient forconsumption expenditure in Viet Nam in thevicinity of 0.37 in 2002, up from 0.35 in 1998and 0.33 in 1993. This increase in inequalityas measured by the Gini coefficient isespecially worrisome in light of Viet Nam’s lowper capita income. Non-food expenditureinequality has increased importantly to 0.49,confirming increasing disparities in expenditureand income patterns.

The share of the poorest households in totalexpenditure also continued to decreasebetween 1998 and 2002. In 1993, the poorest20% of the population amounted to 8.8% oftotal expenditure in Viet Nam, but by 2002 this

share had declined to 7.8%. In contrast, theexpenditure share of total expenditure of therichest 20% had increased between 1998 and2002 from 43.3% to 45.9%. As a result, therichest 20% of households in Viet Nam reportedin 2002 real expenditure per capita some 6times higher that of the poorest, up from some4.6 times higher in 1993.


Box 1. Community Contribution in Rural Infrastructure: Ownership or burden for the poor?

Community participation in the development of rural social and economic infrastructure is acentral plank in both the government and donor-funded programmes. A key aspect of thisbeneficiary participation in government programmes is the requirement that likely beneficiariescontribute certain percentage of the cost of infrastructure (10-15%) in the form of free labour ormaterials.

The prevalent wisdom is that community contribution helps in instilling a sense of ownershipamong the beneficiaries, thus leading to sustainability of the scheme. It is also assumed that itleads to greater involvement of the beneficiaries in decision-making, which builds their capacity,inculcates transparency and breeds efficiency and empowerment.

With all above-mentioned assumptions and sound arguments about the benefits of communitycontribution, a constant stream of concerns has been raised by various researchers andsupervisory missions over the recent past about the application of this principle. These concernsrelated to:- application of this principle even to large contractor-executed schemes where community is

not an investment owner;- participation, which has become synonymous to free labour rather than empowerment;- arbitrarily fixed flat rates of contribution without taking into account the nature and type of the

scheme or the ability of the beneficiaries;- execution of a number of schemes at the same time with the same requirement by different

programs thereby putting too much burden on the beneficiaries;- an inherent contradiction in the intended aim of providing income generation opportunities to

the poor through wage labour and at the same time expecting them to provide free labour ascontribution;

A study was conducted to examine this practice in various projects in 18 communes in fourdifferent provinces and draw lessons/recommendations for the government and donor fundedrural development programmes. Provinces targeted included Ha Giang, Tuyen Quang, Ha Tinhand Quang Binh, and all selected communes had a wide rage of infrastructure schemessponsored by various government and donor-funded initiatives. The study clearly showed thatcommunity contribution is but one part of the overall process of community participation.

Interviewees remarked that community contributions need to be preceded and succeeded byother essentials of community driven development. Those would include active involvement ofthe beneficiaries in the entire cycle of project implementation; meaningful control over the financesand contracting; training and capacity building; technical support and regular monitoring;inculcation of democracy, local accountability and transparency in decision making, helped byqualified social facilitation staff and concerned technical staff; and incentives for participationand contribution.

Perceptions about limited capacity of commune and village level administrations were addressedin quite different ways in the provinces surveyed. For some provinces, this sufficed as an excusenot to develop any concerted strategy to build the capacity of communes and provinces. Othershave been able to arrange for comprehensive training of officials. Tuyen Quang, for instance, hasarranged training for 700 engineers and technicians for the communes, and key commune staffare being sent regularly to Agriculture Universities or Technical Schools to upgrade their skills.

Tuyen Quang has shown consistent political commitment to the decentralization of ruraldevelopment programmes like Programme 135 to the commune level, demonstrating thatcommunes are capable of taking charge of basic infrastructure programmes provided they areproperly guided and trained, given control and technical support of district level is ensured. Theprovince has taken, in addition, the first step for the implementation of a strong Monitoring andEvaluation system and the commune level with the establishment of the Commune MonitoringBoard of Programme 135.

Another province in the study, Quang Binh, is doing away with the practice of requiring free labouras a Community Contribution and authorities are opting for subsidized labour. Labourers arepaid at half the labour wage rate (around VND 15,000) and the rest is considered their contribution.This might be a better way to ensure the poor derive direct financial support from project-fundedschemes.

UNDP (2003a)


Box 2. Targeting credit for the poor? The new Social Policy Bank

The new Social Policy Bank was established in February 2003 in accordance with Decree 131of the Government with a view to separate policy lending from commercial lending within theframework of the overall banking sector reform. The scope of the new Social Policy Bank will belarger than the scope of the former Viet Nam Bank for the Poor since it gathers policy lendingpreviously undertaken by various ministries, excluding lending to SOEs.

The SPB’s total legal capital will be 5000 billion VND (equivalent to USD 325 million), which inprinciple would allow the Bank to eventually mobilize and lend well over a few billion dollarsworth of policy loans. Mobilized capital to date is however well below the 5000 billion figure. TheGovernment has stipulated that state credit institutions would deposit 2 percent of their mobilizedcapital funds (receiving in return an interest rate over their deposits) to the SPB, to be used aspart of its lending capital. The SPB will also receive the annual state budget allocation fornational programmes such as job creation, housing for flood resistance, etc., and has beenallowed to mobilize ordinary savings as other banks. It could also receive funds from bothdomestic and international sources, grants and loans, with or without interest.

Viet Nam’s Bank for the Poor (VBP) was traditionally housed at the Viet Nam Bank for Agriculture[VBA]) relying on its staff, funds and facilities for its operations. The Social Policy Bank willinitially draw upon the VSP apparatus, but faces the huge challenge of establishing its ownnetwork of branches. An additional and equally important challenge would be to recruit skilledpersonnel for its operations, as it might not be possible to retain VBA staff previously supportingthe operations of the VBP.

The separation of policy lending from commercial lending has been considered a crucial primarystep in the banking reforms. In principle, the creation of the Social Policy Bank could allow forgreater transparency in this process so that the size of subsidized credits is accurately estimatedand planned in advance in order to avoid fiscal instability in Government’s operations. The SPBwould be in charge of providing policy lending with preferential conditions (e.g., with subsidisedinterest rates and without collateral), while other state-owned financial institutions would haveautonomy to focus entirely on commercial lending.

The size of policy lending by the SPB will be determined on the basis of specific criteria, such asthe ratio of poor households, the annual lending scale, etc., in order to accurately estimate thesize of subsidies required. Clear criteria will be determined for the selection of beneficiaries.For example, poor households willing to start a business but lacking collateral would be providedwith loans through the job creation funds. In addition to poor households, those considerednear poor, and unable to get a commercial loan, would be facilitated by access to policy lending.The maximum loan size would be 7 million VND (or USD 500), and average loan size is expectedto be USD 200. The bank is also considering providing loans worth more than 7 million VNDthrough the job creation programme (up to 15 million VND per household), and the flood-resistant housing programme (up to 10 million VND per household).

The selection of beneficiaries will be done at the commune level, on the basis of the povertyassessments undertaken by the district branches of MOLISA. An additional challenge to thesuccess of the Bank will be to ensure the transparency of the process of selection of beneficiaries.Anecdotal evidence would suggest that on occasions the selection of poor households havenot followed the participatory process proposed by MOLISA at the commune level, and thevillage head has exerted a disproportionate influence over the decisions.

As indicated above, the separation between commercial and policy lending is an important stepin banking reform. However the challenges the Social Policy Bank is facing should not be under-estimated. The Government has to develop all the infrastructures required by such an ambitiousinstitution (branch network, staff, management, credit procedures, MIS, etc). Also, the lessonslearnt from the experience of Vietnam Bank for the Poor should be considered, such as thedistortions created by subsidised interest rates or issues linked with the selection process ofdisadvantaged households that can benefit from loans.

UNDP (2003), Monthly Donor Group Forum with Governor of the State Central Bank Le Duc Thuy


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Province Value

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Firstly, increased transparency would berequired in the budget allocations process. Inparticular, lower levels of administration seemto rarely know the overall amount allocated tothe province through the programme and thepriority areas defined for expenditure. In thisarea, additional information on the allocationsto the National Ministry of Defence under theHEPR programme (which may amount tonearly 20% of total HEPR) needs to be furtherevaluated in terms of poverty reduction impact.

The search for increased transparency wouldnotably include the preparation of unified setsof guidelines for both programmes that wouldease their implementation at the local level,and a clear set of incentives that encourageimprovements on provincial and sectoralimplementation performance (probably in theform of higher forthcoming budget allocations).

Secondly, in line with the amendmentsconducted to the State Budget Law, increasing

Viet Nam has maintained a commendableplanning effort in the area of poverty reductionover the last few years, and has increasedimportantly the resources devoted to the fightagainst poverty since 1998. An important newpiece of the institutional and policy frameworkunderpinning poverty-reduction efforts in VietNam, the Comprehensive Poverty Reductionand Growth Strategy (CPRGS), continued toprogress towards implementation in 2003. ThePoverty Task Force of government and donoragencies organized a series of regionalworkshops between May and June 2003 aimedat increasing awareness at the provincial levelon the process of formulation and target settingfollowed for the drafting of the document. Theworkshops are a first stage in the process of“rolling out” the CPRGS to the provinces of Viet

IV. Framework for Further Progress

the flexibility and discretionary powers ofprovincial administrations by the allocation ofannual block grants might improve pro-poorimpact of the programme. Moreover,announcing indicative planning figures early inthe year for provincial block grants would endowthe process with very necessary additionalstability. The determination of the size of theprovincial grants has traditionally been acontroversial issue that might be resolved byensuring block grants are a function of thepoverty levels and of the population size in theprovince.

Lastly, increased accountability in the use ofthese resources appears needed. Theimplementation of a Monitoring and Evaluationsystem, including minimum standards andsimple performance assessments would allowfor enhanced efficiency. This should includeannual preparation of narrative and financialreports on the activities under bothprogrammes in the previous year.

Nam, and are planned to be followed by in depthassistance to selected provinces in order tointegrate the planning process and investmentcriteria in local level administrations.

The implementation of the CPRGS at theprovincial level requires, however, that thecontents and approach of the CPRGS beadapted to the needs of provincial leveladministrations. Cross cutting principles to theformulation of socio-economic plans, likefacilitating broad participation of governmentand non-governmental stakeholders, andensuring gender-sensitive planning andbudgeting process might be prioritised, as wellas the definition of initiatives in assistance ofthe most vulnerable groups.


Thanks to early investments in education,much of which predates even the launch of doimoi, Viet Nam can boast today, according tothe latest data from the VHLSS 2002, an adultliteracy rate of some 91%, a critical indicatorthat reflects sustained improvements in humandevelopment. Progress in improving adultliteracy has also been quite even across ruraland urban areas, while gender differentials havebeen steadily reduced. Preliminary data fromthe VHLSS 2002 suggests over 94% womenbelow 40 years of age were literate, althoughrates for women in this age group from ethnicminorities were significantly lower at around75%.

Current net primary enrolment rates3 in VietNam stand at some 92% (MoET, 2002), whichplace Viet Nam close to achieving the nationaltarget of 97% by 2005. Official estimatesindicate that the Gross Enrolment Rate4 (GER)at 106.8%, revealing a 15 percentage pointsgap between primary GER and NER thatreflects the number of children in school whoare either underage or over age because they

Box 3. Primary Education Salient Features

Net enrolment rate 91.6%Gross enrolment rate 106.8%Completion Rate 77%Repeaters 2.3%Drop-outs 3.7%Pupil-teacher ratio 26.4%

Primary school children 8,927,000Ethnic minority children 1,584,087Disabled children* 200,900

Public expenditure as % of GDP 23.0%Public expenditure on educationas % of total public expenditure 13.9%Public expenditure on primary educationas % of education expenditure 37.0%

* MOLISA 2003 estimates 2.25% disabled out of total children 6-11 yearsof ageSource: MoET, MOLISA (Several years)

enroled late or repeated grades. In spite of thissubstantial gap, Viet Nam reports fasterprogress than most low-income countries inbridging the gap on gross and net enrolmentrates, an important achievement, since highGERs are traditionally a measure of theinefficiency of a primary school system.

Most importantly, available data would suggestprimary education completion rates in VietNam have increased from some 68% in 1998to 77% more recently. Sustained progress incompletion rates is underpinning growth in netenrolment rates in lower secondary education,which currently stand at some 67%,approaching the 80% target set for 2005 bythe Government.

Improving the quality of education in Viet Namhas been highlighted in the recently releasedEducation for All National Actional Plan (MoET2003) as the major challenge of the sector. VietNam seems to be far from achieveinginternational standards in primary education,and ambitious targets have been set for the

3 The primary school net enrolment rate (NER) is theproportion of children in the officially designated age6-10 cohort who are enrolled in primary school.

4 The GER is the number of children of any age whoare enroled in primary school as a proportion ofchildren in the primary age group.

MDG 2 – Achieve Universal Primary Education


1009291.4

6877

0

20

40

60

80

100

120

1998 2002 2015

Prim aryEducationNetEnrolm entRate

Prim aryEducationComple tionRates

Source : V LSS 98 , M oET (2002)

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Q ua n g N a m

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next twelve years. Underfunding of educationservices has resulted in Viet Nam’s children inprimary education attending only some 40%of the schooling hours provided in Thailand(DFID 2002). As the EFA Plan puts it “relianceon community contributions to deliver primaryeducation has led to a widening gap in learningopportunities and learning achievements”.

Teachers training has been rightly underlinedas an investment priority to improve educationstandards. In 2001/2002, some 8% of allteachers received in-service training (4 dayson average) (MoET 2003). The MoET aims toprovide 30 days of in-service training to 100%of teachers by the end of the school year 2003-2004, and will aim to ensure all provinces havea teacher training resource center by 2015. Inaddition, only 50% of teachers in primaryeducation (and 10% in lower secondary)received the teachers’ guide. The Governmentaims to reach 100% of teachers by 2015.

In another indicator of quality of education, only13.4% of primary schools had computerslaboratories, and the same share of schoolsprovided students the services of a functioninglibrary. The Government targets to have 100%of schools in the country with Computer labsand functioning libraries by 2010.

While gender balance on primary educationenrolment has been virtually achieved, Viet Namis still some way from achieving gender equalityin primary education. There is little overalldifference between sexes in primary NER, witha national NER of 91% for girls and 91.7% forboys. However, there is evidence that a

disproportionate share of drop outs in primaryeducation are girls, while they represent some40% of repeaters.

Achieving the 99% net enrolment rate inprimary education by 2010 will importantlyrequire the further integration of ethnic minorityand disabled children into the formal educationcycle. These two groups represent some 20%of the total primary school population in VietNam (18% for ethnic minorities and 2.25%disabled children). Some 33% of disabledchildren have never attended primary school(UNICEF 2003a), and of those participating,only 15% finished primary schooling.

The total share of children ever enrolled in earlychildhood development programmes isestimated at 65%5 in Viet Nam, with girlsenrollment greater than boys, 69% versus 59%respectively. Studies have confirmed thatchildren who participate in organised EarlyChildhood Care and Education (ECCE)activities subsequently tend to perform betterin school, to continue to school longer and toearn higher incomes later in life. These childrenare less prone to delinquency, drug use andother social problems. This better start in lifethat ECCE provides is the most persuasivejustification for the investment, though the costof a comprehensive system is substantial.Countries that have made this investmentrecover the costs through savings in other partsof the education sector for example, throughreduced repetition and dropout incidence at theprimary level (UNICEF 2003b).

5 EFA Plan Annex IV, page 1

II. Provincial and social disparities

An ethnic divide

Reflecting certain ineffiency in the enrolmentof ethnic minority children in primary education,primary education Gross Enrollment Rate(GER) stands at around 130% for this group inthe Central Highlands and in the Northernprovinces. Available data suggest that a largeproportion of ethnic minority children startschool late and repeat grades, making it moredifficult for them to complete primary education.For some ethnic minority groups in the NorthernUplands and Central Highlands, the primaryNER falls below 70% due to poverty, geographicremoteness and language barriers. A NER of41.5% is reported for the H’mong, the lowest

of all the ethnic minority groups (World Bank2002b).

A significant number of ethnic minority childrenstill learn in a 120-week (3 subjects) curriculumcompared with the new 175-week curriculum(6 subjects introduced in grades 1 in 2001/2and grade 2 2002/3 school years) for themajority of school-aged children. The 120-weekcurriculum is one of the major impedimentsfor poor and ethnic minority children’s transitionand acceptance into lower secondary schoolingsince they are ill prepared to pass the


Table 5. Provincial Disparities in NER

Top 12 Provinces

Thai Binh

Ha Noi

Bac Ninh

Ninh Binh

Nam Dinh

Bac Giang

Hai Phong

Hai Duong

Hoa Binh

Vinh Phuc

Phu Tho

Binh Dinh

Average

NER Primaryeducation

99.59

99.07

99.02

98.88

98.82

98.59

98.49

98.43

97.94

97.91

97.83

97.79

98.53

Bottom 12Provinces

Binh Phuoc

Ha Giang

Tra Vinh

An Giang

Cao Bang

Kien Giang

Ninh Thuan

Bac Lieu

Son La

Gia Lai

Soc Trang

Lai Chau

Average

NER PrimaryEducation

87.66

87.64

87.09

85.10

84.84

84.42

84.21

84.21

82.01

80.32

78.98

70.59

83.09

Source: UNDP (2003), Estimates from VHLSS 2002

standardized test for secondary educationcurriculum. However, it is planned that the 120-week curriculum will be gradually phased outduring the coming years and completelyreplaced by the 175-week curriculum by 2007.

Gender equality is a bigger challenge forethnic minority girls

Disaggregation by ethnic groups shows alsosignificant gender disparities among threeminority groups: Dao, Thai, and H’mongrespectively, where the NER for girls is 4.9%,6.7%, and 20% lower than those for boys.

Girls attending branch or satellite schools inremote rural areas are also less likely tocomplete the primary education cycle since


An important amount of additional financialresources will be required to achieve thenational objectives in quality of education andto ensure affordable and equitable provision ofprimary education for all. Financing of the newEducation For All Plan is expected to exceedUS$ 1 billion per year and reach US$ 2.5 billionby 2015. The important financial gap will needto be met with sustained community and donorcontributions, the financial gap would amountto approximately 14 per cent of total resourcesneeded in 2003, including the financial needsof the provincial and district levels ofadministration (MoET 2003).

The financial burden on communities andfamilies to help cover costs of education inputssuch as tuition and fees, stationery, books,uniforms, construction and maintenance ofphysical infrastructure is a major determinantof whether children stay in school. Importantprogress has been observed in the extensionof cost exemption in primary and secondaryeducation. Exemption levels (including full andpartial cost exemption) increased from 18% in1998 to 58% in 2002 of students aged 6-14.However, most of the change oberved is due tothe 2000-2001 policy decision to exemptchildren at state-owned primary schools frompaying tuition fees. Full cost exemption

they would be required to enrol in semi-boardingschools after completion of their second yearof primary education, an unpopular option dueto cultural reasons.

Girls-sensitive policies in the provision ofaccess to primary education would includeensuring the availability of good water sanitationfacilities at the school, reducing distance toschools, and promoting their participation inactivities and leadership within the school.

Provincial gaps are still apparent

Despite impressive national achievements,provincial disparities in access to and qualityof educational services are still evident. TheNER for the weakest 12 provinces in thecountry is an average 83%, while the top 12provinces reported average NER of over 98%.

Steady progress in access to education isincreasinly turning the policy makers’ attentiontowards the need to raise the average qualityof education services, as stated in the newEducation for All Plan (EFA). The more remoteand disadvantaged the provinces, districts, andcommunes are, the lower is the quality ofprimary education. Village or branch schoolsoffer the poorest quality learning experiencesfor ethnic minority children. Factors contributingto the low quality of primary education indisadvantaged areas of the country includepoorly designed school facilities, inadequateteacher preparation, ineffective teaching andlearning methods, limited availability and qualityof learning materials, lack of clean water andsanitary latrines.


(including tuition fees, and other schoolcontributions) for the poorest 20% ofhouseholds in fact decreased from 14% in 1998to 11.5% in 2002 (GSO 2003).

The National Committee on Ethnic Minorities(CEM) study on healthcare and educationpolicies6 (CEM 2003) found that disadvantagedchildren of communes under Programme 135were exempt from annual tuition fees but manywere charged other ad-hoc costs for schoolconstruction, expansion and maintenance. Ifthese fees were not paid, school authoritiescould bar students from attending classes.Parents often resorted to selling livestock andproduce to afford the added costs.

Some 94% of primary school teachers are paidby the Government. While salaries are receivedon time, the money, including bonus andreward schemes, is not enough. For teachers,particularly those working in mountainousareas (five years for men and four years forwomen), poor transportation infrastructuremeans one trip home could cost three monthswages, let alone cover basic necessities.

Education management systems at all levels(central, provincial, district, school) areinadequate to implement education reforms,and the skills required to meet the EFA Planat the provincial level include planning fordecentralised management and administrationas well as support for supervisory and qualitycontrol.

Human resource administration in theeducation sector also require improved policies.There is a need to increase the flexibility oflocal administrations in hiring and trainingprofessionals. Changes to the curricula will notbe effective if the teaching staff remainsunchanged and untrained. The CEM studyfound that teachers from mountainous areas

6 Data should be treated with caution due to thesmall number of observations.

IV. Framework for further progress

National and Local level Policy Framework

The National Framework for Education for All(EFA), 2003-2015 was approved by the PrimeMinister in July 2003. The EFA Plan provides aroad map for the development of four major

were described as less qualified than theirlowland counterparts and are likely to be lessaccepted at lowland schools. In somedisadvantaged areas assessed by CEM, thelevel of unqualified teachers reached 50%.

The full implementation of the Education for AllPlan must allow for better resourcing of primaryand secondary school programmes, particularlyin disadvantaged localities. However, EarlyChildhood Care Education programmes willcontinue to be a shared funding responsibility,where significant costs will be borne by parentsand community. Unless these poorcommunities are exempted from both the costof establishing and financing the programmeitself, such direct costs to parents means thatpoor families would unlikely be able to accessearly childhood care and pre-schoolprogrammes.

Teachers lack appropriate in-service and careerdevelopment opportunities and many are poorlytrained. Their time is under-utilized particularlyfor those teaching the 120-weeks curriculum.Remuneration is low compared to internationalstandards and to salary levels of other sectorsof the economy.

According to the EFA Plan, of some 338,000primary school teachers in the country, 10%are from ethnic minority groups. Chronicteacher shortage meant that many schoolsemployed teachers with low qualifications,some having only five years of primary schooleducation and two years additional training.CEM study on education policies found thatwhile quality of teachers varied from district todistrict, language barriers contributed to lowquality of education for these areas.Vietnamese speaking teachers had importantdifficulties communicating with students inethnic minority areas since textbooks are onlyavailable in Vietnamese.

components (target groups) of the educationsystem during 2003-2015: (1) early childhoodcare and education (ECCE) and pre-schools,(2) primary education, (3) lower secondaryeducation, and (4) non-formal education for out-of-school youth and adults. EFA sets overallnational goals and targets to be reached andidentifies the Action Programmes, which mustbe implemented particularly at local levels, inorder to reach them. The EFA plan preparation


Box 4. Child-friendly Monitoring and Assessment System

Viet Nam was one of the first countries in the world to sign the Convention on the Rights of the Child (CRC) in 1991,which recognizes the right of all children to quality basic education. School participation in and of itself does notassure children of a quality education. For this right to be realized it takes far more concerted efforts. Well-trained andcommitted teachers are first and foremost essential to children’s education. Age appropriate and interesting textbooks,well-designed school facilities as well as parents and community members, who are deeply engaged in the educationof their children, are other important components. However, for children’s right to a quality education to be fully andtruly realized, a positive learning environment that promotes their academic achievement, as well as their physical,psychological, social and emotional growth must be also fulfilled.

