Viet Nam: Second Health Care in the Central Highlands Project

Annual Monitoring Report on the Ethnic Group Development Plan

Project number: 44265-013 December 2018

Prepared by Ministry of Health, Central Project Management Unit for Asian Development Bank.

ABBREVIATION

ADB Asia Development Bank AOP Annual Operation Plan CHS Commune Health Station CPMU Central Project Management Unit EGDP Ethnic group development plan EM Ethnic Minority GAP Gender Action Plan GSO General Statistics Office ICP Inter-communal Policlinics IEC Information, Education Campaign IMR Infant mortality rate HI Health Insurance HICH2 Second Health Care in Central Highland HMIS Health Management Information System HS Health station MDG Millennium Development Goals MMR Maternal Mortality rate MOH Ministry of Health PC People’s Committee PAM Project Administration Manual PPMU Provincial Project Management Unit STD Sex transmission disease TOT Training of trainer U5MR Under 5 years old mortality rate VBA Village birth attendant VMW Village Midwife VHW Village heath worker WWTP Waste water treatment plant

This EGDP monitoring report is a document of the borrower. The views expressed herein do not necessarily represent those of ADB's Board of Directors, Management, or staff, and may be preliminary in nature.

In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

TABLE OF CONTENT

I. INTRODUCTION ...... 1 1.1. Introduction project ...... 1 1.2. Introduction about Ethnic minorities in 5 Central Highlands Provinces ...... 2 II. IMPACTS OF PROJECT ACTIVITIES TO ETHNIC MINORITIES ...... 8 2.1. Positive impacts of project activities ...... 8 2.2 . Negative/unwanted impacts ...... 11 III. PUBLIC CONSULTATION AND INFORMATION DISCLOSURE ...... 12 3.1. Public consultation ...... 12 3.2. Results of community consultation and information disclosure of the project ...... 14 IV. PROCEDURE FOR IMPLEMTATION OF ETHNIC MINORITY ...... 15 V. PENDING ISSUES ...... 17 VI. CONCLUSION AND RECOMMENDATION ...... 17 a. Conclusion ...... 17 b. Recommendation ...... 18

I. INTRODUCTION

1.1. Introduction project The project "Healthcare for the people in Central Highlands provinces - phase 2" (HICH2), sponsored by Asian Development Bank (ADB) was implemented from 2014 - 2019, with the aim to support the development of healthcare system in 05 Central Highlands provinces (Dak Lak, Dak Nong, Kon Tum, Gia Lai, Lam Dong) to meet the increasing health care needs of the people in the project provinces, especially the poor, ethnic minorities and other disadvantaged groups.

Finacial Aid Agreement No. 3038-VIE (SF) of the project was signed between the representative of the Socialist Republic of Vietnam and ADB representative on November 8, 2013 with a value of about US$70 million. The Financial Aid Agreement takes effect from June 23, 2014, and closing date is December 31, 2019.

The project consists of 3 components:

+ Component A: Strengthening primary healthcare at the commune level

+ Component B: Improving quality and access to health services at hospitals

+ Component C: Strengthening management capacity at all levels

The project supports improvement of community health care with a focus on maternal and child care for the poor and ethnic groups in rural areas. With the support of the district health authorities, at least 20% of commune health stations will be selected to perform primary health care tasks for people in the community including health care and nutrition and care for mothers and children. The project builds and extends previous programs to improve basic health care using standard packages and quality assurance mechanisms, helping to improve the healthcare system and address gaps in local health care resources. The impact of the project will improve health and nutrition in the Central Highlands, especially for women, children, the poor and ethnic minorities. The result will be increased use of health and health care services for mothers and children at district hospitals, regional polyclinics and CHSs.

The project has three main results: (i) improving access and quality of public health care, (ii) enhancing access and quality of hospital services, and (iii) strengthening health system management of the province. The project will support 5 Central Highlands

1 provinces, especially activities to improve health care for the poor, ethnic groups, women and children living in remote communities.

Objectives of the Project: To support the development of the people's health care system in the Central Highlands provinces with specific objectives to improve health care services for the people, especially the poor and ethnic minorities and other disadvantaged groups, aiming to reach the millennium development goals that Vietnam has committed to implement.

