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Vietnam Social Security

Social Assessment for Vietnam Social Security

Modernization Project

FINAL

March 2017

SFG3090 REVP

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Abbreviations

CPC

CSOs

Commune’s People’s Committee

Civil Society Organizations

DivLSA Division of Labor and Social Affairs

DoLISA Department of Labor, Invalids and Social Affairs

DPC District’s People’s Committee

EM Ethnic minorities

FGD

ISSCs

Focus group discussion

Integrated Social Security Cards

IT Information technology

MoLISA Ministry of Labor, Invalids and Social Affairs

MIS Management information system

NGO Non-governmental organization

OP Operational Policy

PC

PDO

Personal computer

Project Development Objectives

PPC Provincial People’s Committee

SA

SI/HI

Social assessment

Social Insurance/Health Insurance

ToT Training of Trainers

VSS

VSSMP

Vietnam Social Security

Vietnam Social Security Modernization project

WB World Bank

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Table of Contents

Acknowledgement .......................................................................................................................... 3

Executive summary ........................................................................................................................ 4

I. Project description .................................................................................................................... 11

II. Description of consultation in the project areas........................................................... 12 2.1. Methods of consultation ............................................................................................................ 12 2.2. Selection of sites and information on respondents.................................................................... 13 2.3. Some characteristics of EM groups in the study sites ............................................................... 14

III. Main findings ............................................................................................................................ 16 3.1. Social/health insurance and social assistance management practice in Ha Giang and Quang

Nam .................................................................................................................................................. 16 3.2. The potential impacts of the VSS modernization ..................................................................... 22 3.3. Gender issues ............................................................................................................................ 29 3.4. Stateholders analysis: ................................................................................................................ 30

IV. Recommendations .................................................................................................................. 32 4.1. For design: ................................................................................................................................ 33

Data management: .......................................................................................................... 33 Administration: ............................................................................................................... 33 Design of ICS cards: ........................................................................................................ 33 Ethnic diversity at the local level: .................................................................................... 33 Consideration of gender sensitivity: ................................................................................ 33

4.2. For implementation: .................................................................................................................. 34 Training: ......................................................................................................................... 34 Timing strategy: .............................................................................................................. 34 Communication: .............................................................................................................. 35 GRM: .............................................................................................................................. 35 M&E: .............................................................................................................................. 36

Annexes ............................................................................................................................................ 36 Annex 1: Overview of socio-economic information of the people in the project area .................... 36 Annex 2: A sample of the recaps of the meetings with selected VSS modernization project

stakholders during the field sudy. .................................................................................................... 42

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Acknowledgement

This report was prepared by a team from Vietnam's Social Security, led by Hanh Thi Tran,

under the overall guidance of Giang Tam Nguyen (Social Development Specialist), Nga

Nguyet Nguyen (Senior Economist). The preparation of the fieldwork and production of the

report benefited considerably from comments from various reviewers from VSS, MoLISA

and the World Bank (WB).

This report would not have been possible without the support from Provincial Social Security

agencies and Department of Labor, Invalids and Social Affairs (DoLISA) of Quang Nam and

Ha Giang provinces, and the local authorities from the municipal to the ward levels where the

fieldwork for this report took place. They acted as both informants and reviewers while

helping the team to formulate and review their arguments throughout the research process.

Last but not least, thanks go to all interviewees and group discussants in the research sites,

including those from various ethnic minorities groups, who took the time to share experiences

and views with the team and thus enriched their understanding of the issues to which this

report addresses itself.

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Executive summary

Purpose. SA, in the context of the Bank’s OP 4.10, is a study that aims to explore how

planned project activities under a Bank financed subproject would affect the life of EMs

present in the subproject areas. The purpose of the SA is to ensure if there is any potential

adverse impact as a result of the subproject, appropriate measures are in place (in advance of

subproject implementation) to avoid, mitigate, minimize such potential adverse impacts, or to

compensate for affected population, if unavoidable. The SA also aims to explore, based on

the understanding of EM’s cultural, socio-economic characteristics of the EM communities,

possible development activities that the project can implement (in relation to the project

goal/objectives) to ensure EM peoples in the subproject area receives socio-economic

benefits that are culturally appropriate to them.

Main findings of SA: The main findings of SA conducted for VSSMP are summarized as

follows:

Broad community support: Generally, when explained, respondents expressed their support

for the project from their own perspectives, depending on their working positions or interest

in the benefits of social issuance, health insurance and social assistance. They acknowledge

that the project would address some major constraints of the current paper-based situation,

such as fragmented administration, requirements for multiple pieces of official documents for

use of service or reception of social assistance, non-durability of paper documents with

serious implications for service use.

Positive impacts:

From the administrators’ perspective: The administrators from both VSS and MoLISA

anticipated some positive impacts of the project, including more efficient system

management thanks to an improved electronic system making it easier to monitor and verify;

and better data management leading to faster and timely issuance of cards, which is

especially useful for health insurance purpose. The integrated card system is also believed to

avoid abuse of funds thanks to greater data transparency, particularly avoidance of abuse of

health insurance as cards are expected to include personal photographs and information.

Considerable resources and labor would be saved as it would no longer be necessary to print

new paper cards annually as only electronic updating is needed.

In case, ISSC system is connected with the ATM system, it would lead to improved security

as cash would no longer be kept in an office, whether it be a commune building or a post

office; reduced time pressure and long queues upon receiving benefits as beneficiaries can

choose to withdraw cash at any convenient time for them.

From beneficiaries’ perspective: Potential beneficiaries, including those from EM groups,

highly welcome the utilities of durability, safety and convenience that ISSC system may to

bring about. They find it much easier to keep plastic cards at their homes in hard weather

conditions and can use the cards on a long-term basis without disruption of services,

especially emergency health care, for annual revisions and updating of beneficiary status.

Concerns, needs and expectations of potential beneficiaries

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With the ISSC system to be introduced, the interviewed administrators expressed some

concerns regarding data management, administration and coordination between VSS and

MoLISA at various levels.

Macro-level risks and external impacts: the respondents were concerned about the limited

coordination between the related ministries and sectors; and influential factors from other

sectors beyond the control of VSS. The fast-changing IT development may make the original

objectives and measures outdated, which need changing in accordance with the new

developments during the implementation process. They are also concerned about changes in

macro-level policies relating to social and health insurance and social assistance at the

national level.

Micro-level risks under VSS: According to the VSS administrators, the legislation on social

and health insurance had kept changing, while the coordination between social security,

health care and labor and social affairs sector agencies, for example between district social

security agencies and health centers, has been weak. If the coordination between the related

professional management and policy-implementing divisions is ineffective, it would be hard

to revise and update the related IT applications in a timely manner. The time gap between

policy effectiveness and IT applications in VSS would negatively impinged upon benefits of

beneficiary organisations and individuals. In addition, the implementation capacity of the

related organisations and individuals are unsatisfactory to deliver the objectives. The

divisions and individuals with poor IT skills would face difficulties in their work, and the

new mechanism of communication may result in emerging bottlenecks in their business

process. The success of the Programme would greatly depend on the accessibility to modern

public services by stakeholders, including EM beneficiaries. VSS divisions and beneficiaries

in remote areas with limited accessibility to online services in social and health insurance

provided by VSS may face the issue of inequity, which will, to some extent, constrain the

intended impacts of the Programme.

Data management: The respondents were particularly concerned about the production of a

reliable database for operations of ISSC system from the start. They believed that data

collection, updating and revision would be a very time-consuming and costly process. It

required effective merge of the two existing database managed by VSS and MoLISA. At

present, there has been no integrated database because VSS, MOLISA and MOF have

different management functions and procedures, which make difficulties to establish an

integrated database for SI/HI and SA management. Some additional good surveys and

analysis of data are needed to standardize information and updating changes in beneficiary

information and benefits, especially the changes that happen annually. In some EM areas,

such as those H’mong, women may change their family names after marriage, and some

family names are considered inter-changeable, such as Duong/Giang and Dau/Do are the

same. In areas, where many EM people have no or limited literacy, teachers and village heads

register births and fill in other registration documents for the former, hence leading to errors

in birth certificates and registered documents. This may result in inconvenience for EM

beneficiaries in using health services and receiving social assistance benefits. Therefore, the

respondents believed that clear guidelines and regulations on the implementation process,

including institutional arrangements and data collection and management are critical, which

spell out clear roles and responsibilities of stakeholders and authorized sources on personal

information (such as the stipulated use of information on ID cards, not on household

registration booklets). Some wonder about the consolidation of the verification documents,

i.e. whether both plastic cards and paper copies of beneficiaries’ signatures of payment have

to be used for filing purpose. They also want more guidance on authorized positions to enter,

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revise and update data as well as issue cards in a manner that can ensure confidentiality,

safety and convenience for all related parties.

Coordination: The administrators expressed their concerns about a plan for consolidating the

existing related databases of VSS and MoLISA, which now have different functions and data

collected on a basis of different information sources (one based on ID information while

another on household registration booklets). According to them, due attention should be paid

to the different outreach of the two systems with VSS only to the district level while MoLISA

to the commune level. They expressed their hope for a clear division of roles and

responsibilities during the implementation process. This should be clearly spelled out from

the start. The commune’s labor officers worried that the project might shoulder more

workload on them with no incentives provided, especially regarding registration and

management of beneficiaries, GRM, updating of changes in beneficiary status and benefits, to

avoid late payment and loss of funds. The coordination with the existing projects related,

such as SASSP, should be taken into account for synergy and saving of resources.

Administration: The respondents expressed the needs for new and clear procedures and

processes to run the ISSC system. They were concerned about whether a combination of both

hard and e- copies would still exist under the ISSC system, for example regarding the

verification of payment documents for final accounting will be completely electronic or is

still paper-based when hard copies have to be printed out for checking. The current practice

was described as cumbersome and time-consuming. But if the hard copies were required, the

ISSC system might be more costly and time-consuming as the respondents found it easier and

cheaper to print paper cards. Also, they are concerned that a considerable number of cards

may be wasted every year as people change their status and become no longer eligible. In

case of connectivity with the ATM system, Agribank is the only provider in many remote

areas where many EM groups live. In many areas, only a machine is located in the district

centre, which is far away from many beneficiaries. Commune labor officers are concerned

that if reading machines are not located in CPC, they cannot follow details of payment to

respond to beneficiaries’ queries as they do with paper cards at the moment.

Concerns of potential EM beneficiaries:

Social/health insurance and assistance service users may suffer difficulties in using smart

integrated social/health insurance and assistance cards: Most of the respondents in visited

villages in Ha Giang and Quang Nam have never seen smart cards before. Therefore, they

cannot use smart cards for getting their payment without very careful and effective training.

The people, who get state budget- sponsored social assistance and health insurance, are

usually poor or ethnic minorities, living in remote areas. Most of them are with low education

level or with language barriers in communication. These may be obstacles to them to get the

knowledge transferred on using smart integrated cards. Many people with revolutionary

merits, pensioners and social assistance beneficiaries in EM areas may prefer paper-based

approach in the initial stage, therefore it may be time-consuming to change their awareness

and habits.

The EM respondents were concerned about the issuance of temporary cards for use in health

emergency cases in case of loss and misinformation of beneficiaries. They requested for due

attention to the issue of authorization, such as for guardians of children, elderly people with

severe disabilities and serious mental health illness who can't use ISSCs on their own. The

authorized persons should be allowed to be flexible, not necessarily household heads. They

also raised the issue of potential abuse of authorization to use cards as mortgage for informal

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loans. They also explored the possibility of connectivity with the ATM system, and then

stressed the necessity to address some concerns regarding operations of the ATM system,

such as confidentiality, security, and location of machines (some potential beneficiaries may

need to travel up to 30km to reach the district centre).

Social assistance and health insurance card users may suffer problems in getting payment

through ATM because of forgetting the passwords for their cards. If they note their password

down in some paper or book, the security may be violated.

Financial aspects: The financial aspects of the ISSC system was raised as one of the major

concerns. They were keen to learn about the cost of producing and reproducing ISSC system.