The UN actively supports the Government of Viet Nam to create such child-friendly school environments using aschool and community-based monitoring system called COMPAS – Community-based Monitoring and ProgressAssessment System. It is a first attempt to track the status and progress of the school learning environment over time.COMPAS is currently being applied in 500 of the most disadvantaged rural primary schools, including branch campuseson the basis of rights-based principals.

Inclusive child-friendly schools provide children with a quality education with an environment that is healthy andengaging – a place where they can play, be protected from harm, express their thoughts and opinions and activelyparticipate in the learning process. Seven enabling actions that underpin the inclusive child-friendly learningenvironment concept are as follows:

1) Guaranteeing safe, healthy, clean and protective spaces for children, including strong school buildings,well-designed spaces and clean learning environments with appropriate furniture and light for classroomwork. Clean drinking water, separate sanitary facilities for boys and girls, safe playgrounds, and healthpromoting services like immunisation and nutritional monitoring, are also fundamental elements of a child-friendly primary school.

2) Fostering children’s psycho-social, cognitive and academic development within a supportive learningenvironment and age-appropriate curriculum, ensuring that all children, particularly girls, master thefundamentals of learning, including functional literacy and lifeskills. This is best achieved through child-centred and interactive teaching/ learning processes that respond to children’s physical, emotional andintellectual needs and provide them with opportunities to experiment, play and learn by doing.

3) Ensuring enrolment, attendance and completion by tracing and tracking the enrolment and participation ofall school-age children in the community, especially girls and other disadvantaged children; developingenrolment and retention plans, and assessing and addressing the causes for non-attendance. Heads ofschools, parents, teachers and community leaders are co-responsible for working together to ensure thatthe right to a quality education is realised for all children.

4) Supporting heads of schools to create child-friendly learning environments by building their capacity forgood school planning and management practices, making the best possible use of existing resources andstaff support, in line with the best interests of the child, including promotion of their physical growth, social,emotional and cognitive development, and learning competencies.

5) Raising teachers’ morale and motivation through a supportive environment that provides them withopportunities for professional growth, renumeration commensurate with their experience and qualification,and training. This includes skills and know-how of subject matters and interactive teaching/learningtechniques, access to teaching materials and resources, and regular fora for meetings with their peers andsupervisors to discuss pedagogical challenges and solutions.

6) Mobilizing parental and community support for children’s education with strong community partnerships,for example through the formation of Parent-Teacher Associations that are actively involved in school planningand management together with the leadership of school heads and Education Councils, and through themobilization of funds and other resources for education.

7) Encouraging and respecting children’s participation in a broad variety of school and community activitiesin designing and monitoring of child-friendly policies and practices, in all areas involving their safety, health,academic growth and performance, physical and emotional development and wellbeing, including promotinghigh standards of conduct that foster respect and empathy in interactions both between teachers and studentsand among peers.

Integrating MDGs in programming for education is a central strategy for realising child rights. Community capacitiesmust be supported to promote standards and to monitor performance so that key stakeholders actively identifychildren of school age to enrol and participate in classes, and complete the five-year primary school curriculum,regardless of race, gender, religion, disability or social status.

UNICEF (2003)


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0.97540.91800.90160.90160.86070.86070.85250.82790.81970.81970.81970.81150.81150.79510.77870.74590.72950.70490.69670.69670.69670.68030.64750.60660.60660.56560.54920.54920.51640.50000.48360.47540.45900.45080.44260.43440.41800.38520.36890.31970.30330.29510.28690.28690.27870.26230.20490.20490.18030.16390.16390.15570.13930.13110.12300.09020.09020.05740.05740.04100.0000


process was participatory with engagementfrom all 61 provinces, contributing toidentification of goals, targets and keycomponents.

Decentralization of EFA action programmes andthe new budget allocation system will requirea new way of sector management, i.e. newprovincial level responsibilities, authority andaccountability, and strengthened advisoryfunctions at central level in policy setting,ensuring quality (teacher training, curriculum,teaching and learning materials, fundamentalschool quality levels) and implementationmonitoring.

In order to ensure targets are met, provincesare to be involved directly in the EFA roll-out.An intensive programme of assistance isenvisaged to strengthen technical skills ofprovincial managers in planning,implementation, monitoring and analysis. TheEFA roll-out to local levels will dramaticallyinfluence and is likely to accelerate the deliveryof education services due to its decentralisationin management and finance. However, capacityshortfalls, insufficient resources and otherpractical challenges such as monitoring andquality assurance could hamper achievementof EFA targets particularly in the poorestprovinces. Human resources policies need toincrease the flexibility of local administrationsin hiring and training professionals. Changes tothe curricula might not be effective if the teachingstaff remains unchanged and untrained.

Throughout the development of the EFA Plan,gender mainstreaming was identified as apriority. In order to achieve the EFA goals,including Universal Primary Education (UPE),focus on gender-responsive quality educationis vital, i.e. gender-sensitive curriculum,teaching-learning processes and competency-based learning assessments. It is important

to note that the EDS 2000-2010, which has nowbeen incorporated into the EFA framework, setsobjectives for having 50 per cent of all childrenwith disabilities included into the educationsystem by 2005 and 70 per cent by 2010.

Under the non-formal sector of the four EFAframework target groups, the National LiteracyCampaign emphasises programmes for youngilliterate adults age 15-34, numbering about 1.8million persons, particularly women. Inaddition, under the EFA strategic goal ofproviding lifelong learning opportunities, targetsto be reached during the EFA Plan period includeimplementation of literacy campaigns,expansion of community learning centres up to50% of all communes by 2005, diversificationof post-literacy and life skills programmes. Insupport of 6-14 year olds out-of-school children,complementary primary or lower secondaryschool programmes will be established.

Overall, Viet Nam is on track to achieve theMDG of universalizing primary education.However, strong advocacy should continue formore pro-poor and pro-ethnic minorityinvestments by the government and theinternational community in the areas of inclusive,pre-primary and lower secondary education.

Strengthening capacity for reliable routine dataat sub-national levels is vital. The existingeducation information systems should beimproved, while support is provided for specialsurveys and studies to increase reliability,comparability and coherence in methodologyfor data gathering and indicator definitions.Better applications in using more sophisticatedmethods of assessing learning competenciesrather than subject-based tests andexaminations would also provide MoET withmore valuable feedback on the quality andappropriateness of basic education curriculumand its activities.


MDG 3 - Promote Gender Equalityand Empower Women


Of the eight Millennium Development Goals,Goal 3 on Promoting Gender Equality andEmpowering Women is unique in that progresstowards this goal is integral to the achievementof all other MDGs and to the country’s overalldevelopment process. While the focus of thisglobal MDG is on gender disparities in educationlevels, Viet Nam has identified additionalspecific country priorities that will be discussedin this chapter.

Viet Nam is steadily reducing gender disparitiesin access to education and is increasing thepolitical representation of women in electedbodies. On the downside, women’s equalaccess to land and credit is constrained bythe slow progress on re-issuing Land UseCertificates (LUCs) in the name of bothhusband and wife, and little progress isreported in the assessment of vulnerability ofwomen to domestic violence and thedevelopment of a supportive policy framework.

Gender and Education

While Viet Nam has nearly achieved genderbalance in primary education enrolment, officialdata suggests gender imbalances in educationare still apparent. Overall, girls are less likelyto complete full school year cycles, and havehigher drop out rates. In some rural andmountainous areas, and among poor and ethnicminorities households, access of girls toprimary education is still substantially lowerthan that of boys. A mix of geographic andsocio-cultural factors, such as the traditionalattitude that domestic responsibilities lie withgirls and thus girls do not need education,underlie some of the disparities observed.

Lower participation of girls in lower secondaryschool is highest in ethnic minority areas andamong certain ethnic minority groups. In thearea of non-formal education, girls and womenare least likely to participate in and benefit fromsuch education.

Table 6. Net school enrolment rate by education level and sex:1993 - 2002 (%)

Primary

Lower Secondary

Upper Secondary

1993 1998 2002

Female

87.1

29.0

6.1

Male

86.3

31.2

8.4

Female

90.7

62.1

27.4

Male

92.1

61.3

30.0

Female

91

67

N/A

Male

91.7

67.2

N/A

Source: VLSS 93, VLSS 98, MoET (2002)

Literacy rates of women under 40 years of agehave steadily improved over the 1990s and arecurrently placed at 94.3%, close to the nationaltarget of 95% by 2005. Rural-urban disparitiesin this indicator are slowly being reduced but asignificant gap among ethnic groups persists.Whereas literacy rates for Kinh and ethnicChinese females under 40 are high at over 97%,rates for their female counterparts from ethnicminority groups are slightly over 75% and haveimproved only marginally since 1998.

The ratio of literate females to males of 15-24years old has remained stable while overallrates increased, sustaining an overall genderbalance in this important indicator. Mostremarkable disparities are found among ethnicminorities groups in selected regions, like theSouth Central Coast.

Political Representation - Women inDecision Making Bodies

Currently in Viet Nam, 27.3% of NationalAssembly members (2002-2007) are women,representing the second highest participationrate by women in the National Assembly inthe Asia Pacific region, after New Zealand. Thisis an impressive achievement by internationalstandards.

While women’s participation in legislativebodies is high, executive decision-makingbodies in Viet Nam count among their members

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Table 7. Proportion of Women Representatives on governing bodies

Governing Bodies

National Assembly(2002-2007)

Party CommitteesCentralProvincialDistrictCommune

People’s CouncilsProvincialDistrictCommune

People’s CommitteesProvincialDistrictCommune

Current term Target for nextelection

(PM Decision19/2002/QD-TTg)

27.3%

2001-20058.6%11.3%12.9%11.9%

1999-200422.5%20.7%16.6%

1999-20046.4%4.9%4.5%

33%

2001-200515%15%15%15%

2004-200928%23%18%

2004-2009...

Source: Statistics on Women and Men in Vietnam, NCFAW, 2002

a very reduced share of women. The newCabinet includes only three women out of 30members, and at sub-national level, womencomprise only 6.4% of provincial level People’sCommittees, and even less at loweradministrative levels.

There is also a clear gender division of laborwithin the different Committees of the NationalAssembly and within central Governmentadministration. The traditionally “softer” socialportfolios within the National AssemblyCommittees (e.g. Committee on Social Affairs,Culture, Education, Youth and Children) areheaded by women. Similarly, at the ministeriallevel, women tend to lead ministries withtraditional caretaker characteristics (i.e.ministries of labor, invalids and social affairs;health; and population, family and children) and

men lead other ministries associated withfortitude and strategic decision-making (e.g.defense, trade, foreign affairs and publicsecurity) (UN 2002a). Overall, the share ofwomen in leadership positions in centralgovernment administration remains low, withwomen representing only 11% of Ministers, 7%of Vice-Ministers, 12% of directors, and 13%of deputy directors.

Women’s Access to Land and Credit

Women’s equal access to land and credit isgreatly hindered by the fact that the names ofboth husband and wife usually do not appearon LUCs. As illustrated in the table below, thenational average of households having bothhusband and wife listed on LUCs is extremelylow at 2.3 % (GSO 2003). While some regionsof Viet Nam have fared better than others atensuring registration of LUCs in both names,such as the South Central Coast at 7%, mostregions hover more closely to a mere 1-2%.

Prevailing customary practices and socialattitudes have precluded great numbers ofwomen from having equal access to land userights and credit. While the wording of the LandLaw does not explicitly state that the malemember of a family should be listed on the LUC,in practice, the majority of LUCs are registeredunder the name of the designated head ofhousehold – who is usually the eldest male inthe family. In the event of divorce or familyinheritance, women who do not have theirnames listed on LUCs do not have a legal basisfor claiming their rightful share to land. Thuswomen are effectively disenfranchised fromland, increasing as a result their economicvulnerability and dependency on men forproductive inputs such as land and credit, asshown by the fact that almost two-thirds of allfund borrowers are male. In light of the growingnumber of legal cases for women when theytry to claim their rights to land during divorcesettlements, and in widowhood, this is asignificant problem in Viet Nam.

Land allocation regulations based on age-basedemployment status also put women at adisadvantage. While a standard area of land isallocated to people within the labor age, onlyhalf of that standard land area is provided topeople who are not within the labor age. Sincewomen’s mandatory retirement age in VietNam is 55 compared to 60 for men (i.e. 5 yearsearlier), land allocated to women aged 55-60is only a half of that allocated to men of thesame age. In addition, less land area is

6.4 4.9 4.54

93.6 95.1 95.46

0

20

40

60

80

100

120

Provincial Level District Level Com m une Level

%

Wom enMen

Chart 6. Women and Men in People’s Comm ittees as a proportion of the Total 1999-2004 Tenure


allocated to female-headed households due tothe absence of the husband, lack of labor forceand loose regulation on the labor age. As aresult, total farmland for female-headed farmsis, on average, only 54% that of male-headedfarms. The low number of women working onland administration also poses a problem forwomen as predominantly male landadministrators are, reportedly, not gendersensitive when dealing with documents andcases relating to land issues7.

Gender Based Domestic Violence

In Viet Nam, domestic violence is generallyconsidered as a private issue the outside worldshould not interfere in. Moreover, several smallstudies indicate that it seems to be acceptablein most families and communities as long as

7 Newpaper “Great Unity” – No. 54, 8 July 2003

the woman is not severely hurt. The conceptof violence is restricted to serious body violationcases and followed by criminal cases (RaFH2001). Only very serious and systematic abuseof women, which severely damages thehusband-wife relationship, is considered to beviolent. In many cases it is the woman who isdeemed responsible for the violence as it isconsidered as a sign that she has failed tofulfill her duties as a wife and failed to maintainfamily harmony. Although a comprehensivenational study so far has not been conductedin Viet Nam, analysis of several small-scalestudies suggest that gender-based violencemay be very common in both urban and ruralareas, and within families of all income levels(UN 2002a).

Although domestic violence is traditionallyrooted in unequal gender relations and genderstereotypes, studies from Viet Nam indicatethat economic hardship and alcohol abuse arecontributing factors. Other major factors includeissues of sexuality (eg, adultery, jealousy, andsexual incompatibility) and differing opinionsin child rearing and relations with friends andrelatives. A study from the Women’s Union(2001) indicated that there is initial evidenceshowing a relationship between domesticviolence and the changing role of women inthe transition to a market oriented economy.Domestic violence tended to increase in caseswhere women had a strong economic positionwithin the family, and where husbands felt thattheir traditional role was being jeopardized.

II. Provincial and social disparities

Although major gender equality indicatorsincluded in the MDG/VDG framework presentbalanced progress across the country,substantial provincial disparities still persist inmany critical areas for the full development ofVietnamese women. Data on femalerepresentatives in the National Assembly byprovince shows that only six provinces havereached gender parity in representation; onaverage, in the remaining 55 provinces, only

0

20

40

60

80 W om en M en

Chart 7. Share of Loans, by sex of borrower and source of loan, as a proportion of the total, 97-98

Source : Statis tics on W omen and M e n in Viet Nam , NCFAW, 2002

one in four NA representatives per province isa woman.

In spite of the country achieving near genderbalance in access to primary education, LaoCai, Ha Giang, Son La and Lai Chau stillreported in 2002 female literacy rates lower than70%. The Northwest region also reportedaverage rates of girls to boys in secondaryeducation well below the national average.


III. Framework for Further Progress

Cross-cutting challenges to gender

The persistence of traditional beliefs, attitudesand stereotypes about the role of women andmen in Viet Nam, and the lack of a nationallevel mechanism to collect sex-disaggregateddata and other gender-specific information ina comprehensive, systematic manner arecritical cross sectoral challenges to betterunderstanding and further progress on genderequality in Viet Nam.

In spite of a strong national policy frameworkfor gender equality, local implementation ofpolicies and decisions has been weak. Inaddition, implementation responsibilities areoften assigned to women-focused bodies suchas the Viet Nam Women’s Union or theNational Committee for the Advancement ofWomen instead of other overall national policymaking bodies, constraining the extent towhich gender analysis and implementation isintegrated into mainstream national institutionsand public policy processes. The legal statusof the Viet Nam Women’s Union (VWU) hasrecently been enhanced with a newGovernment Decree (No. 19/2003/ND-CP,March 2003) stipulating that Governmentadministrative agencies at its various levels areresponsible for ensuring the participation of the

VWU at its various levels in state management.Specifically, Government authorities mustconsult women’s unions of the same levelsconcerning matters relating to the rights andinterests of women and children, and alsoassure their participation in state managementof these matters. This provides for a usefulsafeguard system, but more needs to be doneto ensure that gender issues are integrallyconsidered within government agencies and aslaws and policies are being implemented. TheGender Equality Law currently beingconsidered by the National Assembly proposesto ensure greater accountability on the part ofgovernment agencies to mainstream genderequity into formal government administrativesystems

To provide follow up and supportimplementation of the National Strategy for theAdvancement of Women and the National Planof Action by 2005, each province andmunicipality is required to develop andimplement a local Plan of Action (PoA). Thusfar, 42 of 44 ministries and sectors havecompleted developing their PoAs, and 59 of 61provinces have completed their PoAs.8 Thus

8 Activities for the Preliminary Report of the NCFAW,Viet Nam, First 6 months, 8 July 2003.

Table 8. Share of Female National Assembly Deputies per Province,2002-2007

Top 12Provinces

Phu Tho

Tra Vinh

An Giang

Cao Bang

Long An

Tuyen Quang

Tien Giang

Quang Ngai

Son La

Ben Tre

Ba Ria –Vung Tau

Bac Ninh

Numberof

femaledeputies/numberof total

deputies

5/8

4/7

5/10

3/6

4/8

3/6

4/9

3/7

3/7

3/8

2/6

2/6

Share ofwomen

63%

57%

50%

50%

50%

50%

44%

43%

43%

38%

33%

33%

Bottom 12Provinces

Ha Giang

Lai Chau

Lang Son

Quang Tri

Yen Bai

Binh Thuan

Quang Ninh

Soc Trang

Khanh Hoa

Thua Thien–Hue

Hai Duong

Ninh Binh

Numberof

femaledeputies/numberof total

deputies

1/6

1/6

1/6

1/6

1/6

1/7

1/7

1/7

1/8

1/8

1/9

0/6

Share ofwomen

17%

17%

17%

17%

17%

14%

14%

14%

13%

13%

11%

0%

Source: National Assembly Deputies 2002-2007, Office of the National Assembly,2002


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provinces and ministries have made goodprogress in developing their PoAs. However,preliminary findings from a number of provincialmonitoring missions undertaken by NCFAWshow that while there has been some progresstowards reaching education and health targets,provinces and ministries were having difficultyreaching PoA targets in labor, job creation andstate affairs. Ensuring that adequate budgetswere allocated to implement local PoAs wasalso problematic.

Most importantly, sex-disaggregated data arenot collected in a systematic or comprehensivemanner in Viet Nam. In particular, it issignificant that data on human poverty isdisaggregated only to the household level (i.e.female-headed and male-headed households)rather than to the individual level. In a movetowards collecting and documenting better datarelated to gender equality, the GeneralStatistics Office (GSO) is in the process ofdeveloping CEDAW9 indicators, to be appliedroutinely to data collection. Indicators for thesectors of population, labor, education, healthand leadership, are the first to have genderindicators in Viet Nam (NCFAW 2002).

Education

The new Education for All Action Plan placesspecial emphasis on providing equal accessfor girls to affordable and quality formaleducation services. Moreover, with the EFA planViet Nam aims to ensure all adults, andespecially women, have access to qualityliteracy and post-literacy programmes10, andto affordable and quality life skills programmesand lifelong learning opportunities.

Education policies, incentives and supportprograms that positively favor girls, such asacademic scholarships for girls, arerecommended in order to correct the prevailingcultural bias against girls. Such programsshould encourage families to keep their girlsin school and help lower girls’ drop out rates,

particularly in upper secondary school. It is alsonecessary to undertake concrete action toensure appropriate school facilities and toimprove the learning environment for both girlsand boys, including the development of gender-sensitive curricula, textbooks, educationadministration and teacher training which donot reinforce gender stereotypes.

Political Representation

A variety of Government Decisions anddocuments set targets to support more equalparticipation of men and women in electedbodies, government administration and thepolitical system overall. The 2002 PrimeMinister’s Decision 19/2002/QD-TTgspecifically calls for 50% women leaders instate agencies and other organizations at alllevels by 2010. The VDG of increasing women’sparticipation by 3-5% annually over the next10 years may thus have to be revised toaccelerate women’s participation, in line withthe Prime Minister’s Decision.

Access to Land

In addition to the Law on Family and Marriage(2000), which stipulates that LUCs for commonland must list the names of both husband andwife, as of May 2003 the Government requirescouples living together as husband and wifewithout a marriage certificate, to apply for oneby 31 December 2004 and to register. Themandatory marriage certificates are intendedto protect the property rights of women andchildren in the occurrence of a separation fromor the death of the male partner.

To date, women’s names do not appear, onaverage, on 97.7% of existing Land UseCertificates and a formal program for reissuingLUCs has not been developed or implemented.The central Government may need to considerissuing specific implementation guidelines/regulations and instructions to local officials atthe provincial, municipal and loweradministrative levels so that they can be legallyempowered to implement the Family andMarriage Law such that both the names of bothhusband and wife are listed on LUCs.

The responsibility of ensuring that both spousesare listed on LUCs should be placed on localpublic officials so that officials are heldaccountable for implementing this law within ashort, time-bound period of time. A system tomonitor the re-issue of LUCs is also necessary.Justice and land administration officials should

9 Convention on the Elimination of DiscriminationAgainst Women (CEDAW)

10 Within the context of the United Nations LiteracyDecade, MOET recently launched a National LiteracyPlan to undertake further work on universalizationof literacy among adults and young people. The Planwill focus on providing literacy and post literacyprogrammes relevant and appropriate to the needsof women, and in particular target ethic minoritywomen through community-based programmes incooperation with the Viet Nam Women’s Union.


receive training on women’s rights and courtofficials should also be held accountable forthe fair judgments and interpretation of the lawin cases of inheritance, widowhood, divorce,and separation. In addition, as legal resourcesfor poor women are not readily available, anexpansion of legal aid programs to supportwomen, particularly poor ethnic minoritywomen, to redress legal grievances is stronglyrecommended.

At the same time, it will be necessary to raisewomen’s awareness at the community leveland explain in simple legal terms the reasonsand need for reissuing LUCs according to theFamily and Marriage Law, as a means forprotecting women’s land use rights andincreasing women’s access to formal credit.This will provide women with both theknowledge and incentive to initiate this processlocally. Such information should be translatedinto different ethnic minority languages asnecessary, so that women in thesecommunities are also reached.

Domestic Violence

The legal framework on domestic violenceremains weak in Viet Nam and improvementswithin the legislative area are urgently needed.The Criminal Code (1999) and the Law onMarriage and Family (2000), included tougherpenalties against perpetrators and provisionsfor more protection to women and children.However, there seem to be a need to formulateand pass a specific law and regulations ondomestic violence. Specifically, it is necessaryto ensure that all forms of violence againstwomen and girls constitute crimes, including

the criminalization of marital rape and harsherpenalties for child sex abuse and domesticviolence. Victims also need to be provided withprotection, redress and counseling services atthe local level.

Mass organizations and social groups couldplay important roles in preventing domesticviolence. At the provincial level, and in mostdistricts, the Women’s Unions are a significantsource of support services for women seekinghelp in cases of domestic violence. However,current resources and capacity of local levelwomen’s unions and social groups, particularlyin providing legal support and counseling areneither systematically available nor sufficientfor addressing existing needs, especially forpoor women. In each province, there are LegalAid Departments working under the Ministryof Justice which provide general legal supportto aid the poor. However, it does not have aspecific focus on services for women. In apositive step, provincial Women’s Unions haverecently signed an agreement with the provincialDepartments of Justice to jointly conducttraining on legal awareness on divorce andreconciliation and laws.

Among the most urgent priorities in this areawould be conducting a national or larger scalesurvey to obtain accurate statistics ondomestic violence and gain a deeperunderstanding of domestic violence in theVietnamese context. The survey could serveas the basis for a comprehensive policyframework to prevent and address domesticviolence in the country. Until now, only smallscale, usually qualitative studies have beenconducted on the subject.