1.2. Introduction about Ethnic minorities in 5 Central Highlands Provinces According to survey data of the General Statistics Office and the Committee for Ethnic Minorities in the socio-economic survey of 53 ethnic minorities in Vietnam, the Central Highlands is one of the regions with a large number of ethnic minorities and diversity of ethnic composition. According to statistics by 1 July 2015 of the General Statistics Office, the Central Highlands population is 5.5 million people, of which Kinh people account for 64.7% of the region's population. Up to now, in the Central Highlands, all the 54 ethnic groups of Vietnam present. Except for a number of ethnic groups with a small population in the northern mountainous region with little migration such as Khang, La Ha, La Chi, Kho Mu, Xinh Mun, Ha Nhi, Phu La, Lu, Bo Y, Cong and Si La, Pu Peo, La Hu, Pa Then and O Du (have only a few population present in the Central Highland), over 40 other ethnic groups have migrated and found their residence area in 5 provinces of the Central Highlands for many years.

Table 1: Population of Ethnic Minority in Central Highlands (as of 1 July 2015)

Ethnic Kon Tum Gia Lai Dak Lak Dak Nong Lam Dong

Tay 2,855 12,432 56,534 23,054 21,737

Thai 7,453 4,992 19,570 10,463 5,863

Muong 7,257 7,788 17,027 4,468 4,880

Nung 2,800 12,804 74,222 27,747 24,978

Mong - 1,700 26,321 26,040 3,672

Dao 109 4,647 17,010 15,297 2,826

E de 417 397 330,936 6,121 202

Ethnic Kon Tum Gia Lai Dak Lak Dak Nong Lam Dong

Gia Rai 23,740 425,209 18,286 65 54

CO Ho 3 10 171 185 166,391

Xo Dang 122,618 797 9,595 5 15

Ba na 61,827 177,270 361 40 42

Mnong 30 1,700 26,321 26,040 3,672

Brau 448

Ro Mam 479

Source: GSO, 2015, Ethnic Minority Committee, Socio-Economic Investigation of 53 Ethnic Minorities

According to Committee for Ethnic Minority Affairs (CEMA), the poverty rate in the Central Highlands provinces is quite high, especially in Kon Tum, Gia Lai and Dak Nong provinces. In addition to the local ethnic groups with high poverty rates, ethnic minorities migrating to the Central Highlands also have very high poverty rates, notably the Mong, Dao,…

Table 2: Ratio of the poor and near-poor ethnic minority households in 5 Central Highland provinces

Overall

Region/ province Total Poor Near-poor Others Households households

V4. Central Highlands 100.0 21.8 10.6 67.6

32 Kon Tum 100.0 27.1 10.2 62.7

33 Gia Lai 100.0 27.6 12.7 59.7

34 Dak Lak 100.0 19.2 10.4 70.5

35 Dak Nong 100.0 27.9 10.9 61.2

36 Lam Dong 100.0 6.6 6.9 86.5

Source: GSO,2015 Ethnic Minority Committee, Socio-Economic Investigation of 53 Ethnic Minorities

As of July 2015, implementing the socio-economic survey of ethnic minorities, also the beginning of the People's Health Care Project in the Central Highlands provinces- phase

2, the proportion of CHSs with doctors in the Central Highlands provinces only reached 82.5%, of which the lowest was in Gia Lai province (only reached 61.8%) and the highest was in Dak Lak province (98.7%)

Table 3: Number of health stations with doctors and the ratio of health stations with doctor, as of 1 July 2015

Number of Ratio of health stations health stations NO Administration unit with doctor with doctors (%)

I Overvall in communes and villages with 2 845 69.2 ethnic minorities

1 Urban 277 60.7

2 Rural 2 568 70.2

II Central Highlands 501 82.5

1 Urban 48 68.6

2 Rural 453 84.4

3 Kon Tum Province 88 91.7

4 Gia Lai Province 123 61.8

5 Dak Lak Province 151 98.7

6 Dak Nong 49 84.5

7 Lam Dong province 90 89.1

Source: GSO,2015 Ethnic Minority Committee, Socio-Economic Investigation of 53 Ethnic Minorities

According to survey data of the General Statistics Office and the Committee for Ethnic Minorities in 2015, the proportion of clinics with doctors in the Central Highlands is equal to the national rate. However, there are significant differences between urban and rural areas; between provinces, for example, in Gia Lai province the rate of health stations with doctors only reached 61.8%, while that in Dak Lak province reached 98.7%.