They discussed at length the issues on whether to penalize the loss of electronics and, if yes,

the implications of these penalties and to what extent they should be. These concerns are

related to their potential needs for regular updating and revision of personal and household

information as well as insecure practice of card storage, especially in EM areas.

Communication: The respondents were concerned about effective communication, including

regular consultation and training on usage, with potential EM beneficiaries. The consultation

and training on ISSCs usage would be given to village heads, mass organizations officials

and voluntary members first before training to beneficiaries. Cultural factors should be

considered in selecting beneficiary meetings and venues for usage of ISSCs, preparing EM-

friendly and culturally appropriate guidance on use, reproduction of cards in case of loss, and

calculating the costs for updating and reproduction.

Administration of the ISSC system: The biggest concern was about the location of service

points and reading machines and/or other necessary facilities, and post offices and commune

centres were cited as more convenient venues. The respondents were raised the issue on

which agency would be responsible for reproduction and re-issuance of cards as well as

responsibility and budgeting for maintaining and repairing reading machines to avoid long-

term disruption of service, especially for health insurance. They were also concerned about

the timing for issuing cards as paper cards are now issued on the 1st day of the month while

users may need it earlier after registration. In case of no connectivity with the ATM system,

attention should be paid to allocation of sufficient and flexible time for receiving benefits.

Design of ISSCs: The respondents expressed their concerns about the types, capacity, and

contents of ISSCs, particularly transparency of information in ISSCs for health insurance

usage and SA benefits. They questioned about the offline and online usage functionality of

ISSCs. They also wondered what types of personal and household information would be

provided on (e.g. beneficiary names and DoB) and inside cards (e.g. family members, photo,

DoB, health checks, all benefits). They questioned whether the ISSC system would be

connected with the SMS service to provide more timely information and transparency for

beneficiaries. They also worried about potential production of fake cards. In addition, there

might be a sense of comparison among pensioners, health insurance and social assistance

beneficiaries if their ISSCs look the same for different categories of beneficiaries.

Recommendations:

Specific measures will be required to ensure that some of the most vulnerable EM

communities in upland areas are not disadvantaged by VSSMP. EMDPs, prepared in

conjunction with the social asessment findings, are a vital tool in this regard.

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For design:

Data management: A reliable standardized database available from the start of the project is

crucial. The establishment of a common database should take advantage of the latest surveys

from VSS and MoLISA (Decree 136 census and the poverty census). The SI/HI and SA

business processes should be renovated and the objective of using data by VSS and MOLISA

agencies should be clear before designing the integrated information system. Information

sharing mechanism should be established. Enumerators of personal or household data should

have good understanding of socio-cultural profiles and practices that may lead to changes or

bias of information that they are expected to collect.

Administration: A socio-political analysis of stakeholders, including cost/benefit and SWOT

analyses, is needed. There should be a coordination board at the district level, including

representatives from the health, labour and insurance sectors, to ensure smooth

implementation. In addition, direct and regular consultations with stakeholders,

administrators and users alike, are important. To promote close coordination between

different related ministries/agencies in related policy making and the program

implementation, a steering committee should be established at the national level, chaired by a

Deputy Prime Minister, with the members as representatives from the health, labour and

insurance sectors.

Design of ISSCs: The personal and household information on and in ISSCs should be

beneficiary names, DoB, family members, photo, health checks, and all benefits. The validity

period of a card should be long-term. Furthermore, it is important to consider individual

accounts linked to the ISSCs for online access beneficiaries’ information on insurance and

social assistance benefits, as is being done with the Vietnam Improvement Land Governance

(VILG) project.

Ethnic diversity at the local level: The needs and approaches to the project information vary

considerably among EM groups, depending on their differences in the level of development,

ability to receive, environmental conditions and platform experiences. Cultures and customs

also vary among ethnic groups as well as within an ethnic group. All activities in the VSSMP

should be designed with the considerations of ethnic diversity as most of the beneficiaries of

the project are ethnic minority. Mitigation measures are very different in each province as a

result of differences in their cultures and customs. Hence, VSSMP should have different

measures for different EM groups to avoid irrelevance.

Consideration of gender sensitivity: This project is gender-informed. As part of the SA, the project also carried out gender

analysis. The SA reflected benefits of the ISSC towards women in managing household

benefits and indicated the necessity to increase the participation of women, especially those

from EM groups, in project activities, such as information dissemination and training. It is

important to raise women’s awareness of their rights and benefits in social insurance, health

insurance, unemployment insurance and social assistance, as well as access to the ISSC, their

rights to access to the GRM system and how to lodge their complaints when needs arise. The

SA showed that female attendance at information workshops and meetings may be low. The

SA recommended the following gender agenda which would contribute to reducing the

gender gaps (i) promoting the participation of women throughout the project cycle; (ii)

organizing information dissemination activities specifically for women who will be

household managers and users of cards, to enhance women’s current access to information

and their associated engagement in the project; (iii) reducing women’s household workload

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through the introduction of the ISSC with more convenient services; (vi) training provided to

local administrators as well as project staff should take into account cultural relevance and

gender sensitivity; and (v) boosting the participation of grassroots women’s unions in

communication activities, complaint resolutions, and gender-sensitive support to female users

of the ISSC. During the monitoring of the EMDP implementation, the key indicators of

gender actions will be monitored and reflected in internal and external monitoring reports.

For implementation:

Training: Adequate training should be provided for administrators and beneficiaries. In

particular, ToT may be considered for training district and commune cadres first, and then

village heads and local people. Furthermore, training sessions for EM beneficiaries should

ideally be conducted directly at a village level, with hands-on demonstration, in EM

languages, and by the same EM people, preferably village heads. More careful training may

be provided to village heads who can later serve as focal points for queries on the use of ICS

cards and benefits. Also, guidance should be recorded on CD and transmitted through by

community sessions, smart phones and local TVs, among small groups, with due attention to

poorly educated EM beneficiaries. Adequate timing of training sessions to maximize

attendance is essential. In addition, assistance should be provided during the registration,

issuance and guidance for use

Timing strategy: Given many constraints in the EM areas, many respondents, both

administrators and beneficiaries, suggested piloting and phasing for EM areas and EM groups

to learn lessons. They preferred the phased implementation from the lower to the higher land

areas, from towns to rural areas, as well as from areas with better educated people to those

with less educated ones.

Communication: It is important to prepare a communication strategy with culturally

appropriate activities for EM people regarding project information. Awareness-raising

activities and events in EM areas are important so that EM beneficiaries would know how to

use and protect cards well, possibly through the FPIC process, village heads, role-plays, and

DVDs. Socio-cultural events may be taken into account for communication work. Different

ways of communication should be considered for different groups of EM beneficiaries with

different levels of awareness. Ideal venues for communication events should be taken into

account, such as a village community house, Gould house (for Ko tu).

It is important to take advantage of socio-cultural characteristics for the communication

strategy, including for community activities and events, although a diversity of situations may

exist across the country. Amongst the EM populations, wherever possible written forms of

information should be minimized, while greater attention should be paid to capacity building

amongst heads of villages and local cadre to ensure that these individuals fulfill their current

role as key disseminators of information more effectively. As EMs tend to be heavily

dependent on village leaders and cadre as sources of information, capacity should be built at

this level to ensure householders are regularly updated about the processes, and their potential

involvement. For example, for the H’mong and Dao groups in Ha Giang, it is important to

communicate project information and guidance to village heads who are considered closer to

their community and can make a substantial impact on households and individuals. It is ideal

to produce user-friendly guidance with pictures and short, as well practical hands-on

demonstration guidance, which could be recorded into DVDs for standard and repeated use

among EM groups. Moreover, finger-print technology should be used for illiterate people. It

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is also necessary to examine the roles of village heads, elderly and respected persons in

community life, particularly in communication and GRMs. In many cases, they may be useful

but may face constraints when they themselves do not understand issues.

Citizen engagement: Consultations were carried out in October, November and December

2016. Apart from community consultations, including those with various EM groups,

meetings were held with representatives from VSS and MoLISA at the national, provincial,

district and commune levels. The SA reviews have confirmed a general interest amongst the

stakeholders in the introduction of and access to the ISSC. The SA also identified a potential

risk that the poor and remote areas could be excluded from project activities and benefits. To

address this, the project would undertake targeted activities to reach out and ensure

participation of/consultation with poorer communities, women, EM communities and other

vulnerable groups to ensure that beneficiaries of the ISSC are well informed of their rights

and responsibilities.

GRM: Many EM respondents prefer direction communication, rather than through a help-line

service. They trusted the role of the village management boards and respected village persons

in settling grievances. Meanwhile, some administrators argued that grievances can be

redressed through annual meetings with voters and VSS’s annual meetings with local people

because there is a grievance redressal system under VSS from the national to district levels.

District grievance redressal centers have to give training and guidance on GRM to commune

officials, village heads or other related people and run VSS’s annual meetings with local

people regularly.

The women’s unions may be incorporated into the institutional structure of implementation

under the project, especially for mobilizing participation and being involved in informal

grievance redress channels. Efforts will be needed to arrange a location and time suitable for

women, and additional promotional activities may also be necessary to maximize attendance

by female householders. For meetings with EM groups, it will be necessary to identify

individuals with proficiency in EM dialects, who can act as interpreters and provide a careful

briefing to ensure that the issues and terms to be used in Vietnamese are clearly understood

and well communicated.

M&E: Some key indicators should be monitored during the implementation of the project,

including number of cards issued to EMs and the poor and number of visits to medical

facilities by EMs and the poor.

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I. Project description

The Program Development Objective (PDO) is to enhance the efficiency of social security

administration and improve quality of services for clients of VSS, as well as support

synergies in social protection implementation between VSS and selected public agencies. The

Project would comprise three components, as follows:

Component 1- Supporting VSS Administrative Reform and Modernization Program

Implementation (Proposed budget: US$ 8,000,000 USD)

This component would provide advisory services and capacity strengthening to VSS to carry

out administrative reform in order to simplify business processes and thus improve efficiency

of service delivery. The ultimate objective of the measures supported is to reduce the

compliance burden on enterprises, health facilities and individual SI participants in line with

Government targets. Further simplification and re-engineering of business processes of VSS,

with an emphasis on automation of processes, is a key element of their Modernization

Program. This would enhance convenience and value of VSS services to participants,

employers, and service providers, and increase efficiency in transaction processing and

decision-making. In order to realize the operational benefits of improved business processes,

the component would also support HR reforms and capacity strengthening. Finally, this

component would assist VSS in preparing its systems for enhanced data exchange with other

agencies, in particular MOLISA, but also other such as Tax Agency.

Component 2- Build an Integrated Social Security Card system (US$ 90 mln)

This component is to support VSS to build an integrated Social Security Card (SSC) system

which will be used not only by VSS, but also by MOLISA, health facilities and individual

clients to promote more intergated, efficient and user friendly social protection service

delivery. The expected functions of the integrated SSC would include: (i) identification of

insured people and supporting utilization of health insurance services; (ii) identification

management and payment of health insurance, pension and other SI short term benefits

administered by VSS; and (iii) identification and payment for social assistance programs

administered by MOLISA, including merit and disability beneficiaries.1 The component

would include four subcomponents, including (i) business requirements assessment; (ii)

designing specifications for an integrated SSC system informed by global good practice; (iii)

testing, production, and rollout the Social Security Card system: The component would

finance card production and supporting infrastructure procurement (e.g. card readers;

scanners), with the scale of coverage dependent on units costs and decisions on functionality

of the cards; and (iv) providing supporting staff training and technical assistance to ensure

that the SSC system operates seamlessly with the underlying business systems of VSS and

that it is sufficiently secure to avoid introducing cyber threats into VSS systems.

In order to incentivize rollout, the component is also proposed to include a Disbursement

Linked Indicator reflecting the progressive expansion of coverage of the SSC system (this

could be in terms of number of cards issued, in terms of number of provinces with some

threshold level of penetration, in terms of share of corte service providers with operational

card usage infrastructure).

1 VSS has indicated that the integrated social security card which is used in Taiwan, China provides a broad

model with relevance to Vietnam.