MDG 4 - Reduce Child Mortality


While official data would suggest consistentimprovements to child mortality rates since theearly 1990s, the apparent magnitude ofunrecorded child mortality in Viet Nam wouldadvise caution in the assessment of levels ofinfant and under five mortality rates.

Available estimates place current InfantMortality rates at 30 deaths per 1000 births11

(UNICEF 2002a), down from an estimated 44.4per 1000 live births in 1990 (GSO 1995, Inter-census Demographic Survey). Under-5Mortality rates have followed similar patterns,having been reduced from a baseline level of58 deaths in 1990 to an estimated 38 deathsper 1000 live births in 2002 (UNICEF 2002a).Additional available data sources, including theViet Nam’s Demographic and Health Survey(VNDHS) 2003 and the VHLSS 2002, confirmdownward trends. However, as the VNDHS 2003states “such extraordinary low rates and rapiddecline should be viewed cautiously”12.

Underreporting is the biggest challenge

Improving the quality of mortality data in infantsand young children in Viet Nam is an urgentchallenge. Systematic under reporting of

11 As a reflection of data shortcomings in this area, other IMR estimates include 26 deaths per 1000 live births fromthe Population Dynamics and Family Planning Survey 2002, and 18 deaths per 1000 from the VHDS 2003.

12 In the VNDHS 2003, the confidence intervals for Infant Mortality Rates are in the range of 9-27 per 1000, quitesizeable for the current levels of the indicator.

deaths, stemming from the absence of aneffective vital registration system of births anddeaths; the lack of child and neonatal mortalitysurveys; and the consistent overlooking ofneonatal mortality issues in maternal mortalitystudies and other surveys are behind the dearthof quality data in the area.

An indication of the size of unrecorded childmortality can be drawn from available data onMaternal Mortality Rates (MMR). The MMRstudy carried out in 2002 resulted in estimatesfor MMR for Vietnam being readjusted from 90to 165 deaths per 100,000 births (MoH 2002b).According to the study, 25.6% of children diedafter the death of their mothers, which wouldsuggest a review of IMR estimates in light ofnew information available. Nearly three quartersof the infants who died were from mountainousareas, mainly from the provinces of Cao Bang,Dac Lac and Quang Tri.

Moreover, available data suggests some 68%of deaths under one year occur in the first monthof life (MoH 2001). However, the neonatalmortality rate, the indicator measuring childdeaths occurring in the first month after delivery,is not yet a national indicator. No national level

Chart 9. IMR as a percentage of U5MR

Source : P opulation Census 1999

10

90

70

50

30

0

R ed River Delta

N orth East

N orth W est

N orth C en tral C

oast

South C entral C

oast

Central High lands

S ou th E as t

Mekong D elta

7967 65

78 80

6677 73

Chart 8. IMR and U5M R (deaths per 1000 live births)

44.4

30 25

58.1

38

32

010

20

3040

50

60

70

1990 2002 2010

IMRU5MR

Source : G SO (1995), UN ICEF (2002 ), G oV (2002)

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G ia L a i


studies have been undertaken in this area,resulting in poor and incomplete data.

Importantly, data from the Viet Nam NationalHealth Survey 2001-2002 (MoH 2003b)estimates that less than half of children under5 years of age dying received any medical careprior to death. Since routine reports on nationalmortality data for the under 5 come from healthfacilities, it is therefore likely, in light of thisdata, that the number of deaths occurring insome provinces significantly higher than thelevels reported.

13 National Institute of Hygiene and Epidemiology 2002


Provincial disparities in infant mortality ratesare clearly illustrated in the data from the 1999Population Census, still the most reliablesource of provincial level data on IMR. Averagerates of around 60 deaths per 1000 live birthsfor the weakest 12 provinces in the countrycoexist with rates in the vicinity of 10 deathsper 1000 in the main urban centres of Ha Noiand HCMC.

The new VNDHS 2003, with a sample of some7000 households, confirms the markeddisparities observed in IMR across thecountries. Rural infant mortality rates are morethan double those in urban areas, and nosignificant gender disparities in IMR areobserved. Especially striking are the reporteddisparities in rates by the educational level ofthe mother. IMR are in the vicinity of 60 deathsper 1000 live births for those with mothers whohave never attended formal education, whereasnewborns from mothers having completed uppersecondary education are nearly 5 times lesslikely to die in their first year of age.

In addition, while IMR are generally higher forethnic minority groups than for the Kinh/Chinese majority, important disparities are alsoobserved among ethnic minorities, with the Gia-Rai reporting IMR of nearly 70 deaths per 1000live births or more than double the nationalaverage and more than three times higher thanthose of the Kinh. Among ethnic minoritygroups, the Khmer would report the lowestinfant mortality rates, followed by the Muong.

Although the coverage rates for immunisationprograms aimed at reducing childhoodmortality in Viet Nam are extremely high, thereare very significant disparities in coverage by

province and ethnic group. Whereas the toptwelve provinces in the country average DTP3immunization rates of nearly 94%, the weakesttwelve report rates of 57%, or 34 percentagepoints lower. The recent VNDHS surveyshowed that less than 45 % of children inNorthern uplands are protected against all 6vaccine preventable diseases compared with88% of those children from the Red River Delta(GSO 2003b).

Chart 10. IM R and U5MR by Educational Level

010

20

3040

50

60

70

N one S om e p rim ary

C om ple tedprim ary

C om ple tedlow er

secondary

C om ple tedh igher

secondary

58.6

66.2

24.5

35.7

17.9

26.7 26.9

33.3

13.219.0

IM R U 5M R

Source : VNDHS 2003

K inhTay

Tha i

Ch inese

Khm er

M uongN ung

H ’mong

Dao

K inhGia-Ra i

Othe rs

Source : P opulation Census 1999

The implementation of measles immunizationcampaigns over the last two years has allowedfor measles immunisation coverage of 96.7%13

of children under one year of age beingimmunized. Due to the high sensitivity ofmeasles coverage rates to the implementationof national campaigns, another commonsurrogate indicator of children immunization,DTP3 immunization rates, may be a moresensitive indicator than measles coverage,when measles campaigns are in place. Asreported in the National Health Survey 2003,DTP3 immunization rate for Viet Nam was 77%with provincial rates ranging from 43-100%.


III. Financing, decentralisation, and local governance issues

General access to health facilities hasimportantly increased in Viet Nam since 1998and, according to preliminary data from theVHLSS 2002, nearly 27% of householdsaccessed Government hospitals in the 12months prior to the survey, while 11.5% ofhouseholds accessed Commune HealthCentres. The latter figure increases to 18.5%when the situation of the poorest 20% ofhouseholds is analysed, an expected resultdue to the rural orientation of Communite HealthCentres, where most of the poor live.

The reasons provided for those not using thecommune health facilities were relatedoverwhelmingly to the perceived low quality ofthe services provided, including the capacityof health workers and medicines andequipment available, and the comparison withalternative public and private services. Only asmall share of respondents included the levelsize of service fees14.

Improving the quality of commune healthservices is a pro-poor strategy that would assistclosing the gap in access to and quality of basichealth services across provinces in Viet Nam.

14 A recent survey conducted by the Ministry of Healthinvolving 28 communes showed that some 26% ofpatients classified as poor had to discontinue medicaltreatment due to the high costs of its provision. Thesurvey also suggested some 36% of farmers inrural and remote areas need to borrow money whena family member required hospitalisation (Ministryof Health, Three Year review of the HungerEradication and Poverty Reduction and Job CreationProgram, October 2003).

Increased resources combined withdecentralization and improved local capacityin those provinces with the highest nationalinfant and under 5 mortality rates could resultin interventions reaching those children athighest risk of death.

The Integrated Management of ChildhoodIllness, for instance, is now implemented in 32Provinces of Viet Nam. The IMCI strategy isaimed at reducing under 5 mortality rates bytargeting the major killers of children (ARI,diarrhoea, measles, etc) using both preventativeand curative measures. The strategyemphasizes the training of health workers onassessing and treating sick children for theirprompt referral to doctors after giving life savingtreatment such as fluids and intravenousantibiotics. There is however low coverage insome provinces with only a few districtsimplementing the management procedures. Atthe commune level, only one health worker istrained per health station in districts where IMCIimplemented, which in occasions is not theone managing sick children. There is an urgentneed to increase the coverage of IMCI in areasof high under 5 mortality in Viet Nam.

IV. Policy Framework and Challenges for further progress

Viet Nam’s policy framework on Child Healthhad recently been enriched with the approvalof several new policies and the on-goingformulation of new regulations in the area.

Currently, a national neonatal health policydoes not exist in Viet Nam but newborn careis considered to be a part of safe motherhoodservices. A positive development in the areawas the naming, in April 2003, of the Directorof MCH-FP (now Reproductive healthDepartment) as coordinator for newborn care.A draft Directive on newborn care is currently

being reviewed and will include an instructionto report data on mortality, further defining rolesand responsibilities among Governmentagencies in the area. This directive recognizesthe significant national burden of neonatal andinfant mortality, due to, in many cases,preventable causes that have never beenaddressed in policy guidelines and training.

A new set of reproductive Health Standards andGuidelines was formally issued in September2002, containing important guidelines onnewborn care and breastfeeding. In addition,the National Master Plan on Safe Motherhood2003-2010 includes measures to improveantenatal care and recognition of obstetricemergencies, and safe clean delivery. Thenational targets include reducing newborn casefatality by 90% by 2010. Provinces with thehighest neonatal mortality rates and those withhigh home delivery rates with unskilledattendants should be prioritised in theimplementation of the plan if the targets are tobe met by the 2010 deadline.


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15 Victora et. al.1989, Infant feeding and deaths due todiarrhoea

Breast-feeding is an evidence based and costeffective method of reducing infant and childmortality. Infants aged 0-5 months who are notbreast-fed have seven-fold and five-fold risks ofdeath from diarrhoea and pneumoniarespectively compared with infants who areexclusively breast-fed.15 Viet Nam activelypromotes breast-feeding, and most mothersbreast-feed, for a period of time, albeit notexclusively. National surveillance data for 2002reports a rate of exclusive breast-feeding at 4months of only 25% (NIN 2003). By the age of4-6 months only 5 percent of infants areexclusively breast-fed.

National breast-feeding policy changed fromexclusive breast-feeding until 4 months toexclusive breastfeeding until 6 months of agein April 2002 in order to improve the nutritionaland health status of young infants and children.Abrupt cessation of breast-feeding and earlyintroduction of complementary foods in VietNam contributes to the high levels of stuntingand wasting seen in Viet Nam, which in turnsaffects mortality importantly.

Policy Priorities at the national level

If Viet Nam is to adequately progress towardsachievement of the MDG/VDGs on IMR andU5MR, it needs to address the growingpercentage of mortality in the under 5’soccurring in the first year and first month oflife, focussing child survival interventions onpopulations at risk. Improving the availability ofquality data via the implementation of anefficient vital registration system that makesbirths and deaths registration a legalrequirement ranks high among the policy

priorities in the sector. Quality mortalitysurveillance must include neonatal mortalitydata to monitor progress towards MDGs andto focus activities

The government has recently updated civilregistration regulations, but coverage of birthregistrations is still difficult to estimate. It ishigh in some areas (70-90%) and low or non-existent in others, with many children beingregistered late. UNICEF (2002b) has shown avariation in districts of children under 16 yearsnot registered at birth from 4.2 to 91%. Theoverall rate of children not registered aged 0-5years was 24.4%.

In addition, financial resources available for thiscritical challenge are still inadequate. The areaof child health has been under resourced andin recent years increasingly donor dependant,and sustaining improvements to national rateswhile emphasizing assistance to vulnerablegroups will require scaling up interventions withadditional finance and by increasing thecapacity and skills of health workers inProvinces with high mortality rates. Recently,however, the Ministry of Health has declarednewborn care a priority, and for the first timethe Government has committed one third of theWHO child health budget to this area.

The required coordination at all levels foreffective progress in the area of child health isfurther hindered by the fact that there iscurrently no department of child health orcoordinator of child health activities within theMinistry of Health. All activities are spreadacross departments and Institutes.


Box 5. Child Mortality: Anecdotal Evidence of Underreporting and Low Local Capacity

In a random sample of 12 communes in Lai Chau, Women’s Union volunteers asked VillageHealth Workers and Hamlet Health Volunteers of any deaths that they had heard about in childrenunder 5 years during the previous year. Seven deaths were reported and recorded at the communehealth station and 26 not reported. All unreported deaths were in children under one year of agewith 65% under one month of age.

An educated woman from Hanoi gave birth to a healthy baby boy in a reputable hospital in HaNoi. She did not immediately register the birth as she thought that it could be done at a later date.At around four weeks of age her son became seriously sick and died 4 days later. She did notregister the death as the birth had not been registered earlier. The child was buried in a cemetery,where no death certificate was requested.

A four year old was admitted to a national centre of excellence with a diagnosis of encephalitis.She deteriorated rapidly and three days later had a cardiopulmonary arrest. The child was senthome as the doctors felt that no further intervention was possible. She immediately died onhome arrival, and as it is common with deaths occurring outside health centres, it was notregistered. The hospital records only recorded “very serious” as the outcome.

At a recent training course in newborn care and resuscitation in a Mekong Delta Region Provincefor obstetricians and paediatricians from the Provincial and District hospitals, only 2 of the 30participants had ever had any formal training on newborn care. The provincial hospital had nonewborn or paediatric bag and mask and none of the staff were able to resuscitate an asphyxiatedinfant or to manage an infant with respiratory complications.

Source: WHO (2003)


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“The maternal mortality and neonatal mortality in Viet Nam are to date still considered as anestimate, for its inaccuracy and unreliability. The morbidity conditions of Vietnamese women ingeneral and of pregnant women and mothers in particular are almost unknown to all-includingthemselves and their families.”

MoH, National Master Plan on Safe Motherhood 2003-2010


Table 9. Indicators for Maternal Health

Indicators Baseline(1990)

Current(2002)

Targetby 2015

Maternal mortality ratio (MMR)

Routine monitoring

Survey

Proportion of births attended by skilled personnel

Routine monitoring

Survey

200

249 (MOH/UNICEF)

NA

165 (MOH)

50

62

78.5%

NA

94%

85%(2002 VDHS)

On the basis of the MoH’s routine monitoringsystem16, Maternal Mortality Rates (MMR) inViet Nam in the baseline year of 1990 wereestimated to be 200 deaths per 100,000 livebirths, although alternative data sources fromthe Ministry of Health would have placed it at249 per 100,000 live births (MoH/UNICEF1990). Recent research on maternal mortalityfrom a study conducted in seven provinces bythe MoH and WHO, estimated maternalmortality rates to be 165/100,000 live births in2002 (MOH, 2002b). Available data wouldtherefore suggest progress, althoughsubstantial, has been slower than expectedand previously reported. On the basis of thisnew data, Viet Nam might be well on track toreduce MMR by three quarters of the 1990 levelby 2015 (MDG target), effectively bringing ratesto some 62 deaths per 100,000 live births.However, it will be more difficult for the countryto reach the VDG target of 80 deaths/100,000live births by 2005 and 70 by 2010.

Estimates from the Viet Nam Demographic andHealth Survey (GSO 2003b) would place theproportion of births attended by skilled healthpersonnel at 85%. The VDHS definition ofskilled health personnel only includes medicaldoctors, and trained nurses and midwives assuch. In comparison, data from the MOHsurveillance system includes as skilledpersonnel not only trained physicians, assistantdoctors, and nurses/midwives, but alsotraditional birth attendants (TBAs) who havereceived government training.

In Viet Nam, the majority (76%) of maternaldeaths are caused by direct causes such ashaemorrhage, pre-eclampsia (hypertension),infection, and complications of abortion,ruptured uterus, and rupture of ectopicpregnancies. Indirect causes account for 24%of maternal deaths, especially obstetrical heartdisease and malaria (MOH, 2002b). Otherfactors that play in maternal deaths aremalnutrition of the mother, poor hygiene,difficulties in accessing health facilities, andinsufficient knowledge about women’sreproductive health and lack of essential drugsand instruments.

16 Routine data is collected from commune health centers and reported to the Department of Planning at theMinistry of Health

MDG 5 - Improve Maternal Health



As in most countries, the reasons for maternalmortality in Viet Nam can be contained in the“three delays framework”, namely i) delay inseeking care; ii) delay in reaching the healthfacility; and iii) delay in receiving appropriatecare after arriving at the health facility. Theincidence and causes of maternal death in VietNam vary greatly across provinces. As indicatedin Table 10, the maternal mortality ratio rangesfrom 411 per 100,000 live births in Cao Bang, anorthern mountainous province, to 45 in BinhDuong in the southeast, nearly ten times lower.

In addition, the lifetime risk of maternal health17

in Viet Nam ranges from 1 in 1176 to 1 in 101,a level considered being high-risk byinternational standards.

While differences between urban and ruralareas have decreased in the past 5 years, stillonly three-fourths of rural children are delivered

Table 10: Maternal Mortality and Lifetime Risk by Province

Province

Cao Bang

Quang Ngai

Dak Lak

Quang Tri

Kien Giang

Ha Tay

Binh Duong

Maternalmortality ratio

(/100 000 livebirths)

411

199

178

162

143

46

45

Maternalmortality rate

(/100 000 womenage 15-49)

19.8

17.6

20.0

6.9

5.8

3.5

2.9

Maternalmortality life-

time risk(one in…)

101

201

148

220

332

1086

1176

Source: MoH (2002b)

Box 6. Working through traditional birth attendants at the local level

The Viet Nam-Australia Primary Health Care for Women and Children project (VAPHC) is being implemented in fivedistricts in Gia Lai and Quang Ngai provinces to provide training to traditional birth attendants (TBAs) (VAPHC, 2003).TBAs form in a unique category, outside of the official health care system, yet continuing to be the source of assistancefor 8-11% of all deliveries (MOH, 2003), especially in remote and mountainous areas.

In the 5 districts where the VAPHC is active, the average distance from households to commune health stations isquite sizeable. As a result, over 90% of women in these areas give birth at home. Lack of financial means and/ortransport to go to health facilities are commonly cited as the main causes for not seeking health care at the communecenters. Women prefer to be at home, where their husbands are available to help, and where there is someone tolook after the other children and the house. They are, in general, shy, afraid of death occurring at the health facility, andafraid of injections.

Social beliefs favour the TBAs in these areas as the primary birth caregiver. However, the project found that “TBAs donot usually wash their hands before giving any help, the umbilical cord is cut by bamboo and tied with homespunthread or normal sewing thread, and the cord is not covered.”

The project took as its basis the CEMMA-UNICEF ‘Three Cleans for Delivery’ training methodology, which has beenapproved by MOH and used in many provinces. The training curricula and materials were reviewed by all stakeholders,and modifications made to adapt it to the local needs.

Basic training received by the TBAs included how to use the clean delivery kits correctly, wash hands properly beforeattending delivery, care for cord properly, basic management of common infant emergency cases (including birthasphyxia and newborn resuscitation), and the identification and referral of basic high-risk pregnancy and emergencycases. Emphasis was also given to the provision of proper counselling for pregnant women.

In spite of important advances in upgrading the skills of TBAs, some of the challenges for further work include theirunclear and unsupported role as providers of health care. They lack supervision, are often poorly linked with thelocal health care system, and rarely receive refresher training. The normalization of their status within the healthsystem would represent an important step ahead.

Source: VAPHC (2003)

17 Risk of a woman dying from pregnancy or childbirthduring her lifetime.

at a health facility compared to almost allchildren in urban areas. In urban areas, theskilled provider is primarily a medical doctor(92.3%), whereas in rural areas there is agreater reliance on midwives (41.4%),


traditional birth attendants (TBAs) (6.3%), andrelatives (11.4%).

Although the official recommendation is thateach woman should have at least five antenatalchecks (MoH 2003c) many women do notattend antenatal care at all, or on feweroccasions. Recent data confirms that womenfrom mountainous and remote areas are athigher risk of death during pregnancy or birthdelivery due to a variety of reasons. Asubstantial proportion of women inmountainous areas received no antenatal care

during pregnancy. As reported in the VDHS2003, some 23.2% of women in the NorthernUplands, and 27.2% of women in the CentralHighlands received no antenatal care, ascompared to only 2.3% of women in the RedRiver Delta region.

In addition, less than half of births in theNorthern Uplands (43.7%) and 63.6% of birthsin Central Highlands take place at a healthfacility, in comparison to 98.7% in the Red RiverDelta, and 96% in the Southeast. Over a third(37.3%) of births in the Northern Uplands areassisted by a relative, and only 56% by a doctoror trained nurse/midwife, compared to lowlandareas where almost 100% are delivered bytrained providers (GSO 2003b).

As suggested by the data from the NationalHealth survey 2003, while less than 1% ofwomen delivering at home in the top twelveprovinces did so without trained technicalassistance, the average rate for the weakestquintile of provinces is close to 60%.

Some disparities are specific to women andcouples from minority ethnic groups. More than80% of women from ethnic minorities deliver athome, compared to less than 30% of the Kinhpopulation (UNDP & FAO 2002). Over 40% ofethnic minority women do not have skilledassistance when they give birth (WHO 2003).Against this background, very few information,education, and communication (IEC) materialsare available in ethnic minority languages(MOH, 2003).


Based on data from the Safe Motherhood fieldassessment, most commune health centres,the first level of health service in rural areas,are poorly prepared for the provision of maternalhealth services, whether antenatal visits,deliveries, or receiving obstetric and newbornemergencies (MOH 2003a).

The Safe Motherhood field assessment (MoH2003a) also revealed that 50% of communehealth centres are not working full time asregulated, and that 36% of commune levelfacilities have multiple supply stock-outs everyyear. In addition, it was found that 86% of districtand provincial hospitals do not have sufficientequipment and personnel to manage obstetricscomplications. As a result, only 68% of district

Table 11. Women Delivering at Home Without Trained Medical Assistance

Province

Ha Noi

Ha Tay

Hai Duong

Da Nang

Vinh Long

Ho Chi Minh City

Tien Giang

Nam Dinh

Hai Phong

Ha Nam

Vinh Phuc

Binh Duong

Proportion ofwomen givingbirth at homewithout helpfrom skilled

birth attedants

0

0

0

0

0

0.42

0.67

0.68

1.39

1.49

2.02

2.25

Province

Ninh Thuan

Phu Yen

Hoa Binh

Lang Son

Kon Tum

Bac Can

Lao Cai

Son La

Gia Lai

Cao Bang

Ha Giang

Lai Chau

Proportion ofwomen givingbirth at homewithout helpfrom skilled

birth attedants

35.82

38.83

42.83

46.19

52.54

54.06

59.60

62.66

63.30

71.02

76.34

86.28

Source: MoH (2003b)

hospitals are currently providing comprehensiveobstetrics care, and more than 30% ofReproductive Health centres are not able tomanage complications of abortion (MOH2003a). Essential bookkeeping, such as birthand death records, are only available at about50% of all commune health centres.

Traditional rural dependence on midwives is notcorresponded by their technical skills (MOH2003a). It is estimated midwives incorrectlydiagnosed around 25% of obstetriccomplications and improperly managed around30%. About 8-11% of deliveries are assistedby TBAs. However, most TBAs (75%) did notknow the danger signs of pregnancy and 26%did not use clean delivery kits.


Box 7. Functioning at minimum capacity

Poor quality of services at the local level is influenced by weaknesses in infrastructure andmanagement. An assessment of local capacities in seven provinces of Viet Nam found thatfacilities in the provinces surveyed had important gaps in basic equipment and essential drugs.While basic equipment such as thermometers, regular stethoscopes and disposable gloveswere available, obstetrical forceps were missing from a third of provincial hospitals and two-thirds of district level hospitals, and incubators for the newborn from two-thirds of provincial anddistrict level hospitals. Capacity of management was found to be good, with quarterly supervisoryvisits to check records, and sometimes to discuss how to improve services. However, almosthalf of the facilities said that feedback from higher-level authorities on reports was insufficient.