Table 4: Number of health workers and staff at commune health stations in ethnic minority areas according to the highest qualification achieved, on 1 July 2015

Unit: person No Administration Unit Total Doctors Nurse Midwi Senior Pharma Other fe Phar- cist staff macist

(A) (B) (1) (2) (3) (4) (5) (6) (7) I Communes in ethnic minority areas Total number of health 26 557 3 258 15 212 4 212 2 128 606 1141 workers + EM 13 026 1 638 7 934 2 029 623 251 551 + Female EM 8 087 675 4 498 1 976 415 160 363 II Central Highlands Total number of health 4 261 590 2 205 746 393 139 188 workers + EM 1 200 296 592 180 56 35 41 + Female EM 693 110 325 167 37 27 27 Urban Total number of health 498 61 264 90 54 14 15 workers + EM 80 24 37 8 7 2 2 + Female EM 58 14 28 7 6 1 2 Rural Total number of health 3 763 529 1 941 656 339 125 173 workers + EM 1 120 272 555 172 49 33 39 + Female EM 635 96 297 160 31 26 25 1 Kon Tum provine Total number of health 645 92 310 103 70 32 38 workers + EM 202 67 80 30 6 4 15 + Female EM 115 25 45 28 5 2 10 2 Gia Lai province Total number of health 1 198 148 703 234 82 12 19 workers + EM 331 50 192 66 15 4 4 + Female EM 172 14 86 61 8 1 2 3 Dak Lak province Total number of health 1 237 181 609 188 142 25 92 workers + EM 362 97 185 40 25 4 11 + Female EM 211 37 110 38 17 3 6 4 Dak Nong province

No Administration Unit Total Doctors Nurse Midwi Senior Pharma Other fe Phar- cist staff macist

Total number of health 435 53 216 73 58 10 25 workers + EM 79 17 37 11 6 2 6 + Female EM 48 6 22 9 4 2 5 5 Lam Dong province Total number of health 746 116 367 148 41 60 14 workers + EM 226 65 98 33 4 21 5 + Female EM 147 28 62 31 3 19 4 Source: GSO, 2015 Ethnic Minority Committee, Socio-Economic Investigation of 53 Ethnic Minorities

According to the data in Table 4, the percentage of health workers and staff who are ethnic minorities in CHSs is very small, especially ethnic minority female doctors. This situation clearly reflects the great training needs for ethnic minority female health workers and officials in the Central Highlands provinces.

Table 5. Number and ratio of female visiting health facilities to give birth and home birth

Number of Number of Ratio of females females females Ratio of visiting health giving birth visiting females No Ethnic facilities to at home health giving birth give birth (người) facilities to at home (%) (person) give birth (%)

Number of Ethnic minority people based on EM population 1,621,782 925,065 63.6 36.3 Survey 2015

1 Tay 298,764 64,289 82.2 17.7

2 Thai 160,229 215,494 42.6 57.3

3 Muong 220,924 59,057 78.9 21.1

6 Nung 139,435 53,729 72.0 27.8

7 Mong 51,040 176,096 22.4 77.4

8 Dao 97,829 81,300 54.5 45.3

9 Gia Rai 41,027 45,466 47.2 52.3

10 E De 49,514 19,107 72.1 27.8

11 Ba Na 20,209 26,374 43.3 56.5

14 Co Ho 27,768 6,258 81.6 18.4

15 Xo Dang 10,494 22,414 31.8 68.0

19 Mnong 10,097 9,794 50.6 49.1

20 Tho 10,660 3,559 74.9 25.0

27 Ma 6,900 1,965 77.8 22.2

33 Chu Ru 3.394 661 83.7 16.3

51 Ro Mam 44 50 46.4 53.6

52 Brau 62 50 55.1 44.9

Source: GSO, 2015, Ethnic Minority Committee, Socio-Economic Investigation of 53 Ethnic Minorities