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Component 3: Project management (Proposed budget: US$ 2 mln)

VSS is the project owner and would establish a Project Management Unit to be in charge of

daily operations of the project.The project management component would include:

The beneficiaries of the project would be: (a) users of VSS and MOLISA systems, including

current contributors to social insurance programs and beneficiaries of both social insurance

and social assistance programs; and employers which are making contributions of behalf of

their workers to social insurance; (b) service providers in the VSS and MOLISA systems.

This includes both the VSS and MOLISA office networks themselves, and the providers with

whom those offices and clients interact on a regular basis, including health facilities (when

insured health services are provided and processing of claims is undertaken) and outsourced

providers such as VN Post (who manage benefit payments for both VSS and MOLISA).

II. Description of consultation in the project areas

2.1. Methods of consultation

A team of two researchers, including one lead researcher, and one team member, have been

employed for this assessment. A number of conventional qualitative research instruments are

employed, including focus group discussions, in-depth interviews, note-taking, and

photographing, and non-participant observation.

Focus group discussions: Each FGD usually includes 6-8 participants who are

recommended and invited by local guides following the requirements of the research

team. Gender-disaggregated data are paid attention through the establishment of

gender sensitive FGDs. Local guides are the chiefs of the selected residential units

who have a very good understanding of the community. In order to understand likely

different impacts and their responses to the project, a variety of respondent groups are

selected, including social security and health insurance officials, users of VSS and

MOLISA systems, including local poor/near-poor and representatives from local

ethnic minorities groups (See the Photo 1 and 2).

In-depth interviews: The team plans to explore some case studies with more in-depth

information. The informants for such in-depth interviews may be selected from the

FGDs (researchers may find some discussants who have more interesting details to

provide so have him/her for a separate in-depth interview). Also, the interviewees

may be recommended directly by local guides after researchers have fully explained

the assessment objectives.

Photo 1: Focus group discussion with a group of women in Thac Tang village,

Cao Bo commune, Vi Xuyen district, Ha Giang

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Photo 2: Focus group discussion with a group of men in Thac Tau village, Cao

Bo commune, Vi Xuyen district, Ha Giang

2.2. Selection of sites and information on respondents

Information on respondents:

The fieldwork was conducted in Ha Giang and Quang Nam provinces, where EM resident

groups have taken a quite high percentage (See Table 3, the Appendix). For each study

province, two districts/towns were selected, and for each district/town, a commune selected

for consultation. At the provincial, district and commune levels, the study team held

consultative meetings and group discussions with various social insurance and assistance

administrators. In total, the team held 12 meetings and group discussions in Ha Giang and 10

meetings and group discussions in Quang Nam with 79 respondents. The respondents

include:

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Social/health insurance and assistance administrators: are officials from the

provincial and district Social Security agencies, provincial Departments of Labor,

Invalids and Social Affairs (DoLISAs), the district Divisions of Labor, Invalids and

Social Affairs (DivLISA), and commune officials (leaders of the people’s committees,

labor and social affairs officers, commune health center officers and leaders of

commune’s mass organizations). They are directly or indirectly involved in

social/health insurance and social assistance administration.

The users of social/health insurance and assistance services: include non-poor,

poor and EM people in the study sites. The EM groups include the Tay and Dao in Ha

Giang, and Co Tu in Quang Nam. Usually, many of the EM respondents are also poor

or near-poor, who live in difficult areas and have poor education.

Table 1: Breakdown of respondents (in numbers) by gender, wealth, residence and

ethnicities.

Stakeholders Organizations The public

Sites Total

VS

S

Labor and

Social

Affairs Total Men Women Kinh

E

M Poor

Quảng Nam 8

22 12 6 4

Provincial respondents

Dong Giang 2 1 1

Song Con/ Dong Giang 2 14 8 6 0 `4

Dai Loc 2 1 1

Dai Hung/ Dai Loc 2 8 4 4 1 7

Ha Giang 16 33 17 16 33 7

Provincial respondents 4 1 3

Vi Xuyen district 4 2 2

Cao Bo/Vi Xuyen district 3 3 19 9 10 19 5

Quan Ba district 3 1 1

Thanh Van/Quang Ba

district 2 2 14 8 6 14 2

2.3. Some characteristics of EM groups in the study sites

The Tay: The social unit of the Tay is village with a male Village head that has great

authority. Tay property regimes are divided into public ownership of the village and into

ownership of private, household property. The public ownership includes all land, forests,

rivers and natural resources within the village. Added to these, roads, bridges, temples and

shrines are classified as public property. Private ownership in its turn encompasses all

production land that is owned, cultivated or reclaimed by each family. In addition, assets such

as houses, agricultural products, household items, handicrafts and other items produced by

household members are private property of the family. Each village has regulations

concerning protection of forests and water resources as well as land and production activities.

Social relations between relatives and neighbors in the village are demonstrated in all aspects

of life, both in production, spiritual life and religious beliefs.

The Nung: The Nung are closely related to the Tay and have the same kind of social and

village structure as the Tay. They share the same language and they often live in the same

15

villages with the Tay. The Nung follow the male line and have a tradition of giving all

inheritance to sons only. Nung houses with clay walls and tiled roof are usually built flat on

the ground with some sections raised on stilts. Houses are usually divided into two parts. One

part is for living quarters and the other part is for working and for ancestor worship. The

Nung are mostly Buddhists with influence of Confucianism, and they worship their ancestors.

They are recognized for their weaving and bamboo handicrafts, for producing curved roof

tiles of clay, for making furniture, baskets, silverworks and paper. The Nung are often

considered as the best horticulturists and blacksmiths in Vietnam. Like the Tay, the Nung

have a long tradition of wet rice cultivation and well-developed irrigation systems. They also

grow vegetables, groundnuts, different fruits, spices and bamboo, and they terrace lower hill

slopes to provide land for the farming activities.

The Dao: Most of the Dao follow Taoism as their religion, and some of them still retain the

Chinese writing system and literary tradition. Their tradition of ancestor worship is

symbolized by use of five colors. Ancient practices are maintained for funerals. Dao’s social

unit is the village with a male Village head. Families follow patrilineal inheritance and men

have a strong position. Each village has its own regulations concerning protection of forests

and water resources as well as concerning land and production activities. Houses are built on

stilts, or with one part built on the ground combined with another part of stilts. Most of the

Dao people are petty farmers with slash-and-burn farming on hill field, some families also

have wet rice fields. Their staple food is rice, maize, vegetables and bamboo shoots. They

cultivate and sell maize, beans and other vegetables and also raise buffaloes, cows, pigs and

chicken for selling. Many Dao households are skilled in weaving, blacksmithing, silverwork,

carpentry and traditional papermaking. Handicrafts selling on available markets therefore add

to household income of the Dao.

The Cơ Tu: There are 61,588 Co Tu people in Vietnam, according to the 2009 Population

Census, which are ling in 38 of 63 provinces/cities Most of Co Tu (74.1% of the total Co Tu

population in Vietnam) lives in Quang Nam (45,715 people) and Thua Thien Hue (14,629

people or 23.8% of the total Co Tu population in Vietnam).

In Quang Nam, most of Co Tu people is living in Tay Giang (taking 90% of the total

population of Tay Giang district), Dong Giang (73.23% of the total population of Dong

Giang district) and Nam Giang (50% of the total population of Nam Giang district).

Co Tu language belongs to Mon-Kh'Mer language with Latin writing, appeared recently.

High land cultivation is the key livelihood activity of Co Tu people with only one season per

year. For livestock they raise buffalos, pigs, goats and chicken. In addition to that, non-timber

forestry products are the one of the key sources of food and income for Co Tu people.

Guoi house is very famous to Co Tu as the place for village community activities. 80% of

the villages in Dong Giang and Nam Giang districts and 90% of the villages in Tay Giang

district have Guoi house.

For Co Tu people community relations are close. Villages are managed quite independently

by their customs, chaired by "An Village Elder (già làng)", who is highly respected by people

in their villages. At present, there are 383 persons, considered as the persons with high

respectation, of which 362 persons are village elders, village heads or big family heads. Only

one person with high respectation is a shaman and 20 persons are from other groups of people

16

among 383 persons with high respectation among Co Tu community in Quang Nam.2 Co Tu

people promote worship of Gods. They are famous with traditional dances, reflecting their

chivalry. Buffalo sacrifice is the biggest festival of Co Tu people.

III. Main findings

3.1. Social/health insurance and social assistance management practice in

Ha Giang and Quang Nam

3.1.1. Current social security system management

Identification of social/health insurance and social assistance grant beneficiaries/users:

Vietnam Social Security has been responsible for administration of the social and health

insurance (SI and HI) system. There are two groups of SI service users, including the group

of people with mandatory SI and the group of people with voluntary SI. The users of HI are

of very wide range, including a group of users with HI contribution made by HI users totally,

one by employers partly, one by the funds from the state budget and one partly from the state

budget and partly from their contribution. MOLISA and its network at local levels are in

charge of the social assistance administration.

The integration of the security cards for the HI users, who belong to the groups of social

assistance beneficiaries, funded by the state budget fully or partly is much more complicated

then for the users, who are not social assistance beneficiaries. Most of the HI and SA service

users of those groups are poor or near poor, whose status can be changed regularly or ethnic

minority. Therefore, the below is the discription of the current practice of the identification,

payment, communication and GRM for the above mentioned groups HI and SA service users.

For the health insurance users, who are also social assistance beneficiaries, the identification

has been done at commune level, and in charge of commune labor and social affairs. There is

only one labor and social affairs official in any commune PC. Along with many other tasks,

the labor and social affairs official is responsible for collecting the data on poor/ethnic

minority households and their members, and on merit and disable people from villages to

prepare the reports to submit to districts. There is no specialized official on social/health

insurance at commune level. The information of the social/health insurance grant

beneficiaries has been got by district Social Security agencies by them selves or from their

district Labor, Invalids and Social Affairs/Social Assistance divisions (for the HI users, who

belong to the groups of social assistance beneficiaries). The work load of commune labor

and social affairs officials has been too high. Therefore, delays have sometimes happened in

updating information and reporting.

District Labor, Invalids and Social Affairs divisions have prepared the list of social assistance

grant beneficiaries and shared with district State Treasury, Social Security and Post Office.

District SS agencies are responsible for delivering social/health insurance cards to the users,

based on the list of social/health insurance users as their clients and the list of SA

beneficiaries, approved by their district PCs. In 2016, Ha Giang's Provincial Social Security

has carried out a household survey to get the data on all households and their members and

health care insurance status from all villages.

2 http://www.quangnam.gov.vn/CMSPages/BaiViet/Default.aspx?IDBaiViet=15704

17

Payment:

The payment of social assistance allowances to beneficiaries (assistance service users) has

been made by District Post Office at commune level from 5th to 18th monthly. Any

undisbursed amounts of social assistance allowances to beneficiaries have been accumulated

to be paid during the next payment. For pension payment, only 500 of 5,700 pensioners in Ha

Giang have used ATM cards for getting payment. All social insurance users (40,000) in Ha

Giang have received social insurance in cash through post office. However, in Vi Xuyen

district, 100% of the government officials have used smart cards to receive their payment.

For receiving social assistance allowances, the users have to show their Residence Books and

ID. Based on the list of social/health insurance and social assistance users, given by district

Labor, Invalids and Social Affairs divisions, post office officials will give payment to the

users. Those delivering post office officials have to sign in the users' Social Assistance

Payment Records for the users to monitor the payment (Photo 3).

Photo 3: Social assistance payment record

The members of poor, near-poor and ethnic minority households and children under six have

received fully sponsored or partly sponsored (for the near-poor) health care insurance cards

from their communes (Photo 4). Using health care insurance cards, the users can get health

care services from hospitals or commune health centers with full or part sponsorships of

health care service costs, depending on the levels of health insurance. In addition to that, the

members of poor and ethnic minority households will receive the reimbursement of the travel

costs from their village to the hospitals. Supporting documents to health care insurance cards

(ID or any documents with personal photo) are required to show for getting sponsored health

care services to justify that they are the right health care insurance cards owners. This

requirement has created problems to the health care insurance cards owners sometimes in

getting health care service if there is an inconsistency in personal data between their health

insurance cards and IDs. In some cases, the sponsored health care insurance users had to pay

for the health care expenses to claim for reimbursement later.