With the increased decentralisation of health services, new energy needs to be directed towardthe improvement of the quality of maternal health services. Only part of the resources can comefrom user fees (currently fees range from 5,000 VND for antenatal services at commune facilitiesup to 11,500 VND at provincial level facilities). The rest has to come from the leadership of thematernal health care managers and the initiative of providers who wish to provide high qualityservices.

Source: Population Council (2000)


Significant progress in the strengthening of thepolicy framework for maternal health has beenachieved in the past two years. The firstNational Strategy for Reproductive Health wasapproved in 2000, providing strategic directionfor safe motherhood and newborn care activitiesduring 2001-2010 and indicating strongcommitment from the Government to improvingmaternal and child health.

The Government approved the first NationalStandards and Guidelines on ReproductiveHealth Care Services in 2002, includingprotocols for maternal health and newborn care.The first effort at establishing unified technicalstandards for the entire country drew onexpertise from a variety of national andinternational organisations, and established abasis against which to measure quality of care.

The Government also adopted in 2002 a unifiedHealth Management Information System(HMIS). Simple and standardised formsreplaced the numerous reporting forms fromvertical targeted programs, with a long-termplan for a networked computer database at thedistrict and provincial levels.

Finally, in 2002, the Ministry of Healthdeveloped the Safe Motherhood Master Planto improve the quality of essential obstetriccare, to enhance the Safe Motherhoodactivities, and to improve mother and neonatal

health in order to reduce maternal and childmortality. It identified crucial issues through aprogram review and field assessment, andoutlined interventions for different regions of thecountry.

Recognising complications

The sustained high percentage of home birthsin rural areas and especially among ethnicgroups demands the improvement ofcommunity knowledge on the risks ofpregnancies. Pregnancy-related managementneeds to be changed to emphasise that allpregnant women are at risk. As most womencurrently receive antenatal visits at least once,it is clear that the opportunity to providecounselling on danger signs is not being fullytaken advantage of. While pregnancies aretaking place at home, it is also critical thatpregnant women and couples identify meansof transportation for emergencies.

The recognition of complications in the homeand transportation to appropriate facilities canbe improved not only through training of healthproviders, but also working with communes toincrease awareness of the risks of pregnancy,and make adequate preparations for birth.Commune-level interventions are notnecessarily costly, but require a significantinvestment of human resources and non-standard approaches relevant to the local


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Ha NoiHa TayHai DuongDa NangVinh LongHo Chi M inh CityTien GiangNam DinhHai PhongHa NamVinh PhucBinh DuongBa Ria Vung TauThai BinhBen TreHung YenCan ThoBac N inhLong AnDong ThapSoc TrangAn GiangDong N aiHa TinhQuang NamTay NinhNinh BinhThua Thien HueKien GiangKhanh HoaPhu ThoThai NguyenTuyen QuangBac LieuBac GiangQuang NinhBinh PhuocNghe AnCa MauBinh DinhQuang BinhQuang NgaiBinh ThuanQuang TriTra VinhDac LacThanh HoaYen BaiLam DongNinh ThuanPhu YenHoa BinhLang SonKon TumBac C anLao CaiSon LaGia LaiCao BangHa GiangLai C hau

0.98360.98360.98360.98360.98360.96720.95080.93440.91800.90160.88520.86890.85250.83610.81970.80330.78690.77050.75410.73770.72130.70490.68850.67210.65570.63930.62300.60660.59020.57380.55740.54100.52460.50820.49180.47540.45900.44260.42620.40980.39340.37700.36070.34430.32790.31150.29510.27870.26230.24590.22950.21310.19670.18030.16390.14750.13110.11480.09840.08200.0656

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context, including knowledge of culturaltraditions among the different ethnic minoritiesand ability to provide information andcounselling in their language.

Treating complications

Direct causes currently contribute 76% of VietNam’s maternal deaths. To reduce deaths fromthese complications, it is essential to improvethe availability and quality of basic andcomprehensive emergency obstetric care.

One of the primary needs for steady reductionsto MMR is to increase the availability of skilledproviders in mountainous and remote areas.Providers must have recent and appropriateskills-based, on the job training on how to treatobstetric and newborn complications. Skilledattendance would also require ongoingsupervision of health workers to maintain high-quality practices.

The current lack of equipment and supplies andbasic infrastructure, such as clean water andtelephones, must be addressed. The challengewould include not only allocating enough fundsfor such improvements, but also ensuring thelogistical supply and maintenance plans arein place. Improved management of healthsystems, including regular supportivesupervision and active problem-solving isnecessary for the development of qualityservices and for attracting clients to all levelsof service, not only district and provincialfacilities.

Addressing high abortion rates

Abortion complications represent some 11.5%of all maternal deaths. Viet Nam’s abortionrate remains one of the highest in the world.Abortions are more common in rural areas,where a woman is calculated to have 0.65pregnancy terminations during her lifetime18

(compared to 0.49 in urban areas) (GSO

2003b). In urban areas, abortions are mostcommon among 25-29 year olds, and in ruralareas, among 30-34 year olds (GSO 2003b).

The VDHS 2003 found that about half of thewomen who terminated their pregnancy had acomplication following the termination.Although specific abortion-related causes ofmaternal deaths are difficult to establish, theoverall quality of abortion care raises concerns.Secondly, increased attention needs to be paidto the decontamination of equipment andinstruments, especially at more peripheralfacilities. These practices could be readilyimproved with appropriate training andsupervision, and do not require additionalexpensive or difficult-to-obtain equipment orsolutions (WHO, 1999)

Improved reporting systems

Obtaining data on maternal mortality continuesto be a challenge. Results from the MCH-FP2002 survey would suggest the routinemonitoring system systematically underreportsmaternal deaths. For example, in the study of7 provinces, the routine reporting systemcaptured on average only 22% of the maternaldeaths found by the survey (MOH, 2002b).

An improved reporting system for maternalmortality, especially from the commune level,is critical if interventions are to be appliedstrategically and impact measured.Consideration should also be given to improvingthe Vital Registration System, including makingit free of charge, which would facilitate theregistration of births and deaths. While thecurrent HMIS is a step in the right direction,additional efforts must be made to develop afunctioning strategy to collect information fromthe commune level about births not taking placeat health facilities. A method for collecting andreporting data on maternal deaths due toabortion or abortion complications should bedeveloped.

18 Reflecting data shortage in this area, routine MOHsurveil lance for 2002 indicates that 46% ofpregnancies are terminated.


Box 8. Recording of Maternal Death in Viet Nam: Looking behind the statistics

A study by Save the Children US, examined the quality of actual data on MMR (Bramley, 2001).Importantly, it was found people are largely unaware of any legal obligations to officially report adeath. They are also constrained by the lack of funds for purchasing a death certificate andpossible loss of the land belonging to the deceased.

“Regarding death declaration, in some cases, after we went to the local Justice Department to buya death declaration form, we came to the family where the relative had just died to ask them todeclare the death. They said they would not do it as after the death of their family member, theyhad no inclination to do it and it would cost them money for the form fee. ‘Who will reimburse us thecharges we pay for the forms?’ That is really a problem. We report these difficulties so that you mayhelp us to solve the problems related to birth and death declaration.” Policeman, Quang Xuongdistrict

“…Having death certificates is better because it ensures people’s benefits. However, having apoor life, the matter of death is not important to the people here. To comply with laws, deathnotifications are not required. But because getting a death certificate costs 10.000 dong [sometimesless], being poor, people don’t want to have it. Therefore local authorities should consider asolution to encourage people to declare. For example, death certificates can be issued freely.”Village head, Quang Xuong district

Moreover, the study also reported confusion on the number and use of official registers at lowerlevels of administration. Village level information gatherers are not able to identify maternalmortalities due to lack of training, and do not possess standardised tools to collect such informationand forward it to health facilities. Often reporting is done orally, dependent on the memory of theperson. Staff was often unable to correctly fill out records and systematically collect data accordingto standardised indicators, and there was no systematic cross-checking of information by police,People’s Committees, and commune health centres.

Source: Save the Children US (2001)


MDG 6 Combat HIV/AIDS, Malariaand Other Diseases


HIV/AIDS

The official estimate of HIV prevalence amongadult men and women aged 15-49 years old inViet Nam was 0.28% by the end of 2002. As of30th September 2003, a cumulative total of72,240 people had been reported as HIVpositive, 11,020 people were diagnosed withfull-blown AIDS, and 6,195 AIDS patients haddied. The Ministry of Health has estimated thatby the end of 2002 there were 160,000 HIVinfections cumulatively and projected that bythe end of 2005, 197,000 people would be livingwith HIV in the country.

As illustrated in Chart 12 the cumulative totalof reported cases of HIV is continuing toincrease, and to follow a classic epidemic curve.HIV cases have been reported from all 61provinces in Viet Nam. Under-reporting of HIV,however, is a continuing problem, as most ofthose infected do not refer to health servicesuntil well into the disease. The vast majority ofreported cases are from urban areas, and thereseem to be indications of large underreporting,and mis-diagnosis from rural areas.

It is clear that in Viet Nam HIV infection israpidly being transmitted among Injecting DrugUsers (IDUs), through sharing needles andsyringe. Chart 13 shows that among of 72,240HIV reported cases by 30th September, 2003,nearly 60% of them were IDUs. Currently, theproportion of reported HIV cases due to sexualtransmission is low. However, as in other Asiancountries, the number of these cases isincreasing, and it is expected that sexualtransmission will become the dominant modeof HIV transmission in Viet Nam in the comingyears.

HIV surveillance is undertaken yearly amongfemale Sex Workers and IDUs in “05” and “06”rehabilitation centers. Based on thissurveillance system, Chart 15 shows that theHIV prevalence rate among IDUs increased from

Chart 14. Trends in HIV Prevalence

The trends in HIV prevalence among IDUs and SWs: 1994-2002

3 1.3 12 9 .3 5

2 3 .9

2 0 .4 5

16 .6 213 .3 5

10 .8 914 .8 9

17 .2 8

0 .6 0 .8 5 0 .73 1.4 6 2 .4 4 3 .77 3 .53 5.24 .6 5

0

5

10

15

20

25

30

35

19 9 4 19 9 5 19 9 6 19 9 7 19 9 8 19 9 9 2 0 0 0 2 0 0 1 2 0 0 2

(%) ID U s

S Ws

Source: Ministry of Health, October 2003

18% in 1996 to 31.31% in 2002. The trendamong SWs rose from 0.6% in 1994 to 5.2%in 2002. Substantial provincial differences inprevalence rates for SWs and IDUs areobserved.

80,000

60,000

40,000

20,000

0

72,2

40

19901991

19921993

19941995

19961997

19981999

20002001

2002

Sep t, 2003

57,7

80

48,2

79

34,0

51

22,8

50

14,4

33

8,65

1

5,77

1

3,99

2

2,54

0

1,17

1

1211

C um m ulativ e cases

Chart 12. Cumulative R eported H IV Infections

Source : M in is try o f Hea lth , O ctober 2 003

Chart 13. Reported HIV Cases

Reported HIV Cases by Risk Groups by September 2003

IDUs57.23%

STIs1.80%

Blood donor0.67%

TB patients 4.46%

Army conscripts1.51%

Others 31.25%

SWs3.08%


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Box 9. Risk Behaviour Patterns

Careful analysis of risk behaviour is critical to understand the potential risk for HIV transmissionin Viet Nam. This includes understanding the behavioural links between IDUs and SWs; forexample, what percentage of female sex workers also inject drugs, and what percentage of IDUsalso go to sex workers. A recent HIV risk assessment survey in 7 provinces (Thanh Hoa, Nghe An,Binh Phuoc, Ha Tinh, Binh Duong, Long An and Soc Trang) found that among 2.000 sex workersincluding street based (SSWs) and karaoke based sex workers (KSWs), the percentage of condomuse with regular clients in the last 12 months was low, 43-61% and 16-70% in KSWs and inSSWs, respectively. A high percentage of SSWs also used and injected drugs (23.8% in Nghe An).Among SSWs injecting drugs, about half to three fourths of SSWs shared needles and syringes inthe last month. The percentage of IDUs who had sex with SWs in the last 12 months ranged from18.2% in Thanh Hoa to 59.4% in Ha Tinh; while only 28.6% and 60.5% (respectively) reportedconsistent condom use with SWs. More than half of IDUs correctly identified three ways of preventingHIV transmission (regular use of condoms, do not share needles and syringes, and faithfulness).

Source: National Committee for Population, Family and Children (2002)

Chart 15. HIV Infection among age group 15-24

Distribution of reported HIV infection by age 15-24 in Viet Nam: 1994-2002

39.842.441.1

42.436.434

10.6 13.417.5

010

2030

4050

1994 1995 1996 1997 1998 1999 2000 2001 2002


Among reported HIV cases, there is anoticeable trend towards a younger averageage. Just over 10% of reported cases wereamong young people aged 15-24 years in 1994.Five years later, just over 40% of all newlyreported HIV cases were found among this agegroup. Since 1999, around 40% of all reportedHIV cases are among young people,highlighting the continuing vulnerability of youthto HIV.

Young people aged 15-24 makes up some20% of total population and more than 70% ofthem are living in rural or suburban areas (GSO2001). A recent survey of HIV risk behaviourwas undertaken among unmarried youth aged15-24 in five mountainous and border provinces(Lai Chau, Quang Tri, An Giang, Dong Thapand Kien Giang). This study showed that only26.3% (24.2% of male and 32.2% of female) ofthem were able to answer correctly twoquestions related to prevention methods ofsexual transmission of HIV (faithfulness,condom use) and to reject majormisconceptions on HIV transmission

(mosquito bites, having meals with HIV infectedpeople). Only half of young men and a third ofyoung women (52.7% male and 33.3% female)used a condom in their last sexual intercoursewith non-regular sexual partners.

Among the most worrisome trends in HIVinfection is the evidence that the epidemic isalso beginning to spread to the generalpopulation. Nationally, HIV prevalence amongpregnant women attending antenatal clinicsincreased more than 10 fold in the past sevenyears, from 0.03% in 1995 to 0.39% in 2002.However, HIV sentinel surveillance data fromfive urban areas shows that the HIV prevalencerate reaches up to 1% among pregnant womenattending antenatal services in An Giang andHai Phong.

Tuberculosis

WHO estimates that there are 140,000 newcases of TB in Viet Nam each year. In 1995the Government of Viet Nam declared TBcontrol a national priority, and since 1996 theNational Tuberculosis Programme (NTP) hasdetected approximately 80% of the casesoccurring each year. Full DOTS (DirectlyObserved Treatment Short Course) coveragewas reached in 1998.

Between 1993 and 2000, the NTP treated294,712 new infectious cases of TB with theWHO recommended short-course treatmentregimen. The NTP achieved the second WHOtarget of curing 85% of new cases from thestart of the program. In total 92% of cases weresuccessfully treated.


Sentinel surveillance data shows that HIVprevalence in tuberculosis (TB) patients hasincreased from 0.57% in 1995 to 3.03% in 2002for the whole of Viet Nam (Chart 16). Howeverin selected provinces the prevalence is between5 and 15%. Though the data is biased byoverrepresentation of hospitalised TB patients,there is still a clear increase in all provinces. Agreat challenge to TB control will be to findand treat new TB cases among HIV positivepersons as early as possible. A secondchallenge is to provide preventive therapy withIsoniazid to HIV positive people who areinfected with TB, but have not yet developedthe disease. The National TuberculosisProgram (NTP) is actively seeking collaborationwith the AIDS program to achieve this.

The increasing numbers of HIV infections, andtheir subsequent infection with TB, poses amajor threat to the efforts of the NTP todecrease transmission of TB in the community.HIV-positive people infected with TB have a 60%lifetime risk of developing TB disease. Thiscompares with 10% in HIV-negative individuals.Chart 16 shows that the number of reportedHIV-positive TB cases has increased ten-foldsince 1995.

Chart 16. HIV + TB Cases

121

264341

622

817

1000

0100200300400500600700800900

1000

HIV

+TB

cas

es

'95 96 97 98 99 2000

Source: Ministry of Health, April 2003

Malaria

Early efforts in the area of malaria included theGovernment of Viet Nam’s implementation ofthe “malaria eradication strategy” from 1958 to1975 in the North and the expansion of itsactivities to the whole country after reunificationin 1975. However, during the period of 1980 toearly 1990, malaria control was given lowpriority and hundreds of malaria outbreaksoccurred. Millions of malaria cases andthousands of deaths due to malaria wererecorded yearly. To reverse this situation, in1991 the MOH included malaria control as oneof the target objectives of the National HealthProgram.

Between 1991 and 2000, the malaria controlprogram also developed and implemented astrategy with interventions at the district levelto sustain the achievements. For example,impregnated bed nets were supplied free ofcost to all target households, target areasreceived regular indoor spraying and anti-malaria drugs were provided free of charge.These steps helped the program reach andsurpass the WHO/WPRO objectives foreffective malaria control.

However, significant challenges remain forsuccessful malaria control. A significantproportion of the country is in the malariaendemic area. This includes 75.6% of alldistricts, 64.7% of all communes; and 72.6%of all villages. Nearly 40% of all communesare in high and moderate malaria risk areas,with a population of about 15 million people.

People in the central highlands area are atespecially high risk for malaria, which includessignificant numbers of ethnic minoritypopulations. In 2000, the malaria morbidity inthe central highland region was 5 times higherthan the average morbidity of the whole country.The malaria mortality was 10 times higher thanthe average of the whole country.

II. Provincial Disparities

Bordering provinces, large urban and industrialcenters and tourist areas continue to reportlarger rates of HIV prevalence. Whereas the12 least affected provinces reported an averageof 10 HIV cases per 100,000 people, the worseaffected provinces reported an average of 200cases per 100,000 people. Quang Ninh, withsome 572 cases, Hai Phong, HCMC, and Baria Vung Tau ranked bottom, with the central

provinces of Quang Binh, Quang Tri, and QuangNgai ranking as those with the lowestprevalence rates.

Southern Provinces on the Mekong, Southeast,and South Central Coast regions reported thehighest rates on TB case detection. An averageof 177 TB cases detected was reported by the12 most affected provinces, with An Giang


Top 12 Provinces Malaria morbidity per100,000 people

Bottom 12 Provinces Malaria morbidity per100,000 people

An Giang

Ha Noi

Can Tho

Ho Chi Minh City

Dong Thap

Long An

Tien Giang

Ben Tre

Ha Tay

Thai Binh

Vinh Long

Da Nang

1.22

1.71

2.98

4.71

7.22

9.11

10.16

17.57

18.20

24.30

25.07

26.18

Quang Binh

Lao Cai

Ha Giang

Ca Mau

Cao Bang

Quang Tri

Dac Lac

Binh Phuoc

Bac Can

Gia Lai

Kon Tum

Lai Chau

670.41

695.28

701.11

733.76

758.98

897.01

955.20

1194.77

1227.51

1317.58

1400.00

1724.30

Source: MoH (2003)

Top 12 Provinces TB cases detected per100,000 people

(2002)

Bottom 12 Provinces TB cases detected per100,000 people

(2002)

Bac Can

Lao Cai

Son La

Ha Giang

Lam Dong

Tuyen Quang

Dac Lac

Lai Chau

Gia Lai

Hoa Binh

Vinh Phuc

Ha Tay

31.09

32.13

36.33

39.20

39.27

44.24

45.49

48.17

51.48

61.33

62.79

69.03

Tra Vinh

Soc Trang

Binh Dinh

Long An

Ninh Thuan

Can Tho

Kien Giang

Dong Thap

Da Nang

Tay Ninh

Ho Chi Minh City

An Giang

139.89

149.13

150.88

154.08

157.94

161.73

166.87

186.46

189.92

195.69

196.70

279.83

Source: National Hospital of TB (2003)

Table 12. Provincial Disparities in HIV/AIDS prevalence, TB, and Malaria

Top 12 Provinces Number of HIV case/100,000 people

(July 03)

Bottom 12 Provinces Number of HIV case/100,000 people

(July 03)

Quang Binh

Quang Tri

Quang Ngai

Ha Giang

Vinh Phuc

Phu Yen

Ha Tinh

Quang Nam

Ca Mau

Thua Thien Hue

Tuyen Quang

Phu Tho

4.27

4.56

5.21

9.64

11.00

11.07

12.67

12.73

12.73

14.64

15.78

16.35

Thai Nguyen

Dong Nai

Binh Duong

Khanh Hoa

Cao Bang

Lang Son

Ha Noi

An Giang

Ba Ria Vung Tau

Ho Chi Minh City

Hai Phong

Quang Ninh

91.27

92.24

94.75

101.51

127.79

150.62

175.40

184.27

229.10

248.05

331.96

572.56

Source: UNAIDS (2003)


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III. Policy Framework and Challenges at the Local Level

HIV/AIDS

The HIV/AIDS epidemic in Viet Nam isspreading rapidly. Forty to 120 Vietnamese aregetting infected every day. The epidemic isevolving into dual and overlapping epidemics,with transmission through both injecting druguse and unprotected sex. This complexepidemic requires a comprehensive policy andprogramme response.

The government is increasingly recognizing theneed to address HIV/AIDS. A directive issuedby the Prime Minister in February 2003emphasized the need for a comprehensive andmultisectoral approach to HIV/AIDS. A HIV/AIDS National Strategy for 2004-2010, with avision to 2020 is being finalized. And theCommunity of Concerned Partners was formedin 2002 as a coalition of stakeholders in VietNam concerned with the growing threat HIV/AIDS poses to the people of Viet Nam and tothe nation’s development, and the achievementof the Millennium Development Goals.

This expanding epidemic needs anextraordinary response from the leadership andpeople of Viet Nam. To be effective, thisresponse must involve all sectors of the county,and be undertaken at all levels. The first priorityis to engage the Party, National Assembly andthe Government in leading and promoting thenational response to the epidemic.

Interventions with drug users, sex workers andtheir male clients must be undertaken on alarge scale, if the number of HIV infections isto be reduced. HIV/AIDS is largely an epidemicamong young people, and they need to beprovided with the information, skills and to

services to protect themselves from infection.There is also a need to strengthen theinvolvement of communities in HIV prevention,care and support, including care for orphanedand vulnerable children. Urgent action is neededto prevent stigma and discrimination againstpeople living with HIV/AIDS, and to promotetheir involvement in HIV/AIDS activities.

Tuberculosis

The NTP has made considerable achievementsover the past decade, but efforts must be takento maintain and institutionalize TB control inViet Nam. In particular, The Ministry of Health,with the support of the National TuberculosisProgramme should develop the next mediumterm development plan for the period 2006-2010, including a strategy for resourcemobilization. There is a need to ensure longterm and adequate financing of the NTPactivities. Expected costs over the next fiveyears amount to US $ 35 million, including US$9 million for drugs.

In the technical area, there is a need to discussand agree on the introduction of new nationaltreatment guidelines which should include FDCregimens for community DOT. Importantly, theexisting good drug management practices ofthe NTP should be continued, including batchtesting of drugs from international and domesticsuppliers. There is also a need for improvedtraining and monitoring of treatment providedby the private sector. Regulations should beestablished prohibiting the sale of 1st and 2ndline drugs in the private sector, to limit thedevelopment of resistance to these crucialdrugs.

Table 13. The success of the Viet Nam Malaria Control Programme, 1991 to 2002

Indicators

Malaria cases

Morbidity/1.000 people

Malaria deaths

Mortality/100.000 people

Outbreaks

Malaria endemic communesin 31 provinces

1991

1,091,251

16.5

4,646

7.3

144

2.167

2002

185,500

2.8

50

0.078

0

709

Reduction(%)1991 - 2002

83

83

98

98

100

67

Source: National Program on Malaria Control, National Institute of Malariology,Parasitology, and Entomology Annual Reviews

(280), HCMC, and Tay Ninh ranking last. Thiscompares with an average of 46 cases of TBdetected among the 12 better-off provinces,where the Northern Uplands provinces rankedamong the least affected.


