The Central North Health Support Project Ethnic Minority Plan (EMP) IPP380 V2 MINISTRY OF HEALTH Public Disclosure Authorized Central North Health Support Project Ethnic Minority Plan Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized October 2009 1 The Central North Health Support Project Ethnic Minority Plan (EMP) TABLE OF CONTENTS ACRONYMS............................................................................................................................... 3 Executive Summary..................................................................................................................... 4 I. INTRODUCTION .................................................................................................................... 8 1.1. Project Introduction .......................... 8 1.2. Ethnic Minority Plan (EMP) ................... 13 II. SOCIO-ECONOMIC SITUATION OF ETHNIC MINORITIES IN PROJECT LOCATIONS............................................................................................................................. 14 2.1. Socio-economic features and population structure in project locations .................... 14 2.2. Ethnic minorities in project locations ....... 14 2.3. Socio-economic conditions of 10 ethnic minority groups in Project locations ....................... 18 III. POLICY FRAMEWORK .................................................................................................... 22 3.1. World Bank’s Policy toward Ethnic Minorities (0P 4.10) ......................................... 22 3.2. GoV’s Policy ................................. 22 IV. CONSTRAINTS THAT CAUSE LIMITED ACCESS TO PUBLIC HEALTHCARE SERVICES BY ETHNIC MINOTITIES................................................................................... 24 4.1. Geographical and transportation constraints .. 24 4.2. Customary constraints ........................ 24 4.3. Economic constraint .......................... 25 4.4. Language and educational constraints ......... 25 V. COMMUNITY CONSULTATION...................................................................................... 25 VI. ETHNIC MINORITY ACTION PLAN .............................................................................. 26 VII. ORGANIZATION AND IMPLEMENTATION ............................................................... 28 VIII. MONITORING AND EVALUATION ............................................................................ 29 IX. COST ESTIMATION.......................................................................................................... 30 2 The Central North Health Support Project Ethnic Minority Plan (EMP) ACRONYMS CPC Commune People’s Committee CPMU Central Project Management Unit EMP Ethnic Minority Plan HC Health Center HD Health Department HI Health Insurance HS Health services MoH Ministry of Health NCR North Central Region GoV Government of Vietnam PC People’s Committee PH Preventive Health PHC Preventive Health Center PMU Project Management Unit PPMU Provincial Project Management Unit WB World Bank VSS Vietnam Social Security 3 The Central North Health Support Project Ethnic Minority Plan (EMP) Executive Summary 1. Introduction 1.1. Project Background The Central North Health Support Project has been promoted by the Government of Vietnam (GoV) to enhance the equity and effectiveness of the health finance and health services provided in 6 provinces in the North Central region (Thanh Hoa, Nghe An, Ha Tinh, Quang Binh, Quang Tri, and Thua Thien Hue provinces). The Project aims to provide better access and improve the healthcare for local people, especially the poor, the near-poor, and ethnic minorities. The priority will be given to the district-level curative and preventative health centers (DPHCs). The project development objective is to strengthen the district-level curative and preventive health services and improve their accessibility for the economically vulnerable population. The intermediate objectives are: - Increasing health insurance coverage among the near-poor population; - Upgrading capacities of district hospitals and DPHCs; - Improving supply and quality of health care personnel. 1.2. Ethnic Minority Plan (EMP) The goal of this EMP is to ensure better healthcare services for ethnic minorities who have limited access to healthcare services. This EMP is prepared with careful consideration of the cultural practices of the ethnic minorities, and the constraints that cause limited access to healthcare services by people in the region. The framework of this EMP is based on the World Bank (WB) Indigenous People Policy (OP4.10; 7.2007) which is applied in all WB-Funded Projects in the ethnic minority areas. The policy aims to: (i) mitigate any potential negative impacts; and (ii) provide prioritized supports for local ethnic minorities. 2. Socio-Economic Situation of Ethnic Minorities in Project Locations 2.1. Socio-economic features and population structure in project locations The Central North region stretches along the coastal line with complicated topography and harsh climate, and consists of 6 provinces, namely: Thanh Hoa, Nghe An, Ha Tinh, Quang Binh, Quang Tri and Thua Thien Hue. The natural land of Central North region accounts for 15.6% of total country area and its inhabitants make up 12.6% of the country’s population, only smaller than that of Red River Delta and Mekong Delta regions. 2.2. Ethnic minorities in