Photo 4: Health care insurance cards

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A respondent as Social Security or Labor administrator shared that in Thanh Van commune,

Quan Ba district, there was more than 10 overlapped health insurance cards, some cases with

data errors in health care insurance cards and of lost/torn cards, happened in 2015. To get a

replaced cards/books social/health insurance and social assistance users have to pay around

ten cents for their lost/torn cards/books. It takes at least one week to get the replaced

cards/books. Replaced cards/books can be delivered to the users only on the 1st day of a

month.

Communication and disputes processing:

The communication on the social/health insurance and social assistance related policies has

been done by village social assistance collaborators and village heads in minority languages.

From the focus group discussion in Thanh Van commune, Quan Ba district, Ha Giang

province, the lady, who was the commune social assistance collaborator, showed her good

awareness of social/health insurance and social assistance related policies and how to use

education/pregnancy assistance allowance to right targets. She lost her position of commune

social assistance collaborator because of the SASSP policy change to using village heads as

commune social assistance collaborators, instead of village women union heads. The

communication on HI has been weak in some cases, like in Dong Giang district, Quang Nam

province. With poor knowledge on how to use the HI for getting health care services, many

minority people have suffered difficulties in getting health care services, especially when

change of hospitals is required.

All other respondents from Ha Giang have agreed on first importance role of village social

assistance collaborators and village heads in carrying out communication on the social/health

insurance and social assistance related policies. The second important role has been given by

the respondents to heads of mass organizations, like the heads of party unit, women union,

youth union.... The female respondents in Thanh Van commune prefer to get the

communication from commune women union unit heads.

Some respondents from Ha Giang showed their dissatisfaction with the 2015, 2016 list of

poor households in their villages. They complained about it to their village heads and didn't

agree with the explanation from their village heads. However, they said they didn't dare to go

further with their complaints. From the focus group discussions in visited villages in Ha

Giang and Quang Nam most of the respondents shared that for sending their complaints they

19

would send their complaints to their village heads first, after that to the person of high

reputation in their villages, followed by heads of village mass organizations. As mentioned

above, some women respondents preferred to send their complaints to their village heads of

women union.

Payment verification and supervision:

The payment of social/health insurance and social assistance allowance can be verified by

the social insurance/health and social assistance service users by themselves through their

social insurance and social assistance booklets (Photo 5). The records of signatures from

social insurance and social assistance users for their receiving payments have been used by

district post office or commercial banks (in the case of using smart cards) for compiling with

district SS or Labor, Invalids and Social Affairs agencies. District State Treasuries are

responsible for transferring funds to district post office for payment at the request from

district Labor, Invalids and Social Affairs agency and controlling the use of the transferred

funds.

Photo 5: Payment verification record

Data management:

For both social/health insurance and social assistance systems, the database on the

social/health insurance and social assistance service users and database management are very

important. Both Vietnam's Social Security and MOLISA have tried to develop their own

computerized database on the social/health insurance by VSS, and social assistance service

by MOLISA, users and database management. For the social/health insurance system, there

are many software, used for SS management, such as: a software for revenues management,

one for health care insurance users management, one for health care verification information

management, one for accounting, and one for social insurance users management... Labor,

Invalids and Social Affairs agencies have applied a software for social assistance payment

accounting. Ha Giang and Quang Nam are two of four provinces participating in the SASSP,

financed by WB. Therefore, there is a MIS for the social assistance beneficiary identification

and payment information management. The respondents as Labor, Invalids and Social Affairs

administrators from Ha Giang shared their view that it was feasible to add the data on social

and health care insurance users into the current SASSP's MIS for both social/health insurance

and social assistance management. However, the respondent from Ha Giang Social Security

thought that it was difficult to integrate the software used by VSS and MOLISA for

developing a software for ISSC system management.

20

3.1.2. Problems in the current social/health insurance and social assistance system:

Inconsistency in information of social/health insurance and social assistance service users,

overlaps and missing cases in proving social/health insurance and social assistance:

Most of the respondents from provincial and district SS agencies shared that many problems

in identification and payment happened because of the cultures and awareness of the current

social/health insurance and social assistance policies by local people. The information of

social/health insurance and social assistance service users has been inconsistent in some cases

because some people have changed their names or date of birth arbitrarily during disclosing

their personal data for making social security booklets or health insurance cards. Therefore,

the information on these books or cards may be inconsistent with the information on their ID

or Residence Book. Not many people have high awareness of the need for consistent

information in the health care insurance cards with other personal documents, therefore, few

of them have checked this when receiving the HI cards. Most of the inconsistencies have

been found at the moment when they tried to use the cards for paying health care services. In

many cases health insurance users with information inconsistency couldn't get the replaced

cards timely because replaced cards are given only at the first day of the month. Therefore,

many people have suffered difficulties in getting money to pay hospital for medical services

during their medical visits or in claiming the money paid by themselves for medical services

(Box 1).

Box 1. Problems of inconsistency in biodata information between HI cards and other

documents

One respondent (Dao minority man), who was a invalid solder, from Ma Hong village,

Thanh Van commune, Quan Ba district, Ha Giang province shared that he had to wait for

three years to get his HI card replaced because of the inconsistency in biodata information

between the HI cards and his ID. For those three years he had to pay by him self for the

medical costs and couldn't claim back until now.

The diagnostic work under an ongoing World Bank technical assistance with VSS found that

at least 55 percent of the business operations were entirely manual, and only around 12

percent of processes were fully automated.3 High proportion of manual social/health

insurance and social assistance beneficiaries identification and management works has made

the process of checking information of social/health insurance and social assistance

beneficiaries difficult, causing overlapping and missing cases.

Problems of using paper cards:

Most of the respondents shared that they put their Social Assistance for Poor

Household/Ethnic Minority and Social Insurance booklets, and health insurance cards at

home. Some respondents shared that they pinned their health insurance cards on medical

records for finding easier and maintenance better. However, many officials said that a

number of people have made their social assistance books or health insurance cards lost or

torn. It happened more to the people, who went to go outside. The lost or torn social

assistance books or health insurance cards is to be replaced or issued newly, but it may create

problems to the users in getting timely payment, especially the payment for medical services

3 Concept note on a proposed credit for the VSS Modernization project, 2016

21

during medical visits. Lost health insurance cards may be found out after getting the replaced

ones. However, the replaced card number is usually different from the one of old lost card. It

may make the users with the lost and replaced HI cards embarrased in using HI cards for

getting health care services.

Paper cards provide no verifiable identity (and is reported to be used fraudulently by

uninsured people who are lent cards), have to be replaced every year, and have no way of

being read electronically to facilitate and verify transactions.

Lack of strong inter-agency coordination sometimes:

The information on both social/health insurance and social assistance service users comes

from commune level. There is one commune labor and social affairs official in a commune,

who coordinates the collection and reporting of that information. District Social Security

agencies have to cooperate with district Labor, Invalids and Social Affairs agencies in getting

the information on social/health insurance service users from their communes. Therefore, the

respondents from both Social Security and Labor, Invalids and Social Affairs agencies at all

levels mentioned about the needs for cooperation between two sectors in social/health

insurance and social assistance service users identification management. However, this strong

inter-agency coordination hasn't been sometimes. For example, recently there were two

surveys done at household level: one on poor households by Labor, Invalids and Social

Affairs agencies and one on household health insurance status by Social Security in

2015/2016, which created high burden to commune officials as complained by some

commune officials. If these two surveys were merged to cover all household information for

both social/health insurance and social assistance, we would have a comprehensive

information for integrated social/health insurance and social assistance cards. Most of the

currently used software are not open, which are not easily to be added/adjusted data by users

or administrators to be more suitable to local conditions.

Realizing the importance of close cooperation between Social Security and Labor, Invalids

and Social Affairs agencies in social/health insurance and social assistance management, a

solution on integrated social/health insurance and social assistance management has been

included in the VSS's Administration Reform plan for 2016-2020. However, some

respondents shared that there has been still no clear mechanism for such kind cooperation,

creating difficulties to both agencies in cooperation, especially to commune labor and social

affairs officials in fulfilling the tasks, relating to social/health insurance.

Poor infrastructure for computerized social/health insurance and social assistance

management:

The infrastructure for social/health insurance and social assistance management in some

communes has been very limited. For example, in Cao Bo commune, Vi Xuyen district, Ha

Giang province, there are only seven computers for seven units of the commune. Therefore,

the commune labor and social affairs official has to share a computer with other officials in

his/her unit. The computers, planned to be given to the communes under the SASSP, haven't

been delivered there.

Problems of getting payment through post office:

The payment through post office has helped to improve the right targeting and adequate

payment, as well as the work load of SS/SA officials. Many SS and labor and social affairs

22

officials mentioned about improved transparency and anti- corruption possibility in SS/SA

payment system as the positive impacts of payment through post office. However, one

disadvantage with the payment through post office were shared by some respondents as post

officers couldn't give immediately answers to SS/SA service users for their questions on

SS/SA policies. Some respondents found less convenient to get the payment through post

office because it took a long way for them to go the commune center, while the amount of

allowance received was too small to them to go for a long way and only heads of household

could get the payment. If heads of households want to authorize other members of the family

to get the payment they have to pay notification fees for the authorization. So some

households haven't got the payment monthly, but put it accumulated. The delays in getting

payment by the SS/SA users have created difficulty to district Social Security and Labor and

Social Affairs agencies in clearing their accounting books.

Limited access to the information on social security policies:

Many respondents in Quang Nam and Ha Giang complained about their limited access to the

information on social security policies. The ladies-respondents from Ma Hong village, Thanh

Van commune, Ha Giang province, said that they didn't know how poor households in their

village were identified by commune PC. They felt the identification of poor households was

not fair.

Many respondents in Quang Nam shared they didn't know what percentage of medical costs

they could get the support from the state budget for health service payment by using health

insurance cards during medical visits. Therefore, they didn't know whether medical workers

followed rightly the social health insurance policies or not.

3.2. The potential impacts of the VSS modernization

Based on analyzing the objectives and scope of the proposed VSS modernization project and

from discussions with a number of social/health insurance and assistance administrators and

the users of social/health insurance and assistance services, the team has found out the

following potential impacts of the project:

3.2.1. Positive impacts:

Reduced time and efforts for social/health insurance and social assistance service

users:

All social/health insurance and social assistance service users/respondents welcome the

integration of social/health insurance and assistance services, which they acknowledge would

considerably save their time and efforts to get the social/health insurance and social

assistance services in comparison to the ones, spent by them when those services were in

separation. At present, a poor or ethnic minority household in Ha Giang and Quang Nam has

to go to his/her commune center to get the payment of social assistance allowances through

post office on certain dates. The queue for getting the payment may be long. Therefore, it

could also take a quite long time and effort for ethnic minority social assistance beneficiaries

(who live far from their commune centers) to get the payment. For education allowance, in

some communes, social assistance beneficiaries may have to go to schools of their children to

get the education allowance because many schools may ask post office officials to use their

schools as the venues for paying education allowance so that school management boards can

23

collect the payment for books, notebooks, already delivered by those schools to their

students.

For getting reimbursement of the travel costs to hospitals/health facilities or of the medical

costs, paid by health insurance users in the case of health insurance card loss, health

insurance users have to go to their district division of health or to their commune health

center for certain dates to get the payment. The integration of social/health insurance and

assistance services would help social/health insurance and assistance service users to save

time and efforts to get the social/health insurance and social assistance services because they

would get all payments from one payment provider instead of some as currently.

Improved administration process for social/health insurance and assistance

service:

As the Social Security Modernization project would provide a technical assistance to help

develop the future business/delivery model of VSS, administration process for public services

and social/health insurance and assistance service would be improved through making the

VSS's business process more simple and transparent for having good balance of outsourced

and in-house services, mixture of human and automated/online client services.