At the district and provincial level, TB controlactivities should be integrated into a largerprogramme for the control of communicablediseases, developed under the leadership ofthe Ministry of Health. A coordinationmechanism should be established to bringtogether all stakeholders, and to ensurelinkages between programmes (e.g. TB andHIV).

Malaria

Important challenges remain in malaria controlin Viet Nam, including the risk of malariaresurgence. Due to internal migration, largernumbers of people are moving into malariaendemic areas, potentially exposing morepeople to malaria. Migrants may take thedisease back to their communities as importedcases, causing transmission and outbreaks.Annually, thousands of people migrate to thecentral highlands and southern provinces foremployment. Reports indicate that migrationto the highly malaria endemic areas included880,000 people in 2000 and 2.2 million migrantpeople in 2001.

Climatic change and man-made actions areexpanding malaria endemic areas. Climaticand environmental changes such as drought,floods or man-made actions such as expandingthe brackish water shrimp cultivation areas,construction of hydro-electronic plants,irrigation projects, road building in the malariaareas and forestation etc. are the main causesof malaria increase and malaria outbreakswhere good surveillance and appropriate controlmeasures are lacking.

People’s self protection against malaria in thehighly endemic and remote areas is limited: Ahigh proportion of population (20-40% of malariapatients in the malaria endemic areas,especially in the southern provinces) buy anti-malarial drugs from the private sector for selftreatment. According to a survey in Tra Mi ofQuang Nam province (8/2001) only 16% of thepopulation used bed nets regularly, the rate of

born bed nets was 73.9%. In Huong Hoa, QuangTri province, only 30% of the people used bednets regularly.

There is a need to strengthen the village andcommune health network in malaria control,particularly in mountainous and remote areas.At present, some 62% of Village HealthWorkers are operative, with only 38.68%trained in malaria control. The mobile team inthe mountainous district is lacking of personnel,means of transportation, and budget forsurveillance and supervision activities. Someprovinces in malaria highly endemic areas stilllack provincial malaria control centers, andneeded personnel, equipment and workingfacilities.

There is a lack of stable funding for malariacontrol. The budget from government andprovinces for malaria control has been reducedin the last few years despite the expandingthreat of malaria, and on occasion, availablemonies provided by the national malaria controlprogramme are used for other activities. Theserious risk of malaria resurgence is still notyet fully understood or accepted by some localauthorities

Policy priorities in this sector would includemaintaining sufficient resources for malariacontrol, for which continued internationalcooperation would be required. Viet Nam needsto improve malaria epidemiological surveillance,case management, and interventions formigrant populations, in particular byestablishing commune microscopic points.

The successful model of civilian-militarycooperation to improve the effectiveness ofmalaria control in remote and border areasneeds to be strengthened, while theintensification of Information and EducationCommunication activities with special attentionto high risk groups are required. Improvecontents and training methodology at all levels,particularly for VHWs and private sectoractivities in malaria control.


Box 10. HIV prevention among Injecting Drugs Users

Sharing needles is a very common practice among the Vietnamese injecting drug users, andremains the major cause of HIV transmission in the country. In response to the fast increase inHIV/AIDS cases observed in the northern provinces of the country, the United Nations InternationalDrug Control Programme (UNODC) in Viet Nam launched in 1997 an innovative initiative toimprove HIV prevention and reduce drug-related harm among high-risk target groups.

As the first initiative of its kind ever executed in Viet Nam, the project aroused much controversy,as many people consider harm reduction lenient and condoning of social evils, running counterto the conventional suppressive measures.

After intense negotiations, the Government of Viet Nam agreed to implement a series of thendaring initiatives in 11 wards of five northern cities and provinces, including Ha Noi, Hai Phong,Lang Son, Thai Nguyen, and Nghe An. Project implementation met with considerable difficulties.Some peer educators were arrested while distributing disposable syringes and condoms in thestreets and the paraphernalia that they carried around were used as obvious evidence for their‘social evil’ activities.

An outstanding feature of the initiative was the adoption of a ‘community-based’ approach toapplying the harm reduction model and providing a comprehensive package of interventionmeasures. Peer education was the major intervention activity carried out at the ward level, withthe direct supervision and participation of the community leaders. Training was provided to thepeer educators with particular focus on life skills in order to achieve behavior change amongdrug-injecting users. In addition, a network of volunteer drug users was also created through thepeer educator groups. The sustainability of the approach is demonstrated by the fact that morethan 50 per cent of the peer educators trained in the project are still working actively with thenational and international NGOs after the project is finished.

Empirical lessons learned in Viet Nam have shown that harm reduction can hardly succeed inthe absence of support from local authorities and law enforcement. Policy advocacy workshopsto create awareness among the law enforcement officers who would facilitate prevention activitiesin the community were indispensable.

Families of drug users and of HIV positive drug users were also encouraged to take care of theirchildren. At least within the project setting, drug users were no longer stigmatized anddiscriminated against, and opportunities were given to drug users, also those with HIV/AIDS, to

play a positive role in the community.

UNODC (2003) Strengthening National Capacity for Prevention of Drug Abuse and HIV/AIDS Among High-Risk Target Groups in Viet Nam (AD/VIE/97/B07)


MDG 7 – Ensuring Environmental Sustainability


Viet Nam is slowly mainstreaming theprinciples of sustainable development into thecountry’s policies and programmes. Rapideconomic growth, along with growingpopulation and substantial migration hasexerted over the last decades enormouspressures over the environmental quality andnatural resources of Viet Nam, makingenvironmental sustainability one of the greatestchallenges for the achievement of the MDGs.Moreover, Viet Nam is a country prone to naturaldisasters, particularly typhoons, floods anddrought. An average of more than 1 millionpeople need emergency relief each year dueto natural calamities. Many of these peopleare just above the poverty line, and the impactof a flood or typhoon often pushes them backinto poverty.

Forest Cover and Biological Diversity

Natural forest cover shrunk from 43 per cent oftotal land in 1950s to 27 percent in 1990, andthough the forest cover has increased to 35.8per cent in 200219, the overall quality of foresthas decreased due to natural forest destructionand loss of biodiversity associated with theintroduction of non-native flora species. Habitatloss has led to a rise in the number ofthreatened species over the last five years. Thenumber endangered species has increasedfrom 365 fauna species and 356 flora speciesin 2000 to 407 fauna species and 450 floraspecies in 2002.

In response to this threat, the government hasencouraged the development of the protectedareas system. The number and total surfaceof protected areas has increased from 95 areaswith 2,175,802 ha, accounting for 6.7% of totalland in 2001 to 121 areas with 2,478,293 ha,accounting for 7.54% of total land in 200320.

19 MARD Decision 2490/QD/BML-KL, 30 July 2003,publication of information on forest areas and forestland as of 2002.

20 Forest Protection Department, MARD (2003)

Chart 17. Forest Cover Recovering but Quality Weakened (percentage of total land)

43.0

33.832.1

30.127.8 28.2

33.235.8

20

25

30

35

40

45

1943 1976 1980 1985 1990 1995 2000 2002

Source: Prime Minister’s Office Decisions (severalyears), MARD (2001)

Water supply and sanitation

Although water is abundant in many parts ofViet Nam, supplies are not evenly distributedand are often polluted by poor environmentalconditions. Despite Government’s determinedaction and the growing involvement of donors,NGOs, and the private sector, still over half ofViet Nam’s rural population do not have accessto a safe water supply, while more than 70% ofthe population lack a hygienic sanitation facility.

Viet Nam has built up important capacity inwater management, developed in response towater shortages during dry season, a monsoonclimate that regularly causes extensive flooddamage, and to the need to intensify agriculturalproduction. Viet Nam is one of the mostdisaster-prone countries in the world: about70% of its population are exposed to the riskof typhoons and torrential rains in combinationwith strong winds and floods. On waterresources, approximately 60% originate fromcatchment in neighboring countries. It isestimated that the total water use is at 4.6billion cubic meters (bcm) a year, which isshared between Urban Water Supply (26%),Industrial Water Supply from private sources(60%) and Rural Water Supply (14%).

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Table 14. Environmental Indicators

Indicator

Percentage of the populationthat has long-term access tosafe water

Forest cover as a percentageof total country area

Percentage of water and airquality monitoring stationsshowing improvements overthe baseline

Source ofVerification

MARD – for RWSand MOC data

Annual forestcover government‘decision’

Annual NEA State ofEnvironment Report

1990

48%

27%

—

1995

—

28%

base-line

1999

53%

-

58%

LatestValue

56 %(2002)

35.8%(2002)

64%(2001)

Current Targets

2005

60% forRWS

38%

—

2010

85% forRWS

43%

—

2015

100% forRWS

—

—

In 2002, between 48-56% of the Vietnamesepopulation had access to safe water supply.This national figure, however, conceals theurban-rural disparities in the country. While78% of the urban households are using safewater supply, only 44% of the rural householdshave access to safe drinking water sources.From 1998 to 2000, Viet Nam increased overallaccess to safe water by 13 percent—anaverage of 4.6 percent per annum. This is oneof the fastest improvement rates in the world.Sri Lanka, Nepal and Paraguay were thecountries with the greatest increases in accessto safe water during the last decade accordingto UNICEF data, yet these countries averagedonly about 1.7 percent growth in coverageannually.

To meet the government’s goal of 85 percentoverall safe water coverage by 2010 and 100percent coverage by 2020, Viet Nam needs anaverage growth rate of 3.3 percent per year from2000 to 2010 and an average annual growth of1.5 percent from 2010 to 2020. Achieving thesegoals is possible provided the governmentmaintains access to safe water as a fundingpriority for the next 20 years.

Quality of air and water

In general terms, air in almost all cities andindustrial areas throughout Viet Nam isseverely polluted. The dust contamination is1.3 to 3 times exceeding permitted level insurrounding areas for factories, even 10 timesin some specific roads.

Water pollution has been observed in majorcities, including Hanoi, Ho Chi Minh City, HaiPhong, Da Nang, Hue, Nam Dinh, and HaiDuong. In Ha Noi and Ho Chi Minh City, most

waste water from households and industriesis not treated before discharging to the openchannels. Available data indicates some 90%of enterprises released waste water withoutmeeting the permitted levels to the environment.Around 73% of those companies did not haveadequate equipment and facilities for treatmentof wastewater21.

The trend on air and water quality was negativefrom 1996 through 1999, and then graduallyimproved in 2000 to 2002. This indicator hasstrong pro-poor implications, since the poorsuffer most from water and air pollution, andthey are the ones who often live in the marginalareas where pollution levels are highest.Moreover, they are the ones who can leastafford medical care for pollution-related ailmentsor the loss of livelihood due to illness causedby pollution.

21 Page 41, State of the Environmental Report, 2002.

Chart 18. Percentage of Water and Air-QualityMonitoring StationsReporting Better or WorseResults versus the 1995 Baseline Year

0 %

2 0 %

4 0 %

6 0 %

8 0 %

10 0 %

19 9 6 19 9 7 19 9 8 19 9 9 2 0 0 0 2 0 0 1

% R epor t i ng B et t er % R epor t i ng W or s e

Source: State of the Environment Report 2002


Important efforts in the enforcement ofenvironmental laws and regulations, andespecially the implementation of the PrimeMinister Decision No./24/2000/CT-TTg of 23November 2000 banning the use of lead petrolfor non-military vehicles starting 1 July 2001,

22 State of the environment report, VEPA, 2003, page32.

II. Provincial disparities

Access to water

The significant disparities in access to safewater at the provincial level are especiallyobvious when provincial rural areas arecompared. The provinces of BR - Vung Tau,Binh Duong, and Tra Vinh reported access ofover 70%. Meanwhile, provinces such as TayNinh (29%), Dong Thap (29%), or Bac Can(29%) reported rates almost three times lower.Looking at access by region, the Tay NguyenPlateau with Kon Tum, Gia Lai, Dak Lak andLam Dong have the lowest access (39 % overallagainst the 51% national average). The RedRiver delta, the North central region, as wellas East southern and Mekong Delta provincesaverage close to or above the national average.

In Viet Nam, the proportion of households withaccess to proper toilet facilities has increasedimportantly from over 10% of households in1993 to some 25% in 2002 (GSO 2003).However, most of the progress seems to haveconcentrated among the richest households,with 70% of them having access to hygieniclatrines, compared to only 2% of the poorestquintile of households. Disparities at theprovincial level, reflected in Table 16, are acute,with main urban centers reporting rates ofaccess to proper toilets of well over 85%whereas the Mekong Delta provinces of TraVinh and Dong Thap do not reach 10% of thehouseholds.

have combined for a considerably positiveimpact on air and water quality over the lastfew years. As a result of the Prime Minister’sdecision, the lead contamination in both HaNoi and Ho Chi Minh city has observed areduction of between 40 – 50%22.

Table 16. Access to Proper Sanitation facilities

Top 12provinces

Ho Chi Minh City

Da Nang

Ha Noi

Hai Duong

Quang Ninh

Bac Ninh

Hai Phong

Bac Giang

Ba Ria Vung Tau

Nam Dinh

Ha Tay

Hung Yen

Average

Having apropertoilet

87.13

85.91

85.63

85.25

78.9

78.52

75.68

71.94

65.5

63.18

62.33

62.29

75.2

Tien Giang

Ca Mau

Son La

An Giang

Kon Tum

Vinh Long

Lai Chau

Ha Giang

Ben Tre

Cao Bang

Dong Thap

Tra Vinh

Average

Having apropertoilet

18.83

16.61

16.53

15.69

15.33

13.33

13.28

12.38

11.92

10.13

9.29

7.45

13.4

Bottom 12provinces

Source: GSO (2003) Preliminary results from VHLSS2002

Table 15. Access to water in rural areas

��

Objectivecoverage (%)

Objectivecoverage (%)

RWS 2002 RWS 2002

plan

83

74

63

70

56

64

70

58

61

68

59

55

BR-Vung Tau

Binh Duong

Ha Noi

Ho Chi Minh City

Long An

Tien Giang

Tra Vinh

Thai Binh

Kien Giang

Hung Yen

Vinh Long

Soc Trang

Impl.

86

76

73

70

65

65

65

62

62

61

60

60

Bottom 12Provinces

Quang Ngai

Kon Tum

Lang Son

Bac Ninh

Bac Kan

Dak Lak

Yen Bai

Phu Yen

Gia Lai

An giang

Tay Ninh

Dong Thap

plan

36

43

38

40

29

45

40

38

37

34

29

29

Impl.

42

41

40

40

39

37

36

36

35

33

29

29

Source: National Objective Program, MARD 2003


operation yet, as these companies are notallowed to fix their own unit price.

The future promulgation of a decree23 enforcinga fee for the discharge of wastewater into theenvironment has the potential of being amilestone in the implementation of the user-pays principle in the generation of revenue forenvironmental policies. The fee will imposedifferent charges for domestic and industrialwastewater, the latter calculated in accordancewith the level of pollution. Significant challengeswill be faced, however, in the calculation of thefee in light of the important number ofenterprises to be charged and the variety oftheir wastewater. The private sector’s truecommitment to this initiative will be critical,especially if the still low monitoring capacity ofthe Ministry of Natural Resources andEnvironment is taken into account. The decreeprovides that water companies will be eligibleto collect no more than 10% of the revenuesand 20% will be allocated to the Ministry ofNatural Resources and Environment to coverthe cost of collection and testing waste water.Some 35% of revenues from the fee will beallocated to the local levels of administration,earmarked for environmental protectionactivities, which provides a good incentive forlocal levels of government in the successfulimplementation of the scheme. The remaining35% will be allocated to consolidated revenueat the State Treasury24.

23 Decree 67/2003/ND-CP24 Viet Nam Economic News, October 14, 2003


Forest Cover

The Government has promulgated a numberlaws and regulation in connection with forestprotection and reforestation, including the Lawon Forest Protection and Development (1991),and the Law on Environmental Protection(1993). Currently, a National Strategy forEnvironmental Protection 2010 and Vision 2020is being considered by the Prime Minister,while the Ministry for Natural Resources andEnvironment is importantly contributing to theamendment of the Land Law.

The Tropical Forestry Action Plan, and the FirstNational Forestry Policy all heralded a shiftaway from state-controlled Forestry. Under theHousehold Forest Programme, households are

III. Financing, Decentralization, and Local Governance

The Ministry of Planning and Investmentestimates that, given current waterconsumption levels and population projections,about US$147 million (VND2.2 trillion) ininvestment capital will be required for the sectorannually from 1999 to 2020.

In recent years, much of the financing for newwater infrastructure has come via loans orgrants from bilateral and multilateral donors.The 1998 Water Resources Law encouragesprivate sector investment in the water sector,but the greatest needs and imbalances arefound in rural areas where few economies ofscale are possible, and there is little potentialfor private sector water profits. Urban areas havebeen more successful in attracting privatesector water investment. At least one privatesector Build-Operate-Transfer (BOT) urbanwater supply project is now operational (BinhAn Water Treatment Plant for HCMC).

In spite of initial experiences in private provision,water supply in urban areas has so far beenmostly provided by SOEs. However, these watercompanies are in weak financial position andface important efficiency challenges. Theunder-pricing of services due to price regulationby government agencies at both central andlocal levels exerts pressure over the financialviability of the companies, forcing them to relyon government subsidies. There are some jointventure water plants in HCMC, but not put into

empowered with long-term use rights overforestlands, receiving technical extensionsupport by reformed state enterprises, andcredited by newly established rural bankingsystem.

Sustainable forest management in Viet Namwill require speeding up forest land re-allocation(both forested and open lands) to householdsand collectives, creating the adequate policyframework for the attraction of privateinvestment into midland forest, and providingsupport to forest farms to undertake the


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effective utilization of lands and forests thathave been re-allocated so far.

Water Supply

The 8th Party Congress resolution alreadyadvised on the need to “ improve urban watersupply and sewerage, and to supply more safewater to rural areas.” The Government Of VietNam adopted the Water Resources Law in 1998and the National Rural Clean Water Supply andSanitation Strategy up to year 2020 in 2000.

On 23rd July 2002, Prime Ministerial Decision99 was issued to establish the NationalStanding Committee on Rural Water Supply &Sanitation (RWSS) for the period, 2000-2005.The decision was administered to enable theformer National Target Program on RWSS(managed by MARD) and the National RWSSStrategy25 to be managed by the StandingCommittee for the National RWSS TargetProgram. The Committee comprisesrepresentatives from concerned Ministries andmass organizations under the chairmanship ofthe Minister of MARD. The current Director ofthe Centre for Rural Water Supply andSanitation (CERWASS), under MARD, wasnominated as the executive secretary of thestanding office, yet to be established. This is avery important decision regarding the futuremanagement of RWSS in Viet Nam, and theprompt definition of CERWASS exact roles andresponsibilities is an issue of criticalimportance.

A primary bottleneck in increasing access tosafe water in Viet Nam is the fact that around35% of the rural population get their water fromuntreated surface sources, whose quality ismore difficult to protect. As in many countries,Viet Nam uses surface water for irrigation anddisposal of wastes, as well as for drinking. Yetmany surface water sources are known to bepolluted. Boiling water to kill microbialcontaminates is the most common form ofsurface water treatment. This does not,however, eliminate many of the environmentalpollutants such as fertilizers and pesticides,which are a growing problem. To ensure safewater quality, more emphasis is needed oneliminating pollution sources (both domesticand industrial). The National EnvironmentAgency capacity in environmental pollutionregulation should be strengthened, and

improvements in monitoring and enforcementof existing water regulations—particularlyArticle 18 of the Water Resources Law—wouldhave a significant impact on surface waterquality.

Following the discovery of a large number ofarsenic contaminated tubewells in Bangladeshand given similar geological conditions betweenBangladesh and the Red River and MekongRiver Delta regions, MARD and other relatedministries have been encouraged to look intothe issue of arsenic in drinking water. MARD,sent official note No.755/TT.BNN-QLN, on 22/3/2002, to the Prime Minister, requestingestablishment of an inter-ministerial SteeringCommittee on Arsenic Contamination, with thePrime Minister’s Decision No. 333/CP-NN on“Arsenic Contamination of Water and RemedialActions”, issued on 4th April 2002 confirmingthe establishment of an inter-ministerial steeringcommittee under MARD, and the developmentof the National Action Plan. At present, theNational Action Plan is under consideration bythe Prime Minister.

Air quality

The Prime Minister’s Decision No.64/2003/QD-TTg, dated 22 April 2003, approving “the Planfor Settling Critical Polluting Resources” haspaved the way to deal with a number of heavypolluters, especially factories andestablishment located within cities and closeto inhabited areas. In addition, a NationalEnvironmental Fund has been establishedthrough the Prime Minister Decision No. 82/2002/QD-TTg, dated 26 June 2002 for which alegal framework is being developed by theMinistry of Natural Resources and Environment.The government has approved an initial seedfund of VN Dong 2 billion, while the fund isexpected to be replenished by application ofthe polluter-pay principles. This fund will helpboth State and private enterprises and NGOsto apply environmental friendly technology andenvironmental protection activities.

Additional efforts will be required in thepromulgation of regulation and criteria to ensureclean air in the cities and industrial areas,promotion of clean production, improving theefficiencies of energy util ization, andstrengthening the capacity and equippingadditional facilities for air monitoring system.

25 Approved by the Prime Minister, Decision No.104/2000/QD-Ttg, dated 25 August 2000


Box 11. Safe water vs. Clean water

“Safe water” and “safe water sources” are concepts somewhat different. Not all water samplesfrom so-called “Safe water sources” are safe. For example, tube wells/boreholes with pump istraditionally considered a safe water source, but past analysis reveals that only 8 of 10 wellsproduce safe water, hence an adjusted coefficient is used of 0.8. Given that 20.48 % of thepopulation in 2000 had access to tubewells/boreholes with pump, applying the adjustedcoefficient of 0.8, the percentage of the population having access to tubewell/borehole withpump would be around 16 %.

The National Rural Clean Water Supply and Sanitation Strategy up to Year 2020 notes that thedefinition of “safe water” is the same as “clean water”. This strategy defines “clean water” aswater that meets the 51 parameters in Ministry of Health Standard 505.


MDG 8 – Develop a Global Partnership for Development


“UNDP considers the MDGs as a global deal, based on the notion of joint responsibilityand mutual accountability. Slow progress in the crucial area of trade will eventually call intoquestion the seriousness with which developed nations are addressing the goal of buildinga global partnership for development…”

UNDP’s Statement at the Cancun Ministerial Conference of the WTO

At the Monterrey International Conference onFinancing for Development, donor anddeveloping countries translated into anagreement - the “Global Deal” – theunderstanding that the first seven MillenniumDevelopment Goals defined at the UNMillennium Summit would be the primaryresponsibility of developing countries, whilegoal 8 deals with the responsibility of OECDcountries to provide an “enabling internationalenvironment” for developing countries toachieve the first seven goals.

The United Nations is actively campaigning inOECD countries to increase awareness on theaccountability of developed countries towardsthe achievement of the MDGs. Moreover, NonGovernmental Organizations are starting to usethe Monterrey deal and the MDG framework todemand that their governments act on the ODA,debt and trade aspects of goal 8.

MDG 8, on develop a global partnership fordevelopment, needs to become, more than anyother, a living framework that is enrichedcontinuously by the cooperation betweendeveloped and developing countries. This wouldinvolve including relevant developmentindicators and targets currently missing in theframework and, most importantly, the definitionof concrete time-bound benchmarks especiallyin the areas of trade and finance fordevelopment, discussed at Doha andMonterrey.

OECD countries must contribute decisively tothe accountability of the MDG framework byboth embedding the internationally agreedtargets and indicators in their national planningframeworks and working hand in hand with theUN as a “scorekeeper” of progress towards theachievement of the MDGs. In addition,determined action by OECD countries in criticalareas of the international trade and financialsystem will be required.