Survey results of the situation of health care for mothers and children in ethnic minority areas, including 5 provinces in the Central Highlands in 2015, clearly show that the proportion of mothers who come to health facilities to give birth among ethnic groups in the Central Highlands is quite low. Home birth rate in some local EM group at of the Central Highlands is high, such as Xo Dang (68%); Gia Rai (52.3%); Ba Na (56.5%); Ro Mam (53.6%)

II. IMPACTS OF PROJECT ACTIVITIES TO ETHNIC MINORITIES

2.1. Positive impacts of project activities

Positive impacts of training activities

The project focuses on training activities to improve professional qualifications for groups of health workers from village level to district and provincial hospitals and managers. Direct training activities with a wide range of training contents have helped health workers to be upgraded in terms of professional qualifications and skills, including a proportion of medical staff who are ethnic minorities.

An important training activity of the project is to support ethnic minority students. The training results have had positive effects, helping a proportion of students and EM students to be formally trained. Training courses include: Safe motherhood for VBAs, midwives and doctors, seminars on gender equality, behavior of health workers to improve linguistic, cultural, geographic and economic awareness. It provides opportunities for ethnic groups to have greater access to health services.

Specifically, the results of training activities in 2018 include:

1. Long-term training:

- Training support specialized doctor I: In 2018 supported 168 medical doctors under the provincial and district levels, support Specialised I training expenses. Among them, ethnic minority students are 69 (Kon Tum: 10; Gia Lai: 26; Dak Lak: 24; Dak Nong: 7; Lam Dong: 2)

- Support for training specialized doctor II: support 43 medical doctors in provincial and district levels, support Specialized II training expenses, of which 4 are EM students.

- Support for 4-year doctors/pharmacists: supported 115 trainees who are intermediate doctors/pharmacists at provincial and district levels to be trained 4-years doctors/pharmacist with training expenses in 2017, 2018, of which there are 05 EM students.

- Scholarship support for ethnic minority students: The project supported the provision of 428 scholarships for 2017 and 2018 for ethnic minority students in nursing and technicians, including 230 students received a scholarship in 2018.

- Support for specialized training: Supported 27/111 district and provincial general practitioners with training for orientation of 9-12 months of tuition fees in 2017, 2018. Among them, there are 11 Ethnic Minorities students.

2. Short-term training:

- Classes organized by CPMU: In 2018, CPMU has implemented 25/37 classes, of which new training for VMWs by June 2018 is 133 people, EM students are 73 people. New training for village midwives is 36 people, all of them are ethnic minorities.

Retraining VMW staff as of June 2010 is 607 people, of which 364 are ethnic minority people. Retraining village midwives as of December 31, 2017 is 248 people, of which 230 are EM people, the plan for 2018 is 129 people.

- Classes organized by PPMU: PPMUs organize implementation: 18 training courses to improve motherhood safety capacity for midwives and village midwives, including 90 ethnic minority people; 23 training courses to improve motherhood capacity for doctors with 311 students, of which 159 are EM students.

Development of community-based health services

- PPMUs continue to organize training courses: 07 training courses on safe motherhood capacity building for midwives and village midwives.

- Provide medical bags for village nurses and VMWs (NCB-E12): medical bags are purchased and handed over to beneficiary units.

- PPMUs continue to provide 240 scholarships in 2019 for ethnic minority students (Dak Lak: 107, Dak Nong: 12, Gia Lai: 60, Kon Tum: 40, Lam Dong: 21)

The training activities of the project have directly supported and improved the capacity of health workers and staff in different levels of professional qualifications, especially the group of ethnic minority female health workers.

Effectiveness / positive impact of communication activities

According to the design of the project, the communication activities of the project are quite diversed, there are many contents of propaganda to raise awareness about health care for people, especially ethnic minorities.

1. Activities implemented by CPMUs in 2018

CPMU has supported community communication and education with communication materials designed bilingual material in national languages and some ethnic minorities such as Ede, Xo Dang, ... Estimated workload of 2018 achieved 50%. Media consulting companies are continuing to support provinces on direct communication techniques at the facility.