Thanks to the integration of social/health insurance and assistance services, respondents as

the representatives from social/health insurance and assistance administration agencies shared

their expectation of considerable improvement in their work, especially at the commune

level. With development of an integrated computerized system of social/health insurance and

assistance service users identification, payment and management, the workloads of commune

labor and social affairs officials is expected to be reduced significantly. The respondents-

administrators think that the use of integrated Social Security Cards would help to reduce the

human and financial costs for social/health insurance and assistance administration thank to

removal of the overlapping tasks between social/health insurance and assistance

administration agencies, for example, the tasks to carry out household surveys to get the data

for household health insurance status by VSS and for household poverty by MOLISA. The

production of integrated social security cards would require an integrated social security

software, which is expected to help in promoting more consistent information management

with better information updating and monitoring. The reason is that for having integrated

social security software set and operated it is neccesary to promote good coordination

between relevant agencies, especially between VSS and labor and social affairs agencies.

Integrated electronic cards would provide verifiable identity and help to facilitate and verify

transactions because the cards will be read electronically.

Enhanced coordination between local and sector agencies:

The integrated social security system cannot be developed without close coordination and

cooperation between Social Security and District Labor, Invalids and Social Affairs agencies.

As mentioned above, the respondents from both Social Security and Labor, Invalids and

Social Affairs agencies at all levels have confirmed the needs for the cooperation between

two sectors. Through working together on an integrated social security system, the

coordination capacity of Social Security and Labor, Invalids and Social Affairs agencies at

all levels is expected to be built and strengthened.

Improved transparency and strengthened anti-corruption:

24

The VSS Modernization project would support development of the institutional and legal

framework for information sharing across databases and agencies, and for information

consolidation and management. This would include elaboration of regulations on data

management and use, including which agency or third party is responsible, the

responsibilities of firms and individual participants, etc. With improved information sharing,

along with clearer rules, roles and responsibilities on information updating and approval, the

transparency would be enhanced, making contribution to reducing corruption in these sectors.

Improved transparency and strengthened anti-corruption as the potential impacts of using

integrated social security cards have been also mentioned by most of the respondents from

provincial and district social/health insurance and assistance administration agencies.

According to them, improving the public access to the information on the list of social/health

insurance and assistance policy beneficiaries and the payments would make the process of

social assistance and social/health insurance users identification more transparent and fair.

Using integrated and smart social security cards can help to prevent from the "ghost list of

social/health insurance and assistance policy beneficiaries", which will strengthen anti-

corruption thank to having electronic verification process for integrated identification and

payment. At present, except four provinces, participating in the WB financed SASSP, using

paper cards and books with manual verification process has suffered difficulty in finding

overlapping, missing cases or wrong names for delivering health insurance cards and social

assistance booklets. Therefore, labor and social officials could add "ghost names" to the

official list of social/health insurance and assistance policy beneficiaries.

Transparency and anti-corruption impacts would be enhanced more when more and more

people, including ethnic minority people, have smart mobile phones and capable to access to

Face book. Some of the young men and village heads in five visited villages in Ha Giang and

Quang Nam have smart mobile phones and Face book addresses. If the list of state budget-

sponsored social assistance and health insurance beneficiaries was online, people with a

smart phone can access to the list and the information on the social security policies more

easily (Box 2). The government officials in charge would be more careful in preparing or

approving the list of state budget- sponsored social assistance and health insurance

beneficiaries because of improved transparency in state budget- sponsored social assistance

and health insurance beneficiaries identification and payment process.

Box 2. Easier access to information with smart phones

The head of Thac Tang village, Cao Bo commune, Vi Xuyen district, Ha Giang province has

a smart phone and a facebook account. He said the team could see their performance at "Dai

Doan Ket" festival (in November 18th 2016) through the facebook. He has learnt about the

social assistance policies from the SASSP training courses as well as from internet. He said

many young guys of his Dao minority group have smart phones. If the list of commune social

assistance and health insurance beneficiaries was disclosed online, they would know better

about the social security works in their communes.

3.2.2. Concerns, needs and expectations of potential beneficiaries

25

With the ISSC system to be introduced, the interviewed administrators expressed some

concerns regarding data management, administration and coordination between VSS and

MoLISA at various levels.

Macro-level risks and external impacts:

The respondents were concerned about the limited coordination between the related

ministries and sectors; and influential factors from other sectors beyond the control of VSS.

The fast-changing IT development may make the original objectives and measures outdated,

which need changing in accordance with the new developments during the implementation

process. They are also concerned about changes in macro-level policies relating to social and

health insurance and social assistance at the national level.

Micro-level risks under VSS:

According to the VSS administrators, as the legislation on social and health insurance keep

changing, while the coordination between social security, health care and labor and social

affairs sector agencies, for example between district social security agencies and health

centers, has been weak. If the coordination between the related professional management and

policy-implementing divisions is ineffective, it would be hard to revise and update the related

IT applications in a timely manner. The time gap between policy effectiveness and IT

applications in VSS would negatively impinged upon benefits of beneficiary organisations

and individuals. In addition, the implementation capacity of the related organisations and

individuals are unsatisfactory to deliver the objectives. The divisions and individuals with

poor IT skills would face difficulties in their work, and the new mechanism of

communication may result in emerging bottlenecks in their business process. The success of

the Programme would greatly depend on the accessibility to modern public services by

stakeholders, including EM beneficiaries. VSS divisions and beneficiaries in remote areas

with limited accessibility to online services in social and health insurance provided by VSS

may face the issue of inequity, which will, to some extent, constrain the intended impacts of

the Programme.

Difficulty in data management:

The respondents were particularly concerned about the production of a reliable database for

operations of ISSC system from the start. They believed that data collection, updating and

revision would be a very time-consuming and costly process. It required effective merge of

the two existing database managed by VSS and MoLISA At present, there has been no

integrated database and VSS, MOLISA and MOF have different management functions and

procedures, which make difficulties to establish an integrated database for SI/HI and SA

management.

As mentioned above, there are different views on the possibility of merging the two existing

database managed by VSS and MoLISA. The reason for the view of supporting merging the

two existing database managed by VSS and MoLISA is clear and reasonable that the software

used by VSS and MOLISA for data management has followed the international standards

with a space for adjustment. However, there is also a negative view on the merge. Therefore,

one of the difficulties in data management is how to get an effective merge of the two

existing database managed by VSS and MoLISA.

Some additional good surveys and analysis of data are needed to standardize information and

updating changes in beneficiary information and benefits, especially the changes that happen

26

annually. In some EM areas, such as those H’mong, women may change their family names

after marriage, and some family names are considered inter-changeable, such as

Duong/Giang and Dang/Tan are the same. In areas, where many EM people have no or

limited literacy, teachers and village heads register births and fill in other registration

documents for the former, hence leading to errors in birth certificates and registered

documents. This may result in inconvenience for EM beneficiaries in using health services

and receiving social assistance benefits. Therefore, the respondents believed that clear

guidelines and regulations on the implementation process, including institutional

arrangements and data collection and management are critical, which spell out clear roles and

responsibilities of stakeholders and authorized sources on personal information (such as the

stipulated use of information on ID cards, not on household registration booklets). Some

wonder about the consolidation of the verification documents, i.e. whether both plastic cards

and paper copies of beneficiaries’ signatures of payment have to be used for filing purpose.

They also want more guidance on authorized positions to enter, revise and update data as well

as issue cards in a manner that can ensure confidentiality, safety and convenience for all

related parties.

Coordination:

The administrators expressed their concerns about a plan for consolidating the existing

related databases of VSS and MoLISA, which now have different functions and data

collected on a basis of different information sources (one based on ID information while

another on household registration booklets). According to them, due attention should be paid

to the different outreach of the two system with VSS only to the district level while MoLISA

to the commune level. They expressed their hope for a clear division of roles and

responsibilities during the implementation process. This should be clearly spelled out from

the start. The commune’s labor officers worried that the project might shoulder more

workload on them with no incentives provided, especially regarding registration and

management of beneficiaries, GRM, updating of changes in beneficiary status and benefits, to

avoid late payment and loss of funds. The coordination with the existing projects related,

such as SASSP, should be taken into account for synergy and saving of resources.

Administration:

The respondents expressed the needs for new and clear procedures and processes to run the

ISSC system. They were concerned about whether a combination of both hard and e- copies

would still exist under the ISSC system, for example regarding the verification of payment

documents for final accounting will be completely electronic or is still paper-based when

hard copies have to be printed out for checking. The current practice was described as

cumbersome and time-consuming. If the hard copies were required, the ISSC system would

be more costly and time-consuming as the respondents found it easier and cheaper to print

paper cards. Also, they are concerned that a considerable number of cards may be wasted

every year as people change their status and become no longer eligible. In case of

connectivity with the ATM system, Agribank is the only provider in many remote areas

where many EM groups live. In many areas, only a machine is located in the district centre,

which is far away from many beneficiaries. Commune labor officers are concerned that if

reading machines are not located in CPC, they cannot follow details of payment to respond to

beneficiaries’ queries as they do with paper cards at the moment.

Concerns of potential EM beneficiaries:

27

Social/health insurance and assistance service users may suffer difficulties in using smart

integrated social/health insurance and assistance cards: Most of the respondents in visited

villages in Ha Giang and Quang Nam have never seen smart cards before. Therefore, they

cannot use smart cards for getting their payment without very careful and effective training.

The people, who get state budget- sponsored social assistance and health insurance, are

usually poor or ethnic minorities, living in remote areas. Most of them are with low education

level or with language barriers in communication. These may be obstacles to them to get the

knowledge transferred on using smart integrated cards. Many people with revolutionary

merits, pensioners and social assistance beneficiaries in EM areas may prefer paper-based

approach in the initial stage, therefore it may be time-consuming to change their awareness

and habits.

The EM respondents were concerned about the issuance of temporary cards for use in health

emergency cases in case of loss and misinformation of beneficiaries. They requested for due

attention to the issue of authorization, such as for guardians of children, elderly people with

severe disabilities and serious mental health illness who can't use ISSCs on their own. The

authorized persons should be allowed to be flexible, not necessarily household heads. They

also raised the issue of potential abuse of authorization to use cards as mortgage for informal

loans.

In the case of connectivity with the ATM system, they stressed the necessity to address some

concerns regarding operations of the ATM system, such as confidentiality, security, and

location of machines (some potential beneficiaries may need to travel up to 30km to reach the

district centre). Social assistance and health insurance card users may suffer problems in

getting payment through ATM because of forgetting the passwords for their cards. If they

note their password down in some paper or book, the security may be violated. Difficulties in

using smart integrated social/health insurance and assistance cards may make social/health

insurance and assistance service users want to come back to the current practice: getting the

payment through post offices at commune centers.

Financial aspects: Social assistance and health insurance card users would suffer problems

in getting their smart integrated cards replaced in the case of loss because the fees for getting

the lost cards may be higher than their expectation. They were keen to learn about the cost of

producing and reproducing ISSCs. They discussed at length the issues on whether to penalize

the loss of electronics and, if yes, the implications of these penalties and to what extent they

should be. These concerns are related to their potential needs for regular updating and

revision of personal and household information as well as insecure practice of card storage,

especially in EM areas. Most of the respondents shared that they would willing to pay VND

20,000 for getting a replaced card for the lost one, or VND 50,000 for some other groups of

respondents, but not higher.

Communication: The respondents were concerned about effective communication, including

regular consultation and training on usage, with potential EM beneficiaries. The issues

concerned by the respondents are specific, like how to use the cards for getting SI/HI and SA

services, how to apply for a replaced card in the case of loss, costs for updating and

reproduction of a card, and how to monitor the payment... Demonstration or training on ISC

use would be given to social assistance and health insurance card users to facilitate their uses

of integrated, smart cards. However, the consultation and training on ISSCs usage would be

given to village heads, mass organizations officials and voluntary members first before

training to beneficiaries. In addition to that, the fact that the female respondents from Thanh

Van commune, Quan Ba district, Ha Giang were not satisfied with the list of 2015 poor

28

households may show that they they don't understand throughly the criteria for selecting

multidimention poor households, which is significantly different from the simple poverty

criteria. The weak communication on multidimention poverty, causing disputes and

complaints as found out currently from the field study, may create delays in integrated

identification of HI and SA beneficiaries, which may influence on the proposed project

implementation progress. Therefore, communication on multidimention poverty should be

added into the communication content.