Increasing Official Development Assistance

Despite substantial increases between 2001and 2002, global official developmentassistance represented only 0.22% of donorcountries’ gross national income in 2001, downconsiderably from 0.33% in the early 1990s(UNDP 2003d). The East Asian region, followingglobal trends, witnessed ODA decrease alsoimportantly during this period. In this framework,it is especially remarkable the continuousincrease in ODA commitments anddisbursements in Viet Nam over the lastdecade, from around US$250 million in 1993to well over US$1 billion annually since 1998.

-200400600800

1, 0001, 2001, 4001, 6001, 800

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002*

U S D mi l l i on

��

�Sour ce: UNDP ODA Sur vey

Chart 19. Annual ODA Disbursements (US$ Million) in Viet Nam

Source: UNDP (2002)

��

Q ua n g B i n h


Q ua n g N a m

K o n T u m

G ia L a i


Box 12. Measuring the Global Partnership: The Commitment to Development Index

The new Commitment to Development Index jointly drawn up by the Centre for Global Development and Foreign PolicyMagazine is an ambitious, but still crude first attempt to measure overall donor countries commitment to the developmentof a Global Partnership for Development as stated in goal 8 of the MDG framework.

By measuring donor countries’ performance in six development-related policy areas, the index importantly attempts tobroaden the debate on aid effectiveness from the traditional indicators of aid to GDP to a wider spectrum of policiesincluding trade, investment, migration, peacekeeping, and environmental policies. It suffers, however, from the commonproblems of designing a composite index, especially at the time of weighting the indicators included, the relativelyhigh complexity of its construction, including a bias against large economies, and the lack of adequate data tomeasure qualitative dimensions of development policies.

The index provides some surprising results mostly due to the equal weights allocated to all six policies areas.Importantly, the US and Japan are ranked at the bottom, scoring relatively high exclusively in the area of trade (in whichthe US is ranked top), while countries like Portugal and New Zealand, far from the aid levels of the most traditionallygenerous donors like Denmark or the Netherlands, rank among the top four.

These startling results should not, however, obscure the main message behind this first annual ranking. As theauthors say, “the most important result of the index, however, lies not on the relative rankings, but in the fact that eventhe top country is barely half way to a perfect score” (Birdsall and Roodman, 2003).

Of special importance for a country like Viet Nam is the ranking attempt to capture not only the quantity of aid disbursed,but also its underlying quality. Under the assumption that aid is more effective when is disbursed in a transparent andaccountable institutional framework, “higher scores are given to countries with good governance than to those wherethe need may be greater” (Birdsall and Roodman, 2003). The study also subtracts administrative costs, principal andinterest repayment and discounts tied aid by 20%.

UNDP (2003c)

Estimated ODA disbursements in 2002 werearound US$ 1.4 billion, up from US$1.36 billionin 2001, or some 4-5% of GDP. The proportionof ODA to basic social services in 2001 (definedas basic education, primary health care,nutrition, safe water and sanitation) stayed ataround 7.5% of total ODA disbursements, thesame level as in 2000. Disbursements in thearea of basic social services will have to beincreased substantially however, if the provincialdisparities in access to and quality of socialservices are to be bridged in the future. Therecently approved Education for All Planestimates that ODA disbursements for thestrategic target areas of the Plan will need tobe doubled to US$150 million by 2005 if thetargets are to be met.

Donor Harmonization

In February 2003, the heads of multilateral andbilateral development institutions expressed,in the Rome Declaration on Harmonization,their determination to effectively address theincreasing transaction costs derived from thevariety of donor requirements and processesfor the implementation and monitoring ofdevelopment projects, which are severely

taxing the capacity of recipient governmentsto administer efficiently ODA disbursements.

Ha Noi served as venue for the Asian regionalworkshop organized in preparation for the RomeForum. Viet Nam is a leading partner in thedevelopment community on harmonizationefforts, with three main initiatives deservingparticular mention.

The Harmonization of procedures among thethree main multilateral banks operating in VietNam (WB, ADB and JBIC) continued toprogress in 2003 with both the AgenceFrancaise de Developpement (AFD) and theKredittanstalt fur Wiederaufbau (KfW) joiningthe original members of the initiative. The groupheld a Joint Portfolio Performance Review onMay 2003 to discuss issues related toprocurement and disbursements plans andreporting systems, and defined an agenda forfuture progress.

The “Like-Minded” bilateral donors’ group is aleading voice in the harmonization debate inViet Nam. The group’s contribution to achievinggreater administrative efficiency in aid deliveryhas focused on supporting the Vietnamese


Table 17. Commitment to Development Index

Countries

Netherlands

Denmark

Portugal

New Zealand

Switzerland

Germany

Spain

Sweden

Austria

Norway

Britain

Belgium

Greece

France

Ireland

Italy

Finland

Canada

Australia

United States

Japan

Aid

6.9

9

2.2

1.7

3.3

2.1

2.4

7

2.8

6.6

3

3.5

1.5

3.1

2.6

1.4

3

1.7

1.7

0.8

1.2

Trade

7

6.8

6.9

7.2

4

6.8

6.8

6.9

6.8

1

6.9

6.7

6.7

6.8

6.6

7

6.8

6.6

7.2

7.7

4.6

Environment

5.7

5

5.1

3.4

7.2

6

6

6.1

5.4

2.8

5

4.5

4.6

4.9

1.6

5.3

5.4

1.7

1.8

1

4

Investment

6.1

1

9

2.3

6.3

1.4

8.2

1.8

2.6

3.5

3.4

1.4

0

1.7

2.3

1.5

1.7

2.1

1.6

2

2.8

Migration

4.5

4.4

1

9

9

8.1

1.8

3.9

6.5

4.6

3.1

4.5

1.6

0.8

4.5

1.1

1.3

6.1

3.7

2.3

1.5

Peace-Keeping

3.5

7.1

6.8

6.9

0.1

3.8

2.9

1.3

2.6

7.4

3.6

3.5

9

5.2

3.7

5.3

2.9

2.4

2.8

1.5

0.5

Average

5.6

5.5

5.2

5.1

5.0

4.7

4.7

4.5

4.4

4.3

4.2

4.0

3.9

3.8

3.6

3.6

3.5

3.4

3.2

2.6

2.4

Source: Center for Global Development and Foreign Policy Magazine (2003)

participation in the international harmonizationprocess – especially the OECD-DevelopmentAssistance Committee and EU initiatives,encouraging debate on new aid instruments inViet Nam and implementing concreteharmonization procedures on the basis of theCPRGS as a common framework for ODAplanning, implementation and monitoring. TheLike-Minded donor group is actively assistingthe Government on the development ofmanagement capacity for ODA management.

The United Nations system, as part of the UNSecretary General’s reform to strengthen theeffectiveness of UN agencies in host countries,is actively working on the simplification andharmonization of its rules and procedures inpriority areas including financial regulations,monitoring and reporting, shared services andrecruitment, remuneration and training ofproject personnel. In Viet Nam, importantprogress has already been achieved in thedefinition of a UN strategic programmeframework.

The increasing size of ODA disbursements andthe limited absorption capacity of theVietnamese administration to manage the hugevolume of resources according to a wide varietyof rules and procedures has placed the need

for harmonization among the priorities of thedonor community in Viet Nam. The rapidincrease of ODA resources without effectivedelivery mechanisms and appropriate nationalcapacity in place for their delivery to those inneed might be encouraging corrupt practicesthat would actually reduce the effectiveness ofODA importantly. Addressing this commonresponsibility will need strong nationalleadership, but also increased accountabilityof the donor community for the potentiallypervasive effects of uncontrolled aid increases.

Increasing Market Access for DevelopingCountries

“Trade has been an indispensable engine foreconomic growth across the world throughouthuman history. But while growth has in manyinstances been translated into sustainedpoverty reduction, the connection is notautomatic.” (Making Global Trade Work for thePeople, UNDP 2003)

The recent collapse of the WTO MinisterialConference in Cancun has raised doubts aboutthe real chances of implementation of a globaltrade regime that balances the interests ofdeveloped and developing countries alike.General failure at meeting the deadlines defined


at the Doha “development round” turned Cancuninto a different summit from the one initiallyenvisaged, increasing the pressures to reachagreement in critical areas like the reductionof agricultural subsidies and the considerationof investment issues.

Cancun has been an important opportunity lostto progress towards the achievement of theMDGs. No progress, for instance, was achievedin Cancun in ensuring tariff and quota freeaccess for exports from the Least DevelopedCountries, a target agreed at Heads of Statelevel in the Millennium Summit and ratified inDoha. Additional efforts are also required, viathe Integrated Framework for Trade-RelatedTechnical Assistance, to strengthen thecapacities of least developed countries for thedesign and implementation of trade relatedpolicies.

Moreover, the much-needed agreement in theagriculture sector was not negotiated since theConference was closed when it was perceivedno agreement could be reached in theinvestment area. Improving overall livingstandards of farmers, the central aim ofdeveloping countries’ requests for reducedagricultural subsidies and tariffs by developedcountries, is however key to sustain a globalreduction of poverty rates and to obtain steadyimprovements to many of the MDGs. It wouldbe indispensable for the future of the developingworld to ensure a quick resolution to stallednegotiations in this area.

The negative impact for developing countriesof high subsidies in this area has been oncemore exemplified in the cotton sector, whereincreased subsidies to US farmers havedamaged importantly the economic prospectsof several sub-Saharan countries.Consideration needs to be therefore given tofurther liberalization of the agricultural sectorof developed countries. Agricultural subsidiesfor OECD countries amount to more thanUS$300 billion per year (or six times higherthan global official development assistance)and a reform of the system could decisivelyimprove farming conditions and benefitconsumers in developing countries. The reformof the European Union’s Common AgriculturalPolicy is a first step in this direction, effectivelyde-linking financial assistance to farmers fromthe volume of production, thus discouragingover-production that damages the prospectsof developing countries’ farmers by bringingprices down.

On the other hand, Cancun has served to showthe bargaining power of collective action bydeveloping countries, a substantial change fromprevious Ministerial conferences, in which poorcountries were easily divided by their nationalinterests, and by powerful western economicblocks.

It is on the basis of this coordinated actionthat a trade agenda including the most relevantissues for developing economies would bemoved forward. Critical elements of such anagenda would include further negotiation of theGeneral Agreement on Trade in Services, sothat it importantly covers the area of movementof natural persons, including categories ofoccupations where developing countries havea comparative advantage. In addition,agreement on the Special and DifferentialTreatment Package26, critical to ease theburden on the implementation of critical tradereforms in developing countries would assistimportantly the creation of a multilateral tradingsystem more responsive to the realities facedby developing countries (UNDP 2003e).

The outcome of the Cancun Summit isespecially disappointing for Viet Nam, sinceagreement of some of the proposals presentedwould have eased considerably the country’snegotiating effort. Viet Nam’s access to WTOrepresents a great opportunity for the countryto spur internal competitiveness, developdomestic markets, access new technologiesand knowledge networks and, in sum allow forimportant improvements to human developmentvia enhanced economic growth.

The country’s exports have soared during the1990s to reach a value of over US$16 billion in2002 (or nearly 50% of GDP) with average

26 Special provisions in favour of developing countrieshave been included in the agreements which,together, constitute the WTO multilateral tradingsystem. These include provisions aimed atincreasing trade opportunities for developingcountries; provisions which require WTO Membersto safeguard the interests of developing countryMembers when adopting protective trade measures;provisions allowing flexibility to developing countriesin the use of economic and commercial policyinstruments; provisions granting longer transitionalperiods for the implementation by developingcountries of various commitments flowing fromthese agreements; and the provision of technicalassistance in the implementation of their commitmentsas well as in their efforts to reap full benefits fromthe results of the Uruguay Round. (WTO website,2003)


annual growth rates of around 19%. Over 50%of Vietnamese exports go to Asian countries,while European countries account for over 23%.Japan remains Viet Nam’s single largest exportmarket, representing around 15% of totalexports. Exports to the US market have howeverrocketed since the implementation of theUSBTA, and the United States has becomethe second most important destination forVietnamese products, accounting for just under15%. China and Singapore, each with over 9%,follow the US.

As negotiations for WTO accession proceed,the Government of Viet Nam must determinedlytake the necessary steps to ensure that thegains from increased trade flows translate intomore efficient social services and pro-pooreconomic growth that enlarge the choices ofall Vietnamese people.

Donor countries, in turn, have a greatresponsibility at developing a non-discriminatory trading system. This shouldinvolve careful analysis of the commitmentsand obligations requested to new entrants(usually higher than for original members) andtheir impact on the human developmentprocess of the acceding countries.

Although its application varies importantly bytrading partner, the Generalized System ofPreferences27 (GSP) provides importantopportunities for increased access ofVietnamese products to developed countries‘markets. Viet Nam has consistently increasedboth the total value of eligible exports and actualexports under preferential treatment to the EU,with preferential exports reaching well overUS$2 billion in 2001 (up from US$1.3 billion in1998). This represents a utilization rate ofeligible GSP exports of around 60%.

In spite of significant progress, recent tradeconflicts (e.g catfish) have exemplified the risksof operating outside the general WTOframework, and the capacity shortage of theVietnamese administration in critical tradeareas. Viet Nam needs to be able to accessthe dispute settlement mechanism operatingunder the WTO in order to effectively defendits interests, while continuously improving itstechnical capacity in areas like disputesettlement, quality and health standards, etc.

27 System through which high-income countries grantpreferential access to their markets to developingcountries.

Box 12 summarizes the evolution of the catfishtrade conflict.

Almost US$6.2 million were disbursed in 2001to directly assist the government of Viet Nambuild international trade capacity, up fromUS$4.4 million in 2000. The bulk of funds weredirected to support the formulation andimplementation of sectoral policies and plans,and on capacity building on global trade policiesand procedures.

Youth Employment

According to ILO estimates, 74 million youngpeople28 are unemployed in the world today;this represents about 41% of the world’s 180million unemployed people. In some countries,youth unemployment is two or three times thatof adults. The national economic challenge inmany developing countries is not limited to highunemployment rates among young people.What often does not show in statistics is themagnitude of underemployment among youngwomen and young men.29 Some work fewerhours than they would like and others work verylong hours with little return. Underemploymentis especially high among young people whowork in the large informal economy.

Viet Nam’s population has nearly reached the80 million mark, with a total work force of around40.7 million (MOLISA 2002). During the period1999 – 2010, an estimated 11 million new jobsare needed to meet the supply of new entrantsin the labour force30. Meaningful job creation,particularly for young people is, therefore, anurgent need. Young people engaged ineconomic activities currently account for some22% of the total work force.

Despite steady economic growth, formal jobcreation in Viet Nam has not been able to matchthe needs of the growing labour force.Unemployment rates appear to have risenmoderately between 1996 and 1999 with thegroup of youth aged 15-24 experiencing higherunemployment rates than older age cohorts.In 2002 youth unemployment was 4.3%(MOLISA 2003). However, the census data for

28 The UN definition of youth is people from 15 to 24.29 MOLISA defines as underemployed a person working

less than 300 days in the previous year and willingand able to take on additional work.

30 Viet Nam Workshop Report, Summary Report of theNational Workshop on Youth Employment, Ha Noi, 4December 2001


Box 13. Fishy Lessons

Catfish farming has been a traditional means of livelihood, small in scale and largely artisanal, for tens of thousandsof Vietnamese in the Mekong Delta for generations. Historically reared for domestic consumption, catfish were firstexported in the mid-80s, which in tandem with the country’s efforts at progressive liberalization, continued to growand find markets overseas. By the late 90s, the US had become a major market, earning farmers on average asizeable sum of US$ 50 million annually. Although these imports comprised a small fraction of the US market, localproducers (numbering less than 15,000) from the southern states like Mississippi and Arkansas, represented by theCatfish Farmers of America (CFA), protested that these imports were hurting their business.

First, the CFA financed a campaign to encourage consumers to buy American catfish only, portraying their cousin fishfrom the Mekong as unclean; a team of US investigators dismissed this slander after visiting the sites. Second, theCFA argued that the Vietnamese catfish were not catfish after all. It lobbied the US Congress to include language inthe 2002 Agriculture Appropriations Act that specifically barred Vietnamese exporters from labeling their fish ascatfish. Only catfish of the species Ictalurus Punctatus can accurately be labeled as catfish, the Act said, Vietnamesefish is of the family Pangasius. Although a dubious assertion in the face of a common reference in English as “catfish”to all the world’s 2500 species belonging to the order, catfish Siluriformes, the Vietnamese complied by renamingtheir fish “basa” or “tra” and dropping the suffix “catfish”. This change in name had little effect on sales — basa andtra stayed popular for their distinctive taste, that also owed their lean shape to the currents of the Mekong, asopposed to growth in stable ponds.

The CFA then resorted to the ultimate trade remedy by filing an antidumping complaint, arguing that the Vietnamesefish were being sold in US markets at unfair prices — below their cost of production, and at prices lower than athome. The Vietnamese maintained that their export prices were competitive because of geographic attributes of theMekong delta, low labor and feed costs, and accumulated traditional knowledge; and there were also no statesubsidies involved. They tried hard to defend their case along these lines, even employing at one point a law firm inWashington D.C. at the rate of US$ 469 per hour. The CFA had petitioned for the low prices to be redressed byslapping a dumping margin (tax) of 191 percent. This was also the first antidumping complaint against Viet Nam inits history.

Although many Vietnamese liken their country to a “market economy with socialist orientation”, the US went on tobrand it a non-market economy for the purpose of anti-dumping investigation, and used prices from surrogatemarkets (Bangladesh and India). On January 27, 2003, the US Department of Commerce announced a preliminarydetermination that imports of frozen basa and tra fish fillets were indeed being dumped, and that the margins againsttheir imports had to be levied in the range of 37.94 to 61.88 percent. Duties on catfish prior to this investigation wereunder 5 percent. These interim rates were more or less confirmed in July by the US International Trade Commission,which after being notified to the Department of Commerce became effective from August 6. Voluntary pledges byVietnamese exporters to restrain their export to agreed quota levels (to 90% of last year’s level in 2003, 95% in 2004,and 100% in 2005) in return for the rescinding of anti-dumping duties does not seem to have worked.

Viet Nam has since seriously tried to diversify its reach to markets in the EU, Japan, Australia and Russia, althoughthe stiff taxes charged by the US on their exports will affect livelihoods of thousands of Mekong farmers (the localindustry employs over 300,000). Recently, in August, they have teamed up with the German supermarket giant, MetroCash and Carry to aggressively market basa and tra globally.

Overall, the catfish dispute provides three broad lessons. First, it demonstrates the need for more stringent multilateralrules and special and differential treatment in the form of meaningful thresholds to protect developing countryexporters and new entrants to the global market from trade harassment by small protectionist interests. Second,although the central government — Ministry of Fisheries — actively collaborated with seafood processing andexporting companies to defend the national interest, huge capacity gaps were evident when it came to affairs ofinternational lobbying and legal defense. This necessitates further international assistance in technical trade mattersto the government. And third, this problem could have been addressed at the WTO if Viet Nam were a member. Thenon–market economy criteria used by the US was out of line with WTO provisions, together with the dumping andinjury findings, as well as the lack of scientific basis for the classification of catfish. These could have been challengedunder the WTO dispute settlement understanding. The WTO would also have been friendlier on issues of sanitaryregulations and use of subsidies for human development objectives in countries with per capita income of underUS$ 1000. This will probably nudge the country to pursue its accession process more vigorously, while seeking toavoid the kind of discriminating terms and provisions that are usually floated more boldly in bilateral agreements.

Source: UNDP Asia Trade Initiative research (2003)


1999 show 11.0 per cent unemployment for 15-19 year group and 6.6 per cent unemploymentfor the 20-24 year group.31 The census dataalso show higher rates of unemployment foryoung men than young women.

The data suggest that young people experiencedifficulties in the transition from school towork.32 Especially youth aged 15-19 faceproblems in finding the first job while their oldercounterparts might have adjusted to the labourmarket and gained some working experience.The economically active young people between15-19 also tend to be less educated on average,since they joined the labour force rather thanpursuing education and training.

Urban youth unemployment and rural youthunderemployment are increasingly pressingissues. The youth unemployment rate for urbanareas (16.1%) is on average eight times thatfor rural areas (2.1%) and almost four timesthat for Viet Nam as a whole (4.3%).

While unemployment is higher in urban areas,rural areas of Viet Nam account for 95% of allunderemployed workers. According to the 2002

31 1999 Population and housing census - Censusmonograph on labour force and employment in VietNam, 2002.

32 1999 Population and housing census - Censusmonograph on labour force and employment in VietNam, 2002.

33 MOLISA defines as underemployed a person workingless than 300 days in the previous year and willingand able to take on additional work.

Chart 20. Urban Unemployment Rates by Age and Sex

05

10152025

1996

1998

2000

2002

Years

%

Youth

Unem ploym ent

rates aged 15-24

Fem ale

Unem ploym ent

rates aged 15-24

Adult

unem ploym ent

rates for m en and

wom en aged 15+

Source: MOLISA (2003)

survey on Labour and Employment there arealmost 4.7 mill ion youth classified asunderemployed33. However, these data shouldbe treated with caution in light of the well-knownseasonal nature of agricultural employment.

Access to Information and CommunicationsTechnologies

Information and Communication Technology(ICT) has become an indispensable tool in thefight against poverty. ICT provides developingcountries with an unprecedented opportunityto meet vital development goals such as povertyreduction, basic healthcare, and primaryeducation, in an increasingly effectively way.Those countries that succeed in harnessingthe potential of ICT can look forward to greatlyexpanded economic growth, dramaticallyimproved human welfare and more effectiveforms of governance along with improveddelivery and access to public services.

Viet Nam Post and Telecommunications Corp.(VNPT) reported 695,703 new telephonesubscribers in the first 8 months of 2003, raisingthe total telephone users in Viet Nam to above6.1 million. Among the new subscribers, thereare 254,703 fixed telephones, 271,854 mobilephones in the Vinaphone network and 117,849mobile phones in the MobiFone network. Thisgives a rate of 78 telephones per 1000people, which compares still unfavourably withChina, but is well above neighbouring countrieslike Laos and Cambodia and is nearing thelevels of Thailand

Although important overall progress inincreasing access to ICT has been achievedover the last decade, the share of householdsowning basic ICT assets, such as TV or acomputer, varies importantly by region andexpenditure groups. While well over 90% of richhouseholds own a TV, only some 30% of thepoorest households do.

ICTs give the burgeoning domestic private sectorand also SOE in Viet Nam a tool to increaseefficiency and competitiveness as well as

Table 18. Access to ICT by Region

1993 1998 2002

Northern Mountains

Red River Delta

North Central

South Central Coast

Central Highlands

South East

Mekong Delta

Viet Nam

Radio

19.3

19.4

18.1

36.6

21.7

43.3

30

26.3

TV

8.7

25

5.5

27

6.7

41.6

28.9

23.1

Radio

36.8

34.6

31.8

47

43.1

56.6

53.4

42.8

TV

46.9

61.8

40.5

53

40.3

72.4

58.6

56.3

Radio

20.9

19.5

21.1

22.4

30

32

35.7

25.8

TV

60.1

73.1

61.7

68.1

61.6

81.4

68.2

69.1

Source: GSO: VLSS93, VLSS 98, VHLSS 2002


Table 19. Internet Penetration

Countries(and year ofestimate)

USA (2002)

Korea (2002)

Singapore (2002)

Taiwan (2002)

Malaysia (2002)

Thailand (2002)

Philippines (2002)

Indonesia (2000)

Viet Nam (2003)

Cambodia (2000)

Laos (2000)

Percent ofPopulation

53.00%

34.90%

30.20%

28.70%

9.00%

5.64%

2.50%

1.0—1.75%

2.50%

0.05%

0.04%

Source: National Institute for Post and Telematics, 2003

enabling them to access market informationnationally, regionally and globally,strengthening a firms ability to operate in theglobal environment and ensure stronger growth.At the same time ICTs are increasinglyassisting the Vietnamese government inproviding public services and strongly supportsuch programs as the Public AdministrationProgram, this is strengthening the both theability of government to provide services as wellas ensuring increased access to governmentservices for both the poor and firms. ICTs areincreasingly increasing the ability ofgovernment and development agencies toassist, support and strengthen povertymapping, monitoring and evaluation in VietNam, further enhancing support to the poor.