2. Activities by PPMUs:

Communication activities in 2018 carried out by provinces include: organizing the initial communication sessions on reproductive health in the community; Organized 38 communication skills training courses and how to use communication materials for staff of the CHS, RPC, district hospitals and district health centers (each unit has 02 staff); Organized 17 community communication campaigns in 11 districts of 5 Project provinces; 166 small group education and communication activities were organized in 108 communes in 11 districts. Specific progress is as follows:

- 40% of communes in each province are provided with primary health care services in the community: Dak Lak province has implemented in the third and fourth quarters of 2018; Dak Nong province: Ongoing implementation; Gia Lai province expects to implement 20% of communes, reaching 50% of the plan of 2014; Kon Tum province is expected to be completed in the third and fourth quarters of 2018; Lam Dong province is expected to deploy in 20% of communes in Quarter III, IV / 2018, reaching 50% of the 2018 Plan.

- Organize 38 training courses on communication skills and how to use communication materials for staff of CHS, RPC, district hospitals and district health centers (each staff has 02 staff). Dak Lak province: Completed 2/10 classes; are deploying 3 classes; Dak Nong province: Completed since 2017; Gia Lai province: Completed 8/14. It is expected to finish the remaining in the third and fourth quarters of 2018. Workload is estimated at 60%; Kon Tum province: 4/4 classes have been completed. Workload is estimated at 100%; Lam Dong province: Completed 8/8 classes. Workload is estimated at 100%.

- Organizing 17 community communication campaigns in 11 districts of 5 project provinces.

- 166 small group education and communication activities were organized in 108 communes in 11 districts.

- The communication activities of the project have contributed positively to changing the awareness of EM people on primary health care, maternal and child health and especially improving communication skills for health workers at commune health stations, general health stations and district health centers.

Building, upgrading new health facilities

Activities to build new health facilities and improve and upgrade CHSs have actively supported local authorities to ensure improved medical care facilities to meet the medical examination and treatment needs of people. The project has built a new district hospital, renovated 04 district hospitals; 72 commune health stations. All new construction and upgrading facilities are located in ethnic minority areas and mainly serve ethnic minorities.

2.2 Negative/unwanted impacts

According to the results of record review and field survey in 5 provinces in the Central Highlands, the total number of investment projects of the project is 74 works. As of November 2018, out of 74 sub-projects related to land acquisition, 72 sub-projects have been issued with land use right certificates or land allocation decisions, only 02 sub- projects with agricultural land acquisition are related to ethnic minorities.

Table 6: Current status of impact and compensation rate to EM households with land acquisition

Subproject/ Total area Area of land acquired Loss Total Poor/ EM Impact household of from compensatio househol extent on Resi- Garden Agri/for cultivation assets n (VNĐ) d livelihoods dential land est land in the on land land land household

1. Dak Ro Nga, Kon Tum

A Don 4,000 0 0 0 Crop 1,859,000 EM Compensat e crop on land acquired

A Hao 3,000 m2 300 737.4 Fruits 79,841,020 EM Mainly fruit of tree trees with residential low number, land doesn’t affect much 5,000 m2 to HH’s of garden income land

2. Quang Hoa commune, Dak Glong district,

Dak Nong province

Nong Van 3000 m2 of 0 0 6,649 Sing-le 305,755,500 EM Long term- Binh field land crop forest plant and rice, 10,000 m2 Acaci-a of forest land

Survey results of the situation of 03 ethnic minority households with land acquisition shows that no EM households are affected with their living places or seriously affected with their livelihoods. Particularly, for Nong Van Binh households in Quang Hoa commune, Dak Nong province, the household has been acquired 6,649 m2 of agricultural land since 2013, the household has agreed to hand over the site to construct the project.

III. PUBLIC CONSULTATION AND INFORMATION DISCLOSURE

3.1. Public consultation

Community consultation activities for EM people have been strictly and fully implemented as prescribed. For land acquisition projects related to EM people, communes prepare compensation plan and have made compsentation payment following below steps:

+ The first step: Notifying the district and commune People's Committees of the project investment plan. Coordinate with the district and commune People's Committees to send notices to ethnic minority villages residing on the components to be implemented. Coordinate with district and commune People's Committees to organize consultation meetings on the implementation contents of the project and organize the planning and implementation of the project compensation plan.