Selecting a relevant method of demonstration or training is very important. The respondents

shared that there are many traditional events among their ethnic minority groups, like

"Buffalo sacrifice" of Co Tu, "Coi singing" of Dao... Most of ethnic minority people, even

from remote areas, would come to attend those events. Therefore, those events could be taken

as the opportunities to meet the people from very remote areas. However, the respondents

concerned about the relevance of those events for organizing the communication/training

activities on the use of ISSCs because of technical nature of the ISSCs. Issuance of leaflets

may not be a good way because of literacy problems among ethnic minority groups in remote

areas.

Training of trainers so that the trainers will transfer the knowledge on how to use ISSCs to

SI/HI and SA users many be more relevant. All respondents from Ha Giang have agreed on

first importance role of village social assistance collaborators and village heads in carrying

out communication on the social/health insurance and social assistance related policies. The

second importance role has been given by the respondents to heads of mass organizations,

like the heads of party unit, women union, youth union....

Administration of the ISSC system: The biggest concern was about the location of service

points and reading machines and/or other necessary facilities, and post offices and commune

centres were cited as more convenient venues. The respondents raised the issue on which

agency would be responsible for reproduction and re-issuance of cards as well as

responsibility and budgeting for maintaining and repairing reading machines to avoid long-

term disruption of service, especially for health insurance. They were also concerned about

the timing for issuing cards as paper cards are now issued on the 1st day of the month while

users may need it earlier after registration. In case of no connectivity with the ATM system,

attention should be paid to allocation of sufficient and flexible time for receiving benefits.

Design of ISSCs: The respondents expressed their concerns about the types, capacity, and

contents of ISSCs, particularly transparency of information in ISS cards for health insurance

usage and SA benefits. They questioned about the offline and online usage functionality of

ISS cards. They also wondered what types of personal and household information would be

provided on (e.g. beneficiary names and DoB) and inside cards (e.g. family members, photo,

DoB, health checks, all benefits). They questioned whether the ISSC system would be

connected with the SMS service to provide more timely information and transparency for

beneficiaries. They also worried about potential production of fake cards. In addition, there

might be a sense of comparison among pensioners, health insurance and social assistance

beneficiaries if their ISS cards look the same for different categories of beneficiaries.

Possibility of using social assistance allowance for wrong purposes: As mentioned above,

heads of most households in the visited villages are men. There is a practice that men can use

the money for some purposes (for purchasing mobile phone, TV...) without agreement of

their wives. The H'Mong ladies from Ma Hong village, Thanh Van commune of Ha Giang

shared that they had to follow their husbands even when they are very drunken. Therefore,

29

there may be cases of using social assistance allowance for wrong purposes. The fact that

some schools in the visited communes/districts asked post office agencies to use their schools

as the venues to pay education allowance can show that school managers feared that their

students' parents could use education allowance for other purposes, but not for supporting

their children's education. The payment through ATM by using smart integrated cards may

make wives in disadvantaged areas difficult to know when their husbands get the social

assistance payment (in the case of getting the payment from post office, the date is

determined). Getting payment in big centers (district centers, for example) may encourage

husbands to buy some things, even for drinking, instead of bringing back home to give their

wives for right household expenses.

3.3. Gender issues

This project is gender-informed. As part of the SA, the project also carried out gender

analysis. The SA reflected benefits of the ISSC towards women in managing household

benefits and indicated the necessity to increase the participation of women, especially those

from EM groups, in project activities, such as information dissemination and training. It is

important to raise women’s awareness of their rights and benefits in social insurance, health

insurance, unemployment insurance and social assistance, as well as access to the ISSC, their

rights to access to the GRM system and how to lodge their complaints when needs arise. The

SA showed that female attendance at information workshops and meetings may be low. The

SA recommended the following gender agenda which would contribute to reducing the

gender gaps (i) promoting the participation of women throughout the project cycle; (ii)

organizing information dissemination activities specifically for women who will be

household managers and users of cards, to enhance women’s current access to information

and their associated engagement in the project; (iii) reducing women’s household workload

through the introduction of the ISSC with more convenient services; (vi) training provided to

local administrators as well as project staff should take into account cultural relevance and

gender sensitivity; and (v) boosting the participation of grassroots women’s unions in

communication activities, complaint resolutions, and gender-sensitive support to female users

of the ISSC. During the monitoring of the EMDP implementation, the key indicators of

gender actions will be monitored and reflected in internal and external monitoring reports.

In many households, men are the persons, who go to their commune center to get

social/health insurance and social assistance allowance payment because men are household

heads as noted in household registration/residence books in many cases. The female

respondents from Ha Giang, of both Dao and H'Mong ethnic minority groups, shared that

husbands had a quite dominant position in many households.

Money recipients can be registered, not necessarily formal household heads. However, most

of the social/health insurance and assistance beneficiaries are poor and ethnic minority, who

live in disadvantaged and remote areas. In remote areas, it usually takes a long way for SI/HI

and SA beneficiaries to go to their commune center from their home to get the payment. Most

of female respondents don't have motorbikes and can't ride motorbikes. Therefore, many

ladies are in more disadvantaged position to receive and use SA alloawance payment,

because it is more convenient for men to go to commune centers for getting the payment and

men are more likely registered as SA recipients.

The ladies respondents in Thanh Van commune shared that most of the decisions on spending

a big amount of money were with agreement of both sides. However, men can make some

30

decisions on using their household income without agreement from their wives because most

of the money are in their hands, for example, for purchasing mobile phones or TV. In some

cases, the education allowance may be used for wrong purposes, but not for children's books,

notebooks and stationary. Therefore, there would be a concern on wrong use of SA allowance

when having ISSCs, if communication on how to promote right targeted SA allowances was

ineffective.

Some gender inequality in visited villages has been reflected in the fact that most of ladies,

respondents, have no mobile phones, while their husbands have. Having no mobile phone,

many female HI/SA beneficiaries would lose a chance to be trained on how to use and read

ISCs through learning through demonstrations on mobile phones. However, many of them

showed their interest in having an integrated cards so that they could use for getting social

assistance allowance and to pay for health care services. They think that they can learn how

to use the cards through watching the demonstration in TV or smart phone of their husbands

or children.

3.4. Stateholders analysis:

The following is the VSS Modernization project stakeholders analysis based on the findings

from the SI/HI and SA practice, the project design, the potential impacts of the project and

the potential concerns of the project stakeholders.

31

Stake

holde

rs

Areas of interest in

project interventions

Areas of concerns in

project activities

Current

constraints in

delivering

SI/HI and SA

Actions

recommended

SI/HI

admi

nistr

ators

.

SS business

administration reform.

Development of the

institutional and legal

framework for

information sharing

across databases and

agencies, and for

information

consolidation &

management.

Building an integrated

Social Security Card

(SSC) system which

will used not only by

VSS, but also by

MOLISA, health

facilities and

individual clients

Staff training & TA to

ensure that the SSC

system operates

seamlessly with the

underlying business

systems of VSS&

that it is sufficiently

secure to avoid

introducing cyber

threats into VSS

systems

Changes in macro-level

policies relating to social

and health insurance and

social assistance at the

national level;

Limited coordination

between the related

ministries and sectors; and

influential factors from

other sectors beyond the

control of VSS.

Fast-changing IT

development may make the

original objectives and

measures outdated, which

need changing in

accordance with the new

developments during the

implementation process.

Lack of incentives to staff

to being built adequate

capacity.

Lack of

integrated

SI/HI and SA

services

delivery

system;

Insufficient

human

resources to

provide

effective

delivery of

SI/HI and SA

services;

Different

business

processes for

SI/HI and SA.

Two

management

information

systems owned

by two sectors

in delivering

SI/HI and SA

services to

users;

.

Prepare specific

regulations on the

roles and

responsibilities of

agencies at various

levels which are

authorized to update

information on the

users/beneficiaries of

SI/HI and SA service

One integrated

management

information system

to manage both SI/HI

and SA service users;

CB in application

and maintenance of

the MIS on SI/HI and

SA and delivery of

the payment to SI/HI

and SA officials;

Com

mune

offici

als

Business requirements

assessment;

Capacity building for

commune officials to

give guidance to

SI/HI and SA service

uses on how to use

ISC, how to read the

information on ISC

and how to monitor

the payment to ensure

sustainability of the

VSSMP outcomes in

the long run;

IT capacity building

to updated

Commune officials may not

understand the project

objectives and activities

because of lack of

involvement from the

beginning;

Commune officials may not

have sufficient resources

and capacity to help SI/HI

and SA users in their

communes in understanding

how to use ISC, how to read

the information on ISC and

how to monitor the payment

to ensure sustainability of

the VSSMP outcomes in the

long run;

Big load to

commune labor

and social

affairs officials

may cause

missing

users/beneficiar

ies of SI/HI and

SA service,

who live in

very remote

areas or

mistakes in

updating

information;

Training to commune

labor and social

affairs officials on

using the software

for updating

information on the

users/beneficiaries of

SI/HI and SA

service;

Training to commune

labor and social

affairs officials on

how to use ISC, how

to read the

information on ISC

and how to monitor

the payment for them

32

information on the

users/beneficiaries of

SI/HI and SA service;

Limited capacity to update

information on the

users/beneficiaries of SI/HI

and SA service.

to give guidance to

heads of

villagers/villagers.

SI/HI

and

SA

users

(gene

ral

publi

c)

SI/HI and SA users

are interested in how

to use ISC, how to

read the information

on ISC and how to

monitor the payment.

Lack of effective

communication activities to

raise public awareness;

ISCs are new to most of

SI/HI and SA users, so most

of users concern about how

to use ISC, how to read the

information on ISC and

how to monitor the payment

Fragmentation,

overlaps and

missing in

SI/HI and SA

beneficiary

identification

and payment;

Effective& practical

communication

strategies for

VSSMP;

Training/guidance on

how to use ISC, how

to read the

information on ISC

and how to monitor

the payment, given to

SI/HI and SA users

SI/HI

and

SA

users

(EM)

Ethnic minority SI/HI

and SA users in both

Ha Giang and Quang

Nam welcome ISC.

They are interested in

how to use ISC, how

to read the

information on ISC

and how to monitor

the payment.

ISCs are new to most of

SI/HI and SA users, so most

of users concern about how

to use ISC, how to read the

information on ISC and

how to monitor the

payment;

Many users concern about

the cost for replacement of

lost cards;

Lack of

knowledge of

how to use

ISC, how to

read the

information on

ISC and how to

monitor the

payment;

Poor literacy;

Language

barriers: The

H'Mong, Dao

in Ha Giang

and Co Tu in

Quang Nam;

Limited literacy of

many EM SI/HI and

SA users requires a

relevant

communication

strategy of the

project (simple, in

ethnic minority

language, culture-

tailored, visual)

Othe

r

vulne

rable

SI/HI

and

SA

users

(poor

/near-

poor)

Similar to ethnic

minority SI/HI and

SA users, poor/near-

poor users also

welcome ISC. They

are also interested in

how to use ISC, how

to read the

information on ISC

and how to monitor

the payment.

Lack of

knowledge of

how to use

ISC, how to

read the

information on

ISC and how to

monitor the

payment;

Poor literacy;

Illiterate people may

be provided with

assistance from

literate neighbors or

village cadres;

Demonstration can

be shown through

smart phones, local

TVs, or by

community sessions

IV. Recommendations

This section highlights strong messages to address the above-mentioned constraints to

minimize potential negative impacts as well as optimize beneficiary utilization of integrated

social/health insurance and social assistance services provided by VSS and Labor and Social

Affairs agencies. The recommendations are presented on a basis of their linkages to various

components, sub-components and activities under the project. They include:

33

4.1. For design:

Data management:

A reliable standardized database available from the start of the project is crucial. The

establishment of a common database should take advantage of the latest surveys from VSS

and MoLISA (Decree 136 census and the poverty census). The SI/HI and SA business

processes should be renovated and the objective of using data by VSS and MOLISA agencies

should be clear before designing the integrated information system. Information sharing

mechanism should be established. Enumerators of personal or household data should have

good understanding of socio-cultural profiles and practices that may lead to changes or bias

of information that they are expected to collect.