Local Governance Challengesin Achieving the MDGs

The need to ensure more balanced economicand social development across Viet Nam, andbetter meet the priorities and needs of localcommunities, has recently focused increasedattention on the important role of localgovernments in Viet Nam’s developmentprocess. The perceived trends in increasinginequalities between urban and rural areas, andamong ethnic groups, are being translated intodramatic provincial disparities. “Localized”mixes of policies are increasingly required forthe balanced achievement of the MDGs acrossViet Nam.

As Viet Nam integrates into the globaleconomy, the protection provided by the centralgovernment to particular industrial sectors inthe form of high import duties and othertechnical barriers to trade will no longer be aviable option to sustain economic activity inmany sectors. The downside of increasedinternational competition, measured in termsof potentially higher unemployment ordepressed economic activity in some regionswill likely be very unevenly spread across thecountry.

Some 95% of the poor in Viet Nam live in ruralareas, and 7 out of 10 ethnic minorityhouseholds can not cover their basic needs.Whereas there is still ample room for the furtherimplementation of broad base socio-economicdevelopment policies, the need for targetedinterventions in favour of disadvantaged groupsis ever greater to tackle the particularchallenges faced at the local level. The greaterthe distance from the political center, the lesslikely the mix of public policies at the nationallevel will reflect the set of preferences of peoplein more distant regions. Viet Nam, with a 70%mountainous area, two deltas, a disaster pronecoastal belt, and a central highlands with itsown socio-political circumstances, is a countrywith very diverse development needs.

The Government of Viet Nam is takingdetermined steps towards allowing forincreased flexibility of local governments in thedelivery of basic services. The administrative

and technical capacities of local levelgovernments, as highlighted in the MDGr 2003,remain a basic constraint for furtherdecentralization of authority from the centre,and one of the priority areas for attention forfuture development initiatives.

Limited discretion over the use of availablepublic funds, dependency on CentralGovernment transfers, and constrained optionsfor the generation of local revenue sourcesfurther limit the ability of local governments toattend to their specific development challenges.The obvious need for additional financialresources in rural and remote areas, where theunit cost of the provision of education and healthservices is much higher than in urban centres,call for the implementation of equitable andefficient inter-provincial transfers, and increasedrevenue raising powers for local governments.Importantly, the efficient implementation at thelocal level of major national reforms like thePAR, SOE and Financial Sector reform, andthe Enterprise Law is critical to develop thelocal domestic private sector, the mostpromising strategy available for job generationand the extension of local revenue bases.

Importantly, recent research (Dapice 2003)points to declining allocative efficiency in PublicInvestment. Every year passing, a higher valueof investment seems to be required to generatea given level of growth, a clearly not sustainablepattern. The underlying quality of growthdeserves the in depth analysis of policy makersand decision takers, and a general tighteningof public investment criteria that ensuressustainability of investment while maximizingits job creation impact seems to be furtherrequired. On the efficiency of public investmentmay greatly depend the development prospectsof many provinces in Viet Nam. If thatinvestment concentrates on unsustainablestate owned industries or low return whiteelephant infrastructure works, the opportunityto reduce dependency of poor provinces on thecentral government transfers might be lost,since the development of a healthy domesticprivate sector would be constrained.

��

Q ua n g B i n h


Q ua n g N a m

K o n T u m

G ia L a i


Decentralization in Viet Nam – Constraintsand Opportunities

Among the most important institutionalconstraints to further decentralization in VietNam is the absence of a national guide or planthat represents a coherent framework orenforcement mechanism for the transfer ofcontrol to sub-national levels of government.The reluctance of provincial and district levelsof government to further decentralize authorityis thus reinforced by the absence of this plan.As an example, the central government’sdecision to allow provinces discretion in thedesignation of communes as “investmentowners” for schemes under Program 135 hasresulted in only a few provinces venturingbeyond the district level in the implementationof the Program.

Decentralization of administrative andexpenditure capacity has been approachedgenerally without proper assessment of thestaffing situation at the local level. When stepsare taken towards strengthening the capacityof local level administrations, these are morereactive than responding to a systematic needsassessment. Moreover, the considerablecapacity imbalance between provincial anddistrict and commune levels of administrationis commonly cited as a constraint for limitingthe transfer of administrative and fiscal capacitybeyond the provincial administration. Theconcentration of investment in capacity buildingand resources at the provincial level, reinforcesthis vicious cycle in which lower levels ofadministration hardly develop any self-government critical mass.

The role of mass organizations like theWomen’s Union, the Youth Union and theFarmers’ Association needs to becomplemented by the work of other civil societyorganizations that allow for increasedparticipatory governance, transparency, andadministrative accountability. In this area, thecreation of a legal environment for thedevelopment of civil society is an importantpriority for which an initial step has been takenin 2003 with the promulgation of the Decree 88on Associations. This is the long-expectedoutcome of a 10 year drafting process, whichgrants MoHA and Provincial People’s Councilsthe capacity to issue permits for permanentestablishment, division, separation, merger,affiliation and dissolution of associations.

Despite representing an important milestonefor the regularization and development of thefledging national NGO sector of Viet Nam, a

more consultative approach on the drafting ofthe Decree could have better allowed reflectingadditional issues of interest for the relevantstakeholders. There are concerns about thewide discretionary powers allocated to MoHAand PPCs on the functioning and day to dayactivities of associations and importantly, thedecree does not establish a mechanism forappeal in case an application for theestablishment of an NGO was rejected, or therelevant government institutions decided toabolish one. It is generally felt that on the wayin which the decree will be interpreted andadministered by local government officials willrest greatly its successful implementation.

In spite of the obvious institutional and capacityconstraints to the decentralization ofgovernment functions, Viet Nam has carefullydrawn lessons from other countries and pilotedwith excellent results innovative initiatives inthis area. Decentralization may prove a goodpolicy option for increased transparency ofgovernment processes, in times in whichcorruption is growingly gaining importance asa development challenge. Participatorygovernment is critical if decentralization is torender increased accountability leading toenhanced government efficiency.

As it will be analysed in this section, the PublicAdministration Reform Program is amanifestation of the Government’s resolvetowards reducing cumbersome procedures,strengthening judicial and legislative systems,and rationalizing staff at all levels. Viet Nam’snetwork of public officials at the local levelsaves the country the huge investment ininstitutional building required in other countriesfor effective decentralization. In addition, therapid growth of information and communicationtechnologies and the development of massmedia have resulted into better awareness ofGovernment policies at the local level, and ofthe apparent gaps between policypronouncements and actual operations.

Migration and Local Governance in Viet Nam

The social implications of mass migration toindustrialized areas and the living conditionsof migrants is one of the most importantpotential development challenges facing well-off industrial provinces like Binh Duong and thegreat urban centres of HCMC and Hanoi. Theresponsibility of local level governments andprivate companies in this area is unavoidablein facilitating the supply of decentaccommodation to migrant workers andassisting migrants in achieving decent living


Box 14. Conflicts from the dual supervision system

There are known instances where the decentralization initiativesof provincial governments were openly contradicted by thedirectives issued by a concerned central ministry. One pertinentexample is that of Farmer Extension Department in one of theNorthern Uplands provinces. After repeated complaints from thepeople of the province about the unsuitability of the hybrid maizeseeds being forced upon them by the Extension Department, theProvincial People’s Committee issued instructions to thedepartment to respect the choice of the farmers in selection ofvarieties and crops. In spite of these instructions, MARD issuedits annual targets for area under various crops in each provinceand the referenced province also got its quota of hybrid maizealong with quota of seed to be distributed by an Extension SupplyCompany. Soon enough, Commune Chairmen were beingpressurized to ensure a certain Ha of hybrid maize were planedin their communes.

UNDP (2003)

conditions. In addition to the most importanturban areas, bordering provinces like BinhPhuoc and the Central Highlands region havein recent years been important recipients ofmigrants.

The Government has in the past activelydiscouraged rural urban migration and organizedrural re-settlement. However, since Viet Namstarted the implementation of Doi Moi, a largenumber of migrants have moved into urbancentres. Data from the 1999 census showedthat approximately 6.5% of the population aged5 and over, or 4.5 million people, moved locationbetween 1994 and 1999 (GSO/UNDP 2001).Official projections suggest that by 2020, only45% of the country’s population will live in ruralareas.

Among those who migrated during the 1994-1999 period, 55% moved to locations within thesame province, 45% moved across provincialboundaries, and 30% of the total also crossedregional boundaries. Hanoi and HCMC, togetherwith the fast industrializing provinces like BinhDuong remain the main magnets for migrants.In addition, only the Southeast and the CentralHighlands region gained population (the lattermostly due to the expansion of coffee crops.

Traditionally, the main concern of localauthorities in relation to migration has been theincrease in crime and social evils that has beenlinked to immigrant population. Lately, thepressures migration exerts in the provision ofbasic social services have come to the fore asa formidable challenge to provincial and districtgovernments, and might be importantly

affecting poverty reduction patterns across thecountry.

Finding adequate accommodation for migrantsis hard, leading them to endure living conditionsthat affect negatively their productivity. Migrantscommonly send home over 60% of their salary,leaving enough for hardly anything more thanfood and a sleeping place. Most earn theminimum salary of 400,000 dong, although asmuch as 100,000 dong can be deducted fromtheir salaries in contributions to healthinsurance and company-provided benefits.Being often requested to work three daily shifts,it is normal practice to refuse to go to thedoctors when illness symptoms appear, for fearof loosing their jobs.

In recipient provinces, the housing offer will needto be increased importantly, and privatecompanies will need to be encouraged to buildhousing of adequate standards for their workers.Migrant workers building houses in the areashould be awarded residential certificates andchildren allowed to join the public educationsystem even prior to the issuing of theresidential certificate. In Ben Cat district (BinhDuong), the district authorities encouragepeople to build guesthouses by providing 10bags of cement for each household willing tobuild a guesthouse. The district is also activelyrequiring that old guesthouses be upgraded inquality to provide better accommodationservices to migrant workers.

Free migration is also leading to fastdeforestation in some provinces. In Binh Phuoc,the authorities acknowledged around 60,000 freemigrants mostly from the North of Viet Namand from Cambodia. Landless migrants settlein the forest, clearing the sites first and bringingtheir families afterwards, rapidly forming smallhamlets. Settlement of free migrants has oftenled to land conflicts with the locals, whocomplain of worsening public security, andincreased “social evils”. Further progress in thisarea will require increased cooperation betweenprovinces of origin and recipient provinces ofmigrants, under the supervision of centralauthorities.

The full development impact of internal migrationin Viet Nam over the last years is still to beaccurately determined, and remains animportant area for future research. However, theobvious consequences at the provincial anddistrict level, in terms of increased pressure onthe delivery of health and education services,law and order challenges, environmentalmanagement, and poverty reduction patterns


reinforce the need to allocate additional flexibilityto local governments to effectively address thischallenges if the equitable achievement of theMDGs across Viet Nam is to be realized.

Policy framework for Decentralization andLocal Governance

Fiscal decentralization

While data from the 2000 Public ExpenditureReview suggests some 43% of totalexpenditures in Viet Nam are made at the locallevel (higher than in countries like Philippines),Viet Nam cannot be considered an effectivelydecentralized country. The introduction of theState Budget Law in 1996 provided for the firsttime some official autonomy to local levelgovernments in the revenue collection andexpenditure functions to the performed at thelocal level, but in 2003 some 10 provinces outof 61 were financially self-sufficient, with therest of the country fully dependent on ring-fenced transfers from the central administration.

In 1998, the stability of the fiscal system atthe local level was importantly improved byfixing provincial revenue shares for severalyears. Recent amendments to the StateBudget Law have further officially enhanced theauthority of Provincial People’s Councils in theallocation of resources to districts andcommunes, an important change from a pastin which district level allocations were alsodecided at the central level. This legislativechange, that should in principle allow forefficiency gains in the matching of resourceswith development priorities at the local level, isconstrained in effect by the low capacity ofPeople’s Councils in the analysis of budgetdocuments and the earmarking of a substantialshare of all local level funds made at centrallevel.

The State Budget Law will now allow urbandistrict governments and commune authoritiesto retain a greater share of the sources ofrevenue available to them. It is difficult toascertain what impact this will have in termsof increasing the funds available to provincestraditionally dependent on central governmenttransfers. The measure provides an incentivefor increased revenue collection, and makesreadily available funds that formerly weretransferred directly to the central government.However, with any substantial increase inspending discretion at the local level, the effectof this policy remains unclear. The amendedLaw confirms the authority of line Ministries in

the definition of ratios and levels of fundallocation to the provinces.

Encouraging the generation of economicactivity at the local level is the most sustainablealternative for the enlargement of local revenuebases and the increased financial self-sufficiency of provinces in Viet Nam. Theimplementation of the Enterprise Law hasshown the enormous job generating potentialof the domestic private sector, the potentiallymost important available development strategyfor rural provinces. The implementation of theEnterprise Law needs to be however importantlysupported by progress on the critical areas ofPAR, and State Owned Enterprises reform, asthe private sector requires a supportive and

Box 15. Ho Chi Minh City: Piloting Decentralization

A critical pilot experience in this area is the DecentralizationDecree 93/2001/ND-CP giving HCMC decentralized areas in a)management of development planning, investment and socio-economic development; b) management of land housing andphysical infrastructure, c) Management of the city’s budget, andd) organization of city administration and personnel. For thesecompetencies, block grants are allocated, greatly increasing thecity’s decision power on areas like personnel and financialmanagement. Since the implementation of the decree, the cityhas promulgated 40 legal normative documents and anadditional 23 documents are being drafted. Preliminaryassessments suggest an important clarification of functions andresponsibilities within and among departments was achieved,together with the delegation of authority to district People’sCommittees in the management of public facilities. In addition,bidding processes and domestic investment procedures havebeen significantly streamlined, while land lease authority wasbeing decentralized. The citizens’ supervision of the city’s PublicAdministration Reform Process is now being encouraged withthe opening of a PAR Hotline in which citizens discuss generalprogress in the organization of public services.

Efficiency improvements in the delivery of public services aremost visible in the areas of electricity provision and garbagedisposal, where services that have been contracted outsuccessfully. As it was to be expected, the HCMC administrationhas been faced with teething problems in the implementation ofDecree 93, mostly related to the lack of a critical mass of capableand skil led personnel, and cultural barriers among thebureaucracy that constraint the innovative attitude required forthe successful implementation of this kind of initiatives. Despitethe obvious benefits derived from the pilot experience, adetermined commitment to capacity building in publicadministration at lower levels will need to be in place for additionalprovinces to be able to undertake this governance challenge.This will need to be coupled with carefully sequenceddecentralization of authority to encourage learning by doingexperiences.

UNDP (2003)


the local outlets do not provide opportunitiesto improve their skills. Finally, the approval andconstruction of new health infrastructure issubject to long administrative procedures. It isnot uncommon for a district health centre totake three years from its inception phase untilthe end of construction.

Administrative Decentralization

During the 1990s, the Government of Viet Namhas incrementally transferred administrativeauthority to sub-national level of Governmentthrough a variety of initiatives. In 2000, theNational Assembly requested the review andadjustment of the division of specificresponsibilities between administrative levelsin each specific sector, beginning with theallocation of responsibilities between centraland provincial governments. The duality ofcontrols in the administrative sphere, where linedepartments are under the dual supervision ofPeople’s Committees and their departmentalhierarchy from central to provincial level, are alimiting factor for the successful implementationof decentralization initiatives. Many regularfunctions at the provincial level are stillcontrolled by Central Government Decrees.Decree 52 on implementation of Civil Works,and Decree 88 the Conduction of Bidding donot recognize a Village Board/Group or a usergroup as a legal entity fit to undertake anysimple civil work. This provides an automaticconstraint to the provincial and districtauthorities for not involving the beneficiaries inactual implementation beyond the extent oftheir contribution in the form of free labour.

Important steps are being taken towards theallocation of increased administrative authorityto provincial and district levels of governmentin Viet Nam. However, the current policy andinstitutional framework is somewhat piecemeal,composed of a wide variety of pilot experiencesin local self-government and several legislativeinitiatives.

In this framework, the Public AdministrationReform Master Programme 2001-2010 refersrepeatedly to the need to develop acomprehensive legal framework for thedelineation of the function of central and locallevels of administration, with a view towardsenhancing the quality of basic social services.

Under the Public Administration Reform MasterProgramme, the Government of Viet Nam iscurrently debating a draft resolution onDecentralization prepared by the Ministry ofHome Affairs that should provide the general

efficient public administration to flourish, andequal access to credit and other resources.

In addition, equitable inter-provincial transfersare required to ensure minimum standards inthe provision of basic social services. Theformulae used for the allocation of resourcesfrom the central government to the provinceswould need to take into account humandevelopment disparities across the country. Inthe Education sector for instance, thepredominance of population as the main criteriafor fund allocations from the central governmentshould be balanced with the introduction of otherneeds-based and quality-related criteria likeliteracy rates, teacher-class ratio, etc. Inaddition, the varying geographical conditionsacross the country determine importantly thecost of the provision of basic services.Maintaining population as a main budgetallocation criterion may well add to theperpetuation of important disparities in accessto and quality of services (Vu 2003).

Despite the increased coverage of exemptionsobserved since the Government resolution toexempt all children from tuition fees in Stateschools was implemented, a wide variety ofinfrastructure and parents fees still poseimportant barriers to the education of poorchildren. Preliminary results from the VHLSS2002 would suggest only 11.5% of the pooresthouseholds in the country received completeeducation cost exemptions.

In Health, a vast amount of funds available toprovinces come through the national targetedprogrammes. Each programme, however, hasits own set criteria for budget allocation,comprising a complex financing system thatstretches the capacity of local administrationsto the limit. Importantly, unspent nationalgovernment allocations to targeted programscannot be carried over to the next year andshould be transferred back to the centralGovernment in December. This punishesprovinces with lower implementation capacity,which are normally those in the greatest needof funds. In addition, targets are defined at thecentral level, constraining the flexibility to dealwith specific local issues.

The share of total health budget representedby hospital fees collection depends greatly onthe general socio-economic situation of theprovinces, and it may come up to only 5-15%of health expenditure in poor provinces. Thequality of services is not helped by the factthat there are hardly any funds for training ofstaff, which makes difficult to retain them since


framework for the further decentralization ofauthority to local levels of government. It iscritical that the resolution being discussedapproaches the general principles ofdecentralization and re-organization of the stateas a means towards the priority developmentalobjectives of Viet Nam. In addition, the fullinvolvement of lower tiers of government, andthe public at large in the preparation of theresolution might prove vital to ensure theappropriate balance between the “top-down”approach required to ensure the achievementof national minimum standards across thecountry, and the “bottom-up” flexibility requiredto ensure local governments are able to tackletheir specific, localized developmentchallenges. In this area, the traditional doubleaccountability of line Ministries to bothPeople’s Committees and central offices in Hanoi should be resolved to ensure goodcoordination in the provision of public goods.

The forthcoming resolution will need to also attendto the significant differences in managementcapacity at the local level. ODA trends seem topoint out to an increased role of sub-national levelsof Government in the planning and implementationof development initiatives funded by donoragencies. The expected increase in ODA fundsbeing delivered at the local level will requiretransparent accounting mechanisms, andefficient administration to be in place if the countryis to avoid the creation of perverse incentives forthe misuse of ODA funds. The Ministry of Planningand Investment has launched an importantinitiative for capacity building for ODAmanagement that highlights general areas ofprocess management; financial management;contracting and procurement management;quality management; social and environmentalsafeguards, and monitoring and evaluation aspriority area for capacity building. A criticalobjective of the initiative would be to ensure thecapacity created spills over the mere domain ofODA and positively impacts in general publicinvestment and social services delivery.

In June 19th 2003, Decree 71 CP onDecentralization of Staff Management in theAdministrative and Public Service Agencieswas promulgated, ensuring the consistency inpayroll administration with the amendmentsperformed to the State Budget Law. The decree,while confirming the enhanced authority ofPeople’s Councils in the approval andmonitoring of annual plans and budgets, fallsshort from providing additional flexibility forpersonnel management at the provincial levelthe way Decree 93 does in HCMC. It would bedifficult for a provincial government to respond

Box 16. Can communes become investment owners innational programs? The case of Tuyen Quang

The province of Tuyen Quang took its first initiative to decentralizepublic investment funds to districts in 1996, when the ProvincialPeople’s Committee decided to pool together all regularresources for infrastructure works into a single provincialinfrastructure development fund, to make subsequently annualbudget allocations to districts. District authorities wereresponsible to make decisions on how to use this infrastructurefund in their areas, becoming effectively investment owners, notjust technical line departments, and reducing the fragmentationof infrastructure works. Vil lage level involvement wasinstitutionalised with the creation of Village Development Boards(VDB), which helped sustain the local participatory planningprocess at the village level1. Every year, a district in Tuyen Quangwould receive some 3-5 billion dong from this provincial fund,an amount that was later doubled with the launching of Program135.

By the time Program 135 was launched, VDB had beenformalized in Tuyen Quang for more than two years, andcommune cadres had been active in working with villageinstitutions and groups. Planning and implementation capacitiesof the VDB had been building up gradually, while monitoringcapacity of the provincial and district authorities werestrengthened. Most importantly, local leaders’ trust in villagelevel institutions was strong, making the option of transferringresources further down to communes a realistic andmanageable one. Communes took over implementation andfinancial management responsibilities, with district departmentsproviding only technical support. The province has obtainedimportant efficiency gains in the provision of infrastructure works,and the close monitoring of local people have in turn renderincrease transparency and accountability of the localgovernments. Local ownership has been strengthened, and astrong motivation for operations and management is perceived.

UNDP (2003)

to specific local development challenges if theadministration is constrained by legislation thatlimit the organization of its human resources.The creation of permanent positions in theadministration continues to be a centralizedand lengthy process, and resort to temporarycontracts is not an option to attract valuablehuman resources.

In a province like Binh Duong, the enormousincrease on newly registered enterpriseswitnessed since the implementation of theEnterprise Law, has not been matched withadditional human and material resources forenterprise registration, service and monitoring.Human resources constraints are especiallyregrettable in a province that has pioneered avery positive attitude towards private sectordevelopment, including a market-friendlyinterpretation of the law, and a policy thatmakes People’s Councils responsible to


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represent the companies to the central leveladministration, accompanying them in supportof their demands.

In an initiative critical to facilitate the successfulimplementation of other decentralizationpolicies, the Prime Minister regulated in 2003the nation-wide replication of the One-StopShop service (OSS) centres. By May 2003,OSSs had opened in some 35 provinces,including 15% of provincial departments acrossthe country, 25% of district level departmentsand 8.5% of departments at the communal level.Main services being delivered are land andhousing services, investment and businessregistration, construction permits, public notaryand complaint settlements.

Political Decentralization

Amendments to the Law on Organization andFunctioning of People’s Committees andPeople’s councils and to the Law on Electionsof Deputies to the People’s Councils werepassed by the National Assembly of Viet Namin November 2003, and are expected tobecome effective in January 2004. Theseparallel and mutually enforcing initiatives aimto facilitate and promote stronger relationshipsbetween voters, and their electedrepresentatives at the local level. In 2004, VietNam will hold new elections to People’sCouncils and for the first time, there will befull-time elected Deputies at sub-national levelsof government. As such, they will haveincreased capacity to respond to voters’demands and get involved in the localdynamics of their constituencies. This will becritical to inform their decisions on budgetallocations to districts and communes.