+ The second step: Direct consultation in the community, specifically the subjects of consultation are poor households and ethnic minorities.

Consultation is not only for affected households due to land acquisition but also for all ethnic minority people living in the project area.

Implementing community consultation process, communes with agricultural land acquisition and site clearance have implemented consultative activities as prescribed. The consultation places are defined as follows:

- People's Committees and socio-political organizations in wards/ communes: Commune-level local authorities have organized consultations at the Commune People's Committee with the participation of representatives of People's Committee and political and social organizations, community organizations and people affected by the project's work items. - Social organizations: Including the Fatherland Front, Women's Union, Farmer's Union, Youth Union, and Elderly Association representing people's aspirations and opinions reflecting issues related to the project. The social organizations have actively participated in closely monitoring the project implementation process, especially the land acquisition and resettlement phase to ensure compliance with the current provisions of Vietnamese law. Community organizations and unions in the community grasp the issues and feedbacks of the people related to the project activities in the process of preparing, constructing and putting into use. The supervision of associations to coordinate with community groups in the community has an important meaning in helping investors and contractors promptly adjust the design and construction activities to minimize the unwanted impact to the life of the people in the affected area. - Village representatives: The village head, the deputy head and the village officials represent the people, reflecting the issues raised during the preparation,

construction and use of the project items. Village officials are the first place to receive people’s feedback related to the project and reflect legitimate aspirations and recommendations of the people to higher authorities. In addition, feedback from village officials also helps to build project items more appropriately, bringing more socio-economic benefits to the communities in the next beneficiary area of the project. - Beneficiaries/affected group: It is the entire households who are residing in the project area and related to the project items. The people in the affected area are also the direct beneficiaries of the project items. - Vulnerable group: Vulnerable people are always focused in the implementation of development projects. Subjects such as disabled people, poor and lonely poor women, widows, policy households (war invalids, family og martyrs, revolutionary workers), poor and hungry households, especially for ethnic minority households

3.2. Results of community consultation and information disclosure of the project

Through the monitoring results in the provinces, the provinces have well implemented the process of community consultation. The steps to coordinate with local authorities at commune/ward levels have been implemented quite well in public meetings to consult government officials, representatives of socio-political organizations, representatives of village officials and household representative. According to the consultation process, in the sub-projects with agricultural land acquisition and implementation of compensation policies, the number of consultations is fully implemented in accordance with the establishment of the district’s ground clearance and resettlement committee, full implementation of commune and village level consultations, providing project information to households in the project area.

At the subproject of the construction of CHS in Quang Hoa commune, Dak Glong district, Dak Nong province, the District People's Committee conducted consultation procedures, publicized compensation price for households whose land was acquired in accordance with the prescribed regulation. Nong Van Binh households whose land was acquired received compensation from November 2013 and handed over the site to the construction project.

For Dak Ro Nga sub-project, Kon Tum province, the procedures for consultation with affected EM households were conducted before issuing compensation rates. 02 affected

households have received full information about the project, consulted on compensation price and other regulations of the project. 02 EM households whose land has been acquired have agreed and handed over the site to the construction project since 2015.