Administration:

A socio-political analysis of stakeholders, including cost/benefit and SWOT analyses, is

needed. There should be a coordination board at the district level, including representatives

from the health, labour and insurance sectors, to ensure smooth implementation. In addition,

direct and regular consultations with stakeholders, administrators and users alike, are

important. To promote close coordination between different related ministries/agencies in

related policy making and the program implementation, a steering committee should be

established at the national level, chaired by a Deputy Prime Minister, with the members as

representatives from the health, labour and insurance sectors. The functions, mandates and

responsibilities of different related agencies for the ISSC system management should also be

defined clearly.

Design of ISSCs:

The personal and household information on and in ISSCs should be beneficiary names, DoB,

family members, photo, health checks, and all benefits. The validity period of a card should

be long-term. Furthermore, it is important to consider individual accounts linked to the ISSCs

for online access beneficiaries’ information on insurance and social assistance benefits, as is

being done with the Vietnam Improvement Land Governance (VILG) project. To help the

ISSC users more convenient in getting the payment for their households, in addition to the

key person, who is registered as the head of households to get SI/SA payment, the second

member of households can be registered with the household code along his/her individual

code in the information on the ISSCs.

Ethnic diversity at the local level:

The needs and approaches to the project information vary considerably among EM groups,

depending on their differences in the level of development, ability to receive, environmental

conditions and platform experiences. Cultures and customs also vary among ethnic groups as

well as within an ethnic group. All activities in the VSSMP should be designed with the

considerations of ethnic diversity as most of the beneficiaries of the project are ethnic

minority. Mitigation measures are very different in each province as a result of differences in

their cultures and customs. Hence, VSSMP should have different measures for different EM

groups to avoid irrelevance.

Consideration of gender sensitivity:

34

It is essential to increase the participation of women, especially in the EM groups in the

project sites, in various project activities and interventions, such as information dissemination

and training. It is important to raise awareness for women of their rights and benefits relating

to social insurance, health insurance, unemployment insurance and social assistance benefits,

their rights to access to the GRM system and how to lodge their complaints when needs arise.

It should be recognized that engagement of and awareness raising for women, especially EM

women, is a time-consuming process which should be planned and phased effectively with

clear and practical short-, medium- and long-term objectives to make various steps feasible,

with lessons reviewed and learnt as well as plans revised after each phase. Importantly,

women from various EM groups should be consulted in good faith throughout the project

cycle, from the design to the evaluation steps to ensure their voices to be heard and paid due

attention to. There is a risk that female attendance at information workshops and meetings

may be low. Specific measures may therefore be necessary to enhance women’s current

access to information and their associated engagement in VSSMP. Efforts will be needed to

arrange a location and time suitable for the participation of women, and additional

promotional activities may also be necessary to maximize attendance by female

householders. Training provided to local administrators as well as project staff should take

into account gender sensitivity.

4.2. For implementation:

Training:

Adequate training should be provided for administrators. In specifically, training will be for

district and commune cadres first, so that they can provide training to village heads or any

capable persons in charge in villages. Training sessions for EM beneficiaries should ideally

be conducted directly at a village level, with hands-on demonstration, in EM languages, and

by the same EM people, preferably village heads. The training for village heads should be

adequate to answer the questions, raised by villagers, on ISSCs and related policies.

Training's presentations should be in CDs or presented at meetings or through smart phones,

local TV..., with special attention given to ethnic minority groups. Time should be aranged

appropriately for people to attend meetings. In addition, villagers are to be supported for

making registration.

. The training given to villagers on how to use smart cards, how to read electronic

information in their cards can be organized together with the meetings of villages or village

Youth Union, Women Union meetings. Guoi houses of Co Tu may serve as venues to

organize trainings with meetings. The training, using demonstration on smart phones may be

more relevant to men than women in non-disadvantaged areas as most of women in

disadvantaged areas have no smart phone and don't know how to use smart phone.

Traditional festivals may be to used as the events as the opportunities to gather most of ethnic

minority people for providing training on how to use smart cards, how to read electronic

information in their cards to Dao, H'Mong and Co Tu minority groups because the biggest

festival of Co Tu is Buffalo Sucrifice, of Dao and H'Mong are Coi, Then Singing festivals..

Timing strategy:

Given many constraints in the EM areas, many respondents, both administrators and

beneficiaries, suggested piloting and phasing for EM areas and EM groups to learn lessons.

They preferred the phased implementation from the lower to the higher land areas, from

35

towns to rural areas, as well as from areas with better educated people to those with less

educated ones.

Communication:

It is important to prepare a communication strategy with culturally appropriate activities for

EM people regarding project information. Awareness-raising activities and events in EM

areas are important so that EM beneficiaries would know how to use and protect cards well,

possibly through the FPIC process, village heads, role-plays, and DVDs. Socio-cultural

events may be taken into account for communication work. Different ways of communication

should be considered for different groups of EM beneficiaries with different levels of

awareness. Ideal venues for communication events should be taken into account, such as a

village community house, Gould house (for Ko tu).

It is important to take advantage of socio-cultural characteristics for the communication

strategy, including for community activities and events, although a diversity of situations may

exist across the country. Amongst the EM populations, wherever possible written forms of

information should be minimized, while greater attention should be paid to capacity building

amongst heads of villages and local cadre to ensure that these individuals fulfill their current

role as key disseminators of information more effectively. As EMs tend to be heavily

dependent on village leaders and cadre as sources of information, capacity should be built at

this level to ensure householders are regularly updated about the processes, and their potential

involvement. For example, for the H’mong and Dao groups in Ha Giang, it is important to

communicate project information and guidance to village heads who are considered closer to

their community and can make a substantial impact on households and individuals. It is ideal

to produce user-friendly guidance with pictures and short, as well practical hands-on

demonstration guidance, which could be recorded into DVDs for standard and repeated use

among EM groups. Moreover, finger-print technology should be used for illiterate people. It

is also necessary to examine the roles of village heads, elderly and respected persons in

community life, particularly in communication and GRMs. In many cases, they may be useful

but may face constraints when they themselves do not understand issues.

Citizen engagement:

Consultations were carried out in October, November and December 2016. Apart from

community consultations, including those with various EM groups, meetings were held with

representatives from VSS and MoLISA at the national, provincial, district and commune

levels. The SA reviews have confirmed a general interest amongst the stakeholders in the

introduction of and access to the ISSC. The SA also identified a potential risk that the poor

and remote areas could be excluded from project activities and benefits. To address this, the

project would undertake targeted activities to reach out and ensure participation

of/consultation with poorer communities, women, EM communities and other vulnerable

groups to ensure that beneficiaries of the ISSC are well informed of their rights

and responsibilities.

GRM:

GRM has been regulated by the Law on Denunciation 03/2011/QH13, Law on SI

58/2014/QH13, Law on Employment 38/2013/QH13, Law on HI 25/2008/QH12, Amended

Law on HI 2014. VSS has recently issued the Decision 868/2016/QD-BHXH in June 8th,

2016 on Complaints and Denunciation. However, because many of the VSS modernization

36

project beneficiaries are the poor and ethnic minorities, the grievance redress mechanism

should be adapted to the needs of specific EM groups in terms of language and cultural norms

on complaints. In doing so, the VSS Modernization project should enable EM groups,

including those with weak political connections, to register complaints on social/health

insurance and social assistance issues.

Some administrators argued that grievances can be redressed through annual meetings with

voters and VSS’s annual meetings with local people. With the proposed ICS, some

administrators suggested that the SI/HI and SA users can send their complaints online

through a menu on ISC or in papers. However, many EM respondents prefer direct

communication, rather than through a help-line service. They trusted the role of the village

management boards in settling grievances. To help the vulnerable groups of ethnic minorities

to be engaged in the feedback mechanism village elders should be involved. Along with

setting an appropriate grievance redress mechanism, communication should be enhanced to

raise the awareness by local people of their rights to send complaints to higher administration

levels or mass organizations/CSOs. As mentioned above, the respondents from Thanh Van

commune, Quan Ba district, Ha Giang shared that they didn't agree with the list of poor

households in their village. However, they didn't dare to come to commune PC for sending

complaints, although they haven't been satistified with the explaination, given by their

villlage head.

The women’s unions may be incorporated into the institutional structure of implementation

under the project, especially for mobilizing participation and being involved in informal

grievance redress channels. Efforts will be needed to arrange a location and time suitable for

women, and additional promotional activities may also be necessary to maximize attendance

by female householders. For meetings with EM groups, it will be necessary to identify

individuals with proficiency in EM dialects, who can act as interpreters and provide a careful

briefing to ensure that the issues and terms to be used in Vietnamese are clearly understood

and well communicated.

M&E:

Some key indicators should be monitored during the implementation of the project, including

number of cards issued to EM, frequency of visiting to medical facilities by EM/female

health insurance users, percentage of EM SI/HI and SA beneficiaries, participating in training

on how to read and use ISSCs.

Annexes

Annex 1: Overview of socio-economic information of the people in the

project area

Vietnam is a country, where equality and equity have been given high attention by the

Government since the establishment of the State. All the poor, the children under six and the

elder people over eighty have been receiving free of charge HI cards and different kinds of

social assistance allowance. Near poor people have benefitted from partly sponsored by the

State HI. Recently, most of the provinces have subsidized 30% of the total fees for HI cards

for near poor people. Therefore, the number of users/beneficiaries of social/health insurance

and social assistance have increased more and more, especially the HI users as near poor

people. For the last three years, the percentage of the people, having HI, has been raised from

68.7% in 2014 to 76.5% in 2015 and 81.3% in 2016 (see the Table 1).

37

Table 1: Health insurance coverage in Vietnam, 2014-2016

2014* 2015* 2016**

% Number % Number %

HI users/beneficiaries,

national wide

68.7 70 76.5 75 81.3

* Source: http://www.nhandan.com.vn/xahoi/bhxh-va-cuoc-song/item/28557902-khoang-77-dan-so-tham-gia-

bao-hiem-y-te.html, 18/1/2016

** Source: http://baocongthuong.com.vn/bao-hiem-y-te-dat-ty-le-bao-phu-813.html, 20/12/2016

The target, set for health insurance coverage by 2020, is that at least 90% of the total

population will have health insurance. To achieve this target, in the context of significant

reduction of poverty (see the Table 2), higher attention has been given to near poor and non-

poor people to increase the HI coverage among those groups of people. This is reflected in

the figure that 90% of near poor people have HI cards by 2016. Promotion of whole

household HI package is also one of the policies, issued by the Government recently, to

increase HI coverage.

Table 2: General poverty rate, multi-dimention poverty rate, by gender and minorities,

2010- 2014

2010 2012 2014

General poverty

Whole country 20.7 17.2 13.5

Urban 6 5.4 3.6

Rural 26.9 22.1 18.6

By regions

Red River Delta 11.4 7.4 4.9

North East 37.7 33.5 29.1

North West 60.1 56.7 54.3

North Central Coast 28.4 21.2 19.4

South Central Coast 18.1 15.3 9.7

Central Highlands 32.7 29.7 30.4

South East 5.6 5.8 4.1

Mekong River Delta 18.7 16.2 9.8

Multi-dimention poverty

Whole country 26.1 23.9 21

Urban 11.2 10.4 7.4

Rural 31.5 29.1 26.6

By gender

Male 27.3 23.7 21

Female 21.2 24.1 21.1

By ethnic minorities

Kinh, Chinese 18.5 16.4 14.1

Others 59.4 57.4 52.4

By regions

Red River Delta 8.4 7.1 8.0

North East 37.1 36.6 36.0

38

North West 58.2 62.0 50.3

North Central Coast 25.7 20.2 26.4

South Central Coast 19.3 19.0 14.0

Central Highlands 33.2 29.4 30.5

South East 15.8 12.4 7.4

Mekong River Delta 40.7 36.1 27.5

Source: GSO, 2016

Ha Giang is in the most Northern location of Vietnam with the major area of high mountains

and many rivers and springs. Travel and transportation are big challenges in Ha Giang. This

has created big difficulties to the people and children in Ha Giang, living in the most

disadvantaged areas, in getting access to social services delivery. It is reflected in very high

multi dimension poverty rate in 2016 of Ha Giang.