The increased amount of responsibility forDeputies at the provincial and district leveluncovers important training needs of electedofficials. They include increased capacity forpolicy analysis, legislation drafting techniques,communication and public speaking skills,questioning and debate facilitation, localdevelopment planning, advocacy skills forwomen and ethnic minorities, womenleadership, public hearings and publicinvestigations, contacts and relationship withthe media, budget oversight and accountability,surveying methods, etc.

The somewhat slow implementation of thelandmark Grassroots democracy decree34 is

commonly attributed to the lack ofimplementation guidelines for the decree, andthe unwillingness of provincial and district levelsof government to devolve authorities to thecommune level. Recent amendments to thedecree provided increased independence of thecommunal level from the district level ofgovernment in land management and financialmanagement and liabilities.

In the recently conducted Participatory PovertyAssessment in the Mekong Delta Region(AusAID, UNDP 2003), locals complained offew opportunities to interact with People’sCouncil members. In addition, public officerswere perceived as unable to effectively facilitateparticipation and consultation forums, whilevillage heads were seen as usually overloadedwith work in spite of receiving only a modestallowance for their dedication. Also, corruptionwas listed as a huge obstacle for implementationof the Grassroots Democracy Decree, includingthe hiding of information or delivery of wronginformation. In fact, most of infrastructure worksat present are decided, called for bids, andowned by district authorities, with localparticipation or consultation being rathersymbolic. For grassroots people, ignorance ontheir rights, benefits and obligations, and lackof self-confidence to express their concerns andconvey their demands were behind the lowexercise of their rights and decision makingpowers.

In addition, the recent Decree on theImplementation of the Revised Ordinance onPublic and Civil Servants35 clarifies the publicservants roles at the commune level, which nowhave importantly been granted the status of civilservants. This should lead to improvements totheir salary allowances, which as civil servantswill now be discussed by the NationalAssembly.

Challenges for successful decentralization

Further decentralization is therefore an optionfor better matching resource allocations withthe development priorities of particularlocalities, allowing all of Viet Nam’s provincesto meet the MDGs by 2015. Decentralization,however, as a means towards improved livingstandards in Viet Nam, requires a critical massof administrative and financial capacity for itssuccess.

35 Decree 114-11734 Decree 29/CP


Firstly, the pillars on which successful localdevelopment processes are founded, namelylocal entrepreneurship and a supportiveinstitutional framework, including an efficientpublic administration, are only very unevenlypresent across Viet Nam for historical andsocio-economic reasons. Effectivedecentralization will therefore involve the carefulsequencing of authority decentralization, aprocess that will need to be matched withimportant capacity building efforts at the locallevel.

Secondly, further decentralization or resourcesand authority must not compromise Viet Nam’slong-term fiscal sustainability. Internationalexperience warns on the risks of uncontrolledfiscal deficit at local levels of Government forwhich the central government is subsidiaryresponsible, but also points out at the limiteddevelopment impact of ring-fenced budgetaryallocations to local level administrations mostlydefined at central levels of Government. Asustainable provincial revenue base should bebased on the generation of income from thedevelopment of private sector and the creationof jobs. For provinces unable to attract FDI,creation of an enabling environment for privateentrepreneurship, including the implementationof the Enterprise Law and the successful reformof Public Administration; and ensuring equalaccess to capital through the reform of StateOwned Enterprises, the State OwnedCommercial Banks and Land Law and is critical.

Thirdly, the legitimacy of the decentralizationprocess must stem from the sub-nationallevels of Government. The demand fordecentralization should be carefully analysedbefore policy initiatives are defined. A processof decentralization of fiscal and administrativeauthority that is imposed from the politicalcenter is likely not to be accompanied by thefinancial and human resources required bylower tiers of government to take up newfunctions.

Fourthly, in spite of several “decentralization”initiatives being implemented over the last fewyears in Viet Nam (e.g. Public Administration

Reform, Enterprise Law, Decree 29 onGrassroots Democracy, etc), the political willof provincial authorities in the implementationof national regulations and in the furtherdecentralization of functions to districts andcommune level governments determines greatlythe development impact of the initiatives.

As an example, amendments to the StateBudget Law that increase the influence ofProvincial People’s Councils in provincialresource allocations are likely to have greaterimpact in those provinces with an alreadyadequate administrative capacity. For otherprovinces, constrained financial resources andlow technical expertise of the localadministrations would limit the efficient re-allocation of resources to social or economicsectors, and the traditional incremental budgetformulation process will proceed.

In order to tackle these and other challenges,it would have been expected the Governmentwould accompany the amendments to theBudget Law with increased flexibility inpersonnel management and recruitment,additional funds for training and the flexibilityto decide on priorities, and implementationmechanisms for the Grassroots DemocracyDecree to ensure the potential of the BudgetLaw amendments for policy change are wellknown by the public at large. Reforms, however,in these areas, are slow.

An improperly managed decentralizationprocess may indeed exacerbate the existingsocio-economic disparities, and compromisethe achievement of the MDGs, since only ahandful of provinces with a critical mass of skillsin the local administration would be able toprofit from increased flexibility in policyprocesses. For those localities lacking thecapacity to experiment with their owninstitutional resources, a supportive centralstate is required to ensure inter-regionalsolidarity. The definition of pro-poor criteria forthe allocation of resources through the nationalbudget process is a critical area to achieve thedesired balanced development process.


Poverty measurement in Viet Nam involves theassessment of a wide range of povertyindicators, from income-based measures to thebroader “deprivations” approach used by theUNDP in its Human Poverty Index. Out of theavailable income-based indicators of poverty,the comparison of Viet Nam’s poverty ratesaccording to the national poverty line, andaccording to an internationally accepted (food)poverty line based on caloric consumption mayappear puzzling. This is due to the differentmethodologies employed in the calculation ofthe poverty lines and the surveying methods.

The General Statistical Office led in 2002 theimplementation of the Viet Nam HouseholdLiving Standards Survey (VHLSS 2002), the firstof a series that merges the former Viet NamLiving Standards Survey and the MultipurposeHousehold Surveys. A total of 75,000households were surveyed, turning the VHLSS2002 into a comprehensive databank to assessthe living conditions of the Vietnamesepopulation at large and of specific groups. Afood poverty line is established on the basis ofthe basket of food items deemed necessaryfor good nutritional status. The internationallyaccepted average is 2100 calories per personper day. The poverty line is then obtained by

ANNEX1:Measuring Poverty in Viet Nam

adding the cost of non-food items on the basisof the actual levels of consumption of the middlequintile of households. The poverty estimatesobtained thus are therefore comparable byprovince, ethnic group, rural urban areas, andgender.

According to MOLISA’s national poverty line,households with an average income of lessthan 80,000 VND per person per month wouldbe considered poor. The MOLISAmethodology for calculating the nationalpoverty line is determined at the incomeequivalent of buying a certain amount of rice.Income estimates are obtained from theprovincial branches of MOLISA. Provincescan alter their poverty lines depending onsuch factors as the cost of living, or theclassification of areas into urban, rural andmountainous areas, making inter-provincialcomparisons difficult. The system implementedby MOLISA presents the important advantageof requiring higher involvement of householdsand village heads. Village meeting councils arein principle convened in order to decide, indiscussion with the village neighbours, whichhouseholds can be defined as poor andtherefore have access to resources fromnational targeted programs.

Table 20. Comparison National and International Poverty Lines

Top 12 Bottom 12 Bottom 12Top 12

National Poverty Line National Poverty LineInternational Poverty Line International Poverty Line

Binh Duong

Ha Noi

Da Nang

Tien Giang

Ho Chi Minh City

Long An

Tay Ninh

Tuyen Quang

An Giang

Vinh Long

Can Tho

Ha Tay

3.23

4.10

4.23

4.39

4.92

5.76

6.01

6.54

6.70

6.83

6.99

7.42

Ho Chi Minh City

Da Nang city

Ha Noi City

Quang Ninh

Ba Ria Vung Tau

Binh Duong

Khanh Hoa

Dong Nai

Hai Phong City

Bac Ninh

An Giang

Binh Thuan

2%

4%

5%

6%

8%

9%

10%

10%

12%

12%

15%

16%

Quang Ngai

Quang Binh

Tra Vinh

Lao Cai

Gia Lai

Quang Nam

Ha Tinh

Dac Lac

Kon Tum

Bac Can

Soc Trang

Lai Chau

18.39

18.6

19.10

19.19

19.46

19.54

21.74

22.03

23.48

26.05

27.08

36.93

Ninh Thuan

Thanh Hoa

Ha Tinh

Dak Lak

Lao Cai

Cao Bang

Son La

Gia Lai

Hoa Binh

Bac Can

Ha Giang

Lai Chau

45%

48%

50%

55%

60%

60%

63%

64%

66%

69%

69%

77%

Source: GSO (2003), Preliminary results from the VHLSS 2002, MOLISA 2003


ANNEX 2:MDG Index Calculation and Indicators

The MDG report 2003 utilized the same methodology for the calculation of the MDG Index that was previously used in theMDG report 2002. The purpose of this index is to compare the overall progress between provinces and cities in theirachieving different indicators underlying the 8 MDGs. As indicated in last year’s report, the MDG Index will be furtherdeveloped as new data and indicators become available. Therefore, at least in the initial years of development, the MDGIndex is not strictly comparable over time, but only for the given year concerned. In this year’s report, 23 indicators wereused for 8 goals. These indicators were selected because they reflected the MDGs (and also the VDGs) and the data forthese indicators were available for all 61 provinces. A number of indicators in last year’s report were utilized again butseveral new indicators were also introduced in this year’s report.

The data were compiled from several official sources for the year 2002 for most of the indicators. For a few indicators forexample: number of HIV case per 100,000 people, or average number of new enterprises registered per 1000 people,more recent data are used. All data were compiled by each of the 61 provinces to allow the ranking and comparison amongthem.

For each indicator, all provinces were ranked according to their performance on that indicator from the best off to the worst offwith the number assigned accordingly from 1 to 61. This procedure was carried out for all indicators within each goal andthen the average ranking of all indicators within each goal was calculated for each province. After calculating the averageranking for each of the 8 goals for each of 61 provinces, the final ranking for each province was calculated by averaging againthe ranking of each province over the 8 goals. Then the next step was to divide the resulting average ranking of each province(over the 8 goals) by 61 to reduce the range of the index to 0-1. Finally, the MDG Index for each province was derived bysubtracting the value of the average ranking (within 0-1 range) from 1.

The specific indicators used for each of the 8 goals in the calculation of the MDG Index in the MDG report this year are listedbelow:

Goal 1- Total poverty rate 2002- Total food poverty rate- Poverty gap index- Share of malnutrition rate among children of less than 5 years old measured by weight/age

Goal 2- Net primary enrolment rate- Total literacy rate for people between 15-24

Goal 3- Proportion of girls at primary school- Proportion of girls at secondary school- Literacy rate for women of more than 15 years old- Share of females in provincial People’ Councils

Goal 4- Infant mortality rate- DPT 3- Proportion of children under one year old fully vaccinated

Goal 5- Share of women without assistance at birth by qualified health worker

Goal 6- Number of HIV case per 100,000 people- Malaria morbidity per 100,000 people- TB cases detected per 100,000 people

Goal 7- Proportion of households with access to clean water- Proportion of households with access to proper toilet- Proportion of households with access to garbage disposal

Goal 8- Share of member of provincial people’ council with at least a graduate degree- Average number of new enterprises registered per 1000 people- Share of ethnic minorities’ representatives in provincial people’ councils relative to ethnic composition of population


Table 21. MDG Provincial Ranking

Ranking RankingProvince ProvinceMDG Index MDG Index

123456789

101112131415161718192021222324252627282930

Ha NoiDa NangHai PhongHa TayHo Chi Minh CityHai DuongThai BinhBac NinhHung YenNam DinhBinh DuongKhanh HoaQuang NinhNinh BinhBa Ria Vung TauDong NaiVinh PhucHa NamTien GiangLong AnBinh DinhThai NguyenThua Thien HueHa TinhBen TreBac GiangPhu ThoNghe AnTuyen QuangPhu Yen

0.90110.81730.76880.73480.73450.71570.70180.69670.67230.67110.66000.64810.64050.63750.63200.62810.61460.61190.61120.61000.59440.57910.57560.56280.55670.55120.54990.54410.52990.5256

31323334353637383940414243444546474849505152535455565758596061

Tay NinhCan ThoBinh ThuanKien GiangLam DongVinh LongQuang BinhQuang NamAn GiangLang SonQuang TriThanh HoaHoa BinhBac CanYen BaiCa MauQuang NgaiDong ThapBac LieuDac LacLao CaiNinh ThuanBinh PhuocSoc TrangTra VinhKon TumGia LaiHa GiangSon LaCao BangLai Chau

0.51790.51550.51210.50020.49150.48870.48090.46570.46170.45320.45220.44280.43750.42450.42230.41440.41330.40920.40200.36320.35140.34940.34840.34360.33860.31110.29200.28130.25870.25580.2039

Table 22. Characteristics of the bottom 12 provinces in the MDG Index ranking

MDG Ranking

505152535455565758596061

Province

Dac LacLao CaiNinh ThuanBinh PhuocSoc TrangTra VinhKon TumGia LaiHa GiangSon LaCao BangLai Chau

Share of ruralpopulation (%) - 2002

79.2182.3071.5384.3881.1486.3066.8974.5389.2388.4086.3487.46

Distance to main city(km)

355*354334*104*230*198*589*541*319339281522

Note: * To HCMC, otherwise to Ha NoiSources: GSO 2002, Population census 1999

Share of ethnicminorities (%) - 2002

29.4966.7421.4918.0528.8830.1953.6043.5686.8382.5695.2982.65


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General Statistical Office (2003), Preliminary Data from the Viet Nam Household Living StandardsSurvey 2002

General Statistical Office (2003b), Viet Nam Demographic and Health Survey. Ha Noi

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Ha, Pham Bich, Vu, Nguyen Anh, Huong, Nguyen Thi, Xuan, Truong Thi, Marsh, David R. (2003),“Why Minority Women Do Not Practice Optimal Maternal, Newborn, and Child Health Behaviorsin Quang Tri Province, Viet Nam: A Baseline Behavioral Determinants Study (Draft 6”, Save theChildren Federation, US, Ha Noi.

Ministry of Education and Training (2003), “National Education for All Action Plan 2003-2015”, Ha Noi

Ministry of Health (2001), “MCH-FP Yearbook 2001”, Ha Noi

Ministry of Health (2002), Viet Nam Health Report. Ha Noi: Medical Publishing House

Ministry of Health (2002b), Research on Maternal Mortality in Viet Nam the Year 2000-2003. Ha Noi

Ministry of Health (2002c), MOH presentation at Second workshop on Monitoring System forMaternal & Child Mortality in Public Health Facilities, 2-5 December 2002 in Beijing, China.

Ministry of Health (2003a), National Master Plan on Safe Motherhood 2003-2010. Draft 6.

Ministry of Health (2003b), Viet Nam Health Survey. Ha Noi

Ministry of Health (2003c), “National Standards and Guidelines for Reproductive Health Services”,Ha Noi

Ministry of Labour, Invalids and Social Affairs, Statistical Data of Labour(2002), Employment inViet Nam 2002, Ha Noi

Ministry of Labour, Invalids and Social Affairs (2003), Statistical Data of Labour – Employment inViet Nam from 1996 to 2002.

National Committee for the Advancement of Women (2002), “Statistics on Women”, Hanoi

National Committee on Ethnic Minorities (2003). “The Quiet Voices: A qualitative assessment ofgovernment healthcare and education policies affecting the women and children of ethnicminorities”. Ha Noi


National Environmental Agency (2002), State of the Environment Report. Ha Noi

Population Council (2000), “A Situation Analysis of Public Sector Reproductive Health Servicesin Seven Provinces of Viet Nam”, Ha Noi: Population Council.

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UNDP and FAO (2002). Gender differences in the transitional economy of Viet Nam, Ha Noi

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United Nations Country Team (2002), Bringing the MDGs Closer to the People, Ha Noi

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VDGs directly based on the MDGs

VDGs directly based on the MDGs Baseline Current Level

>60% (1990)

>30% (1990)

86% (1990)30% (1993)

99% (1993)86.1% (1993)

n/a92.2% (1993)

n/a

18% (1992)

n/a

n/a

44 (1990)

58 (1990)50% (1990)

249 (1990)

1 (1990)

27% (1990)48% (1990)

36.5% (1993)

59% (1999)

29% (2002)

11% (2002)

92% (2001)67% (2001)

99% (2001)93%(1998)

n/a94.3% (2002)

n/a

27% (2002)

n/a2.5% (2002)

n/a

31 (2002)

38 (2002)30% (2002)

165 (2002)

70,000 (2003)

35.8% (2000)56% (2002)

23.6%(2002)

15% (2002)

64% (2001)

1. Reduce the percentage of poor and hungry households

Target 1. Reduce by 40% the proportion of people living below an internationally acceptedpoverty line between 2001 and 2010Target 2. Reduce by 75% the number of people living under an internationally accepted

food poverty line by 2010

2. Universalize education and improve education qualityTarget 1. Increase net enrolment in primary school to 97% by 2005 and to 99% by 2010Target 2. Increase net enrolment rate in junior secondary school to 80% by 2005

and 90% by 2010Target 3. Eliminate the gender gap in primary (ratio girls to boys in primary education)and secondary education by 2005, (ratio girls to boys in lower secondary education)and the gap with ethnic minorities by 2010Target 4. Increase literacy to 95% of under-40-year-old women by 2005 and 100% by 2010Target 5. By 2010 have improved the quality of education and increasefull-day schooling at primary level (exact target depends on funding)

3. Ensure gender equality and women empowermentTarget 1. Increase the number of women in elective bodies at all levels (female MPs at NA)Target 2. Increase the participation of women in agencies and sectors [includes ministries,central agencies and enterprises] at all levels by 3-5% in the next 10 yearsTarget 3. Ensure that the names of both husband and wife appears on the land-useright certificates by 2005Target 4. Reduce the vulnerability of women to domestic violence

4. Reduce child mortality, child malnutrition and reduce the birth rateTarget 1. Reduce the infant mortality rate to 30 per 1000 live births by 2005 and 25 by 2010and at a more rapid rate in disadvantaged regionsTarget 2. Reduce the under-5 mortality rate to 36 per 1000 live births by 2005 and 32 by2010Target 3. Reduce under five malnutrition to 25% by 2005 and 20% by 2010

5. Improve maternal healthTarget 1. Reduce the maternal mortality rate to 80 per 100,000 live births by 2005and 70 by 2010 with particular attention to disadvantaged areas

6. Reduce HIV/AIDS infection and eradicate other major diseasesTarget 1. Slow the increase in the spread of HIV/Aids by 2005 and halve the rate of increaseby 2010(number HIV reported Cases)

7. Ensure environmental sustainabilityTarget 1.Extend forest cover to 43% by 2010 (from 33% in 1999)Target 2.Ensure that 60% of the rural population has access to clean and safe water by2005and 85% by 2010. This should be the case for 80% of urban people by 2005.Target 3.Ensure there are no slums and temporary houses in all towns and cities by 2010(Percentage of Households Living in Temporary Houses - Data Includes Rural Households)Target 4.Ensure that all waste-water in towns and cities is treated by 2010Target 5.Ensure that all solid waste is collected and disposed of safely in all towns and citiesby 2010(Access to garbage disposal)Target 6. Air and water pollution must attain national standards by 2005(Percentage of water and air quality monitoring stations showing improvements over thebaseline of 1995)


8. Reducing vulnerabilityTarget 1. By 2005, increase the average income of the lowest expenditure quintile to140% of that in 2000 and to 190% of that by 2010(Growth in per capita expenditure of the poorest 20% of households)(Mean per capita expenditure as percentage of the Poverty Line)Target 2.Reduce by half the rate of poor people falling back into povertydue to natural disasters and other risks by 2010(Number of People Needing Emergency Relief Annually due to Natural Disasters)

9. Improving governance for poverty reductionTarget 1. Effectively implement grass-roots democracyTarget 2. Ensure budget transparencyTarget 3. Implement legal reform agenda

10. Reducing ethnic inequalityTarget 1. Preserve and develop the reading and writing ability of ethnic languages(Range of primary school enrolment rates for ethnic minority groups)(Literacy rates for ethnic minorities aged 15-24)Target 2. Ensure entitlement of individual and collective land-use rights in ethnic minorityand mountainous areas

(Share of ethnic minority households with both the names of husband and wife on LandUse Certificates)

Target 3. Increase the proportion of ethnic minority people in authority bodies at variouslevels

(Share of ethnic minorities’ representatives in provincial people’s councils relative toethnic composition of the population)(Poverty rates for Ethnic Minorities)(Food Poverty Rates Ethnic Minorities)

11. Ensuring pro-poor infrastructure developmentTarget 1. Provide basic infrastructure to 80% of poor communes by 2005 and 100% by2010

(Communes identified under Program 135)(Communes identified under HEPR)(Newly Identified coastal poor communes)

Target 2. Expand the national transmission grid to 900 poor commune centers by 2005

2362 Poor communes reached800 out of 987 poor communes99 coastal poor communesnewly identified (2003)

70% (2002)41% (2002)

VDGs and Targets not directly based on the MDGs

VDGs not directly based on the MDGs Baseline Current Level

28.7% (1993-1998)167% (1993)

8.9% (1998-2002)168.5% (1998)

n/a 1 million (2002)

Several significant legal and Institutional Reforms (a)

41.5% (Hmong) - 94.9% (Tay)74.4 (1993) 84.1% (2002)

n/a 1.2% (2002)

75% (1998)41% (1998)

Source: United Nations Country Team 2003Various Government of Viet Nam SourcesNote: This is a summary of a fuller set of VDGs outlined in the CPRGS. The VDG papers have more targets and indicators

(a) Amendment to the Law on Organization and Functioning of People’s Committees and People’s Councils submitted toNational Assembly in 2003. National Budget Documents Published since 2000

Legal Sector Development Strategy submitted to Standing Committee of National Assembly in 2003


Main Acronyms

ADB Asian Development BankADF Agence Francaise de DeveloppementAIDS Acquired Immunodeficiency SyndromeCPRGS Comprehensive Poverty Reduction and Growth StrategyCEM National Committee on Ethnic MinoritiesDFID Department for International DevelopmentECCE Early Childhood Care and EducationEFA Education for All Action PlanFDI Foreign Direct InvestmentGDP Gross Domestic ProductGSO General Statistical OfficeGSP Generalized System of PreferencesGoVN Government of Viet NamHEPR National Programme on Hunger Eradication and Poverty ReductionJBIC Japan Bank for International CooperationKfW Kredittanstalt fur WiederaufbauICT Information and Communications TechnologiesIDU Injecting Drug UsersIMR Infant Mortality RatesLUC Land Use CertificatesMARD Ministry of Agriculture and Rural DevelopmentMCH-FP Mothers and Children Care and Family Planning DepartmentMDGs Millenium Development GoalsMoH Ministry of HealthMOLISA Ministry of Labor, Invalids and Social AffairsMOET Ministry of Education and TrainingMMR Maternal Mortality RatesNCFAW National Committee for the Advancement of WomenNEA National Environmental AgencyNMR Neonatal Mortality RatesODA Official Development AssistancePIP Public Investment ProgrammeRWSS Rural Water Supply and SanitationSOE State Owned EnterpriseSPB Social Policy BankSW Sex WorkersTB TuberculosisTBA Traditional Birth AttendantsU5MR Under five Mortality RatesUNDP United Nations Development ProgrammeUNGASS United Nations General Assembly Special SessionUNICEF United Nations Children’s FundVDGs Viet Nam Development GoalsVDHS Viet Nam’s Demographic and Health SurveyVHLSS Viet Nam Households Living Standards SurveyVWU Viet Nam Women’s UnionWB World BankWHO World Health OrganizationWTO World Trade Organization

Graphic Design:Dang Huu Cu

Photos:Diem DamNguyen Van Thanh

The designations employed and the presentation of material on all maps in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations or UNDP concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries.

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