IV. PROCEDURE FOR IMPLEMTATION OF ETHNIC MINORITY No Period Activities Implementation schedule as of 30 June 2018 Training activities 1 Improve Long-term training: Specialized I First-level specialized doctors: professional (132 targets); specialized II (30 69 (Gia Rai ethnic group; Ba capacity for targets); specialized orientation Na; Tay; Nung) human (111 targets); Doctor, pharmacist Specialized doctor level II: 4 resources in to higher qualification (125 doctors health care targets); scholarships for Specialized orientation: 11 intermediate nursing and Joint training: 5 technicians (150 targets) Ethnic Minority Scholarship: 230/428 doctors 2 Improve skills New training and retraining of -New training for female and methods, village midwives; New training midwivies: 36 (Kon Tum) professional and retraining of health care, -Retraining of midwives: 230 skills safe motherhood capacity (Kon Tum: 83; Dak Nong: 76; building for doctors and Gia Lai: 71) comprehensive nursing care - New training of VMW staff: training 73/133 (Kon Tum: 32; Lam Dong: 41) -Retraining VMW staff: 364/607 (Dak Nong: 46; Gia Lai: 61; Kon Tum: 178; Lam Dong: 79) -LMAT capacity for doctors: 159/311 (Dak Lak: 5; Dak Nong: 36; Gia Lai: 33; Kon Tum: 53; Lam Dong: 32) - LMAT capacity for village midwivies 90/307 (Dak Lak: 1; Dak Nong: 4; Gia Lai: 15; Kon Tum: 36; Lam Dong: 34) 3 Train trainers on basic methods - Short traning on methodology: 10/200 4 Maintain and preserve medical -Training:1/56 equipment Training hospital managers - Training: 30/231 6 Training technicians - Training: 16/188

No Period Activities Implementation schedule as of 30 June 2018 7 Training key personnel on - Tranining: 23/182 infection control 8 Health service management - Training: 24/155 training for Head of Health Care Center/ General Hospital Communication activities 1 Improve Trainning on communication communication skills capacity 10 Community - Organizing small group - Dak Lak province: 2018 communication communication and plan has been on primary organizing communication developed for districts health care and campaigns in the and implemented from maternal and community: Organizing 17 July 2010 child health community - Dak Nong Province: communication Completed campaigns in 11 districts - Lam Dong Province: of 5 project provinces. Developed plans for districts and implemented from September 2018 - Kon Tum province: 40% of communes / towns have been implemented - Gia Lai Province: Planning is being developed 11 Communication Training on HIV / AIDs prevention - Dak Lak: Construction on HIV / AIDs knowledge for workers at the project Krong Buk and prevention construction site, including EM clinic 719: 116 workers people and local people (including 23 ethnic minorities) in May 2017 - -Kon Tum: construction of 35 commune health stations: communication for 360 workers, including 95 EM people - Lam Dong: Organized at 9 General Statistics Offices with 192 workers

No Period Activities Implementation schedule as of 30 June 2018 - Dak Nong: Completed in 2017 - Gia Lai: ongoing Attracting local laborers who are ethnic minorities - Kon Tum Province: 98/360 - Gia Lai Province: In progress - Dak Lak province: 10/170 - Dak Nong province: 6/120 - Lam Dong: 23/200

V. PENDING ISSUES Issues are continuing or pending: NO Recommendation Implementation Issues plan 1 Conducting surveys and assessing Information gathering in 5 1-12.2018 impacts on EM people at provinces construction works 2 Conduct training activities on Organize training and 3-12.2018 communication activities in the communication classes community 3 Building communication materials Media products are released 1-12.2018 for EM people 4 Continue to communicate to raise Organize media campaigns 1-12.2018 awareness about safe health and pediatric health care for ethnic minority people 5 Continuing to communicate gender Organize media campaigns 1-12.2018 equality and preventing domestic violence against ethnic minorities 6 Evaluate the effectiveness of the Field assessment in 5 1-5.2019 project to access opportunities for provinces ethnic minorities

CONCLUSION AND RECOMMENDATION

1. Conclusion

According to the progress until August 2018, the activities of the project have made a clear effect on EM people in improving the capacity of EM staff and health workers; raising awareness of ethnic minority people in primary health care. The training activities have been completed according to the plan of the year. However, because EM human

resources are quite limited for the types of long-term training and highly-qualified staff training, the completion of EM targets may be difficult.

Communication activities have been carried out as planned, but in some provinces the implementation is still slow, especially community communication and small group communication activities. Communication and organizing products of communication activities need to keep abreast of the contents of the project in order to substantially and raise awareness for EM people in access to primary health care services and maternal and child health care.

The targets of the project on EM are basically completed or can be completed in the project implementation period.

2. Recommendation - Expanding the target groups of EM people at short-term training courses. - Strengthen small group communication and community communication to raise awareness for EM people about primary health care and health care for mothers and children.