There are more than twenty ethnic groups in Ha Giang. Hmong takes a highest proportion of

the population (32.0%), followed up by Tay (23.3%) and Dao (15.1%). Only 13.3% of the

provincial population is Kinh. Because of high proportion of population belong to ethnic

minority groups, most of the people living in Ha Giang has health care insurance cards.

Table 3: Ha Giang' population by ethnic groups, 2015

Persons %

Total 806,702 100

H'Mong 262,378 32.52

Tay 187,422 23.23

Dao 120,592 14.95

Kinh 104,243 12.90

Others 132,067 16.40

Ha Giang is the one of three poorest provinces in Vietnam. The multi dimension poverty rate

in 2016 of Ha Giang is lower than only the one of Dien Bien province. (Dien Bien (48.14%),

Ha Giang (43.65%), and Cao Bang (42.53%). There are one city and ten districts with 177

communes, 5 wards and 13 towns in Ha Giang. Six of ten districts belong to 62 poorest

districts in the country (See the Table 4).

Table 4: Multi- dimension poverty in Ha Giang, 2014- 2015 (%)

2015 2016

Total Kinh Ethnic

Minorities Total Kinh Ethnic

Minorities Total 43.65 1.49 98.51

Hà Giang city 1.33 25.95 74.05 0.81 21.00 79.00

Bac Quang 13.90 10.66 89.34 11.89 5.81 94.19

Quang Biình 33.65 3.32 96.68 29.01 1.67 98.33

Vi Xuyen district 33.50 3.4 96.6 29.32 3.11 96.89

Bac Me 38.73 1.95 98.05 36.55 0.21 99.79

39

Hoang Su Phì 61.04 1.67 98.33 53.19 0.06 99.94

Xín Man 62.22 0.06 99.94 54.78 0 100

Quan Ba district 61.17 0.27 99.73 54.55 0.29 99.71

Yen Minh 61.42 0.1 99.9 53.88 0.1 99.9

Dong Van 71.14 0.22 99.78 65.07 0.01 99.99

Meo Vac 66.01 0.02 99.98 59.99 0.02 99.98

Source: Ha Giang DOLISA

Vi Xuyen is one of four better-off districts in Ha Giang. 100% of communes in Vi Xuyen are

accessible by cars and connected to the national electricity grid. 70% of the households in Vi

Xuyen have used electricity services and 90% the households have television. There are 15

ethnic groups in Vi Xuyen, including Tay, Dao, Kinh, Nung… 80% of the population in Vi

Xuyen are ethnic minority. 96% in 2015 and 99.5% of the people in Vi Xuyen has health care

insurance cards.

In Cao Bo commune, where the team took the visit, more than 90% of population is Dao

ethnic groups. Kinh has taken only some percentage of the commune population. Therefore,

most of the people in Cao Bo commune has health care insurance cards and their children

have been benefiting the education social assessment.

Quan Ba is one of six poorest districts in Ha Giang with the multi-dimension poverty rate of

higher than 60%. There are one town (Tam Son) and twelve communes in the district,

including Bat Dai Son, Can Ty, Po, Dong Ha, Lùng Tam, Nghia Thuan, Quan Bạ, Quyet

Tien, Ta Van, Thai An, Thanh Van, Tung Vai. There are fourteen ethnic groups in Quan Ba

with highest population proportion of H'Mong, followed up by Tay ethnic minority. Kinh

takes only 5% of the district population. Because of the high percentage of ethnic minority

population, the percentage of people, having health care insurance cards, is very high in Quan

Ba (99%).

Ha Giang is one of the provinces with high proportion of population, having health care

insurance because of high percentage of poor and ethnic minority households. Around 96%

of people in Ha Giang have health care insurance cards (Table 5).

Table 5: Number of people with health insurance in Ha Giang, 2014- 2015

2014 2015

Total Kinh

Ethnic

Minorities Total Kinh

Ethnic

Minorities

Total

Hà Giang city 31,158 24,647 6511 45,913 39,632 6281

Bac Quang 91011 34032 56979 89852 50545 39307

Quang Biình 59,457 12,463 46994 59,797 22,234 37563

Vi Xuyen district 93501 26831 66670 97698 40404 57294

Bac Me 51,980 11,596 40384 52,260 11,925 40335

Hoang Su Phì 63,550 13,882 49668 65,334 14,908 50426

Xín Man 61,501 12,876 48625 64,011 14,635 49376

Quan Ba district 48,623 11,676 36947 50,149 7,233 42916

Yen Minh 84,396 20,042 64354 88,505 21,873 66632

Dong Van 71,484 16,380 55104 73,472 13,431 60041

Meo Vac 71,801 14,198 57603 76,685 21,334 55351

40

Source: Ha Giang's VSS

Note: Excluding the data on the HI owners, who are solders and on maternal leave

Quang Nam is also a poor province (Table 4), which has suffered a lot of natural disasters.

Most of Co Tu (74.23% of the total Co Tu population in Vietnam) is living in Quang Nam.

Table 6: Poverty incidence in Quang Nam, 2015

TT Districts/t

owns

Total

populatio

n

Poor and near

poor HHs Broken down by

Total

(HHs) (%)

Poor HHs Near poor HHs

Number

of HHs %

Number

of HHs %

A B 1 2=4+6 3=5+7 4 5=(4:1)x100) 6 7=(6:1)x100)

Whole province 401,772 76,751 19.10 51,817 12.90 24,934 6.21

Low land 323,699 38,409 11.87 19,922 6.15 18,487 5.71

1 Tam Ky 29,272 1,342 4.58 500 1.71 842 2.88

2 Hoi An 21,301 491 2.31 121 0.57 370 1.74

3 Dai Loc 40,464 6,975 17.24 3,394 8.39 3,581 8.85

4 Đien Ban 54,268 3,646 6.72 1,663 3.06 1,983 3.65

5 Duy Xuyen 34,436 4,731 13.74 2,826 8.21 1,905 5.53

6 Thang Bình 52,925 7,525 14.22 4,332 8.19 3,193 6.03

7 Que Son 27,617 6,904 25.00 3,352 12.14 3,552 12.86

8 Núi Thành 41,811 5,263 12.59 2,991 7.15 2,272 5.43

9 Phú Ninh 21,605 1,532 7.09 743 3.44 789 3.65

Mountain. areas 78,073 38,342 49.11 31,895 40.85 6,447 8.26

03 poor districts,

NQ 30a 17,399 10,924 62.79 10,055 57.79 869 4.99

1 Tay Giang 4,387 2,182 49.74 2,108 48.05 74 1.69

2 Phuoc Sơn 6,320 3,863 61.12 3,203 50.68 660 10.44

3 Nam Tra My 6,692 4,879 72.91 4,744 70.89 135 2.02

03 districts with

high poverty rate 22,952 13,422 58.48 12,162 52.99 1,260 5.49

1 Bac Tra My 10,306 5,956 57.79 5,365 52.06 591 5.73

2 Dong Giang 6,374 3,460 54.28 3,154 49.48 306 4.80

3 Nam Giang 6,272 4,006 63.87 3,643 58.08 363 5.79

03 hill districts 37,722 13,996 37.10 9,678 25.66 4,318 11.45

1 Hiep Duc 11,249 3,459 30.75 2,442 21.71 1,017 9.04

41

2 Tien Phuoc 17,895 4,607 25.74 2,564 14.33 2,043 11.42

3 Nong Son 8,578 5,930 69.13 4,672 54.46 1,258 14.67

42

Annex 2: A sample of the recaps of the meetings with selected VSS

modernization project stakholders during the field sudy.

November 22nd, 2016

Started at 14h and ended at 15h

Interviewer 1: Nguyen Tam Giang

Raporteur: 2.

Venue: Thac Tau village, Cao Bo commune, Vi Xuyen district, Ha Giang

Province District Commune Village Code

Ha Giang Vi Xuyen Cao Bo Thac Tau 1

2

Group discussion members::

1. Male stakeholders, Ethnic minorities: 8 3. Village heads: 1

2. Female stakeholders, Ethnic minorities: 1 4. Participants

STT Name Sex Age Ethnic

minority

Position Mobile

1 Bang Van Giang Man 1982 Dao Village heads 0129376000

2 Bang Van Qui Man 1972 Dao Head of party

unit

3 Dang Xuan Thai Man 1964 Dao Farmer

4 Bang Van Trang Man 1987 Dao Farmer

5 Dang Van Giang Man 1982 Dao Farmer

6 Bang Van Bong Man 1984 Dao Farmer

7 Dang Van Kien Man 1971 Dao Farmer

8 Dang Van Nhang Man 1992 Dao Farmer

9 Dang Thi Dung Woman 1988 Dao Collaborator

43

Recap of the meeting in Thac Tau, Cao Bo, Vi Xuyen, Ha Giang

22 November, 2016

1. Information on the respondents

The respondents are men from ethnic minorities of Thac Tau village, including the head of

village and farmers.

100% of the respondents are with health insurance cards and three of them are poor and one

is disable, having social assistance allowance.

100% of the respondents haven't seen and used electronic cards.

2. Social security card utilization practice

All respondents understand rightly the importance of social security cards and booklets and

the needs for keeping the cards and booklets carefully. Therefore, not many cases of

card/booklet loss and torn happened. However, there are some cases, that many household

members couldn't use HI/SA cards/booklets when needed because those HI/SA

cards/booklets are kept by one member of the families.

At present, social assistance beneficiaries are to receive their allowance at commune centers

from post office on the 5th day monthly. Respondents have to wait for 2-3 hours in a qeue to

receive payment. However, the respondents didn't complain about the time consumption for

getting payment. If they miss the date, the accumulated payment will be delivered in a next

month.

To get payment, they have to show their ID and residence books as the supporting document.

One of the respondents shared that there was a mistake in his HI card and it took a quite long

time to get the right HI card replaced. Therefore, he had to pay by him self for his medical

costs. Up to the time of interview, he hasn't received the reimbursement for the paid medical

costs.

3. Potential concerns and positive impacts from suing ISSCs

100% of the respondents shared that they hadn't seen and used smart cards. However, most of

them welcome and supported the use of moving from using paper cards to ISSCs;

According to the respondents, the following are the potential positive impacts of the use of

ISSCs:

- Safer use of ISSCs thank to that the information in ISSCs is more comprehensive to

help improving privacy;

- The cards are more sustainable, not tornable and waterable, which are not easily to be

cleared as paper cards;

- Plastic cards make the card owners feel more important to keep their cards carefully;

- People shown their welcome to get social assistance payment through ISSCs.

However, the most of the respondents shared the following concerns on ISSCs:

- Are the cards eligible to being replaced by news ones in losing cases? Are the fees for

replacement to be paid? How long to get the lost cards replace? For the waiting time,

how to get the payment of social assistance and insurance?

44

- According to the respondents, the replacement fees of VND 50,000 are acceptable,

VND 100,000 is high;

- Old people, the people, who are illiterate or don't know Vietnamese, can't us ISSCs;

- Whether there is abuse in using ISSCs?

4. Communication, guidance and proccesing the problems, happned in using ISSCs:

Most of the respondents recommended to use heads of villages, or heads of party units or

commune labor and socials officials for processing claims;

The following is list of stakeholders, prioritized for being engaged in communication and

training, ranked by respondents:

- Heads of villages/heads of party unit should involve in communicating and giving

guidance on the use of ISSCs;

- Commune labor and social affairs officials would give guidance directly to villagers

wth participation of heads of villages;

- Demonstration shows, clips;

- Bulletins.

The below is the list of people, who would be consulted by villagers in the case of having

problems, ranked by the respondents:

- People with high reputation in local areas;

- Heads of villages/heads of party unit;

- Commune labor and social affairs officials;

- Commune one stop-shop officials;

- District labor and social affairs officials;

- Established hotline: The respondents shared that they were not informed about the

hotline by their heads of village. The Thac Tau village head knows about the hotline,

but hadn't shared with his villagers, so he didnlt share the information with people

with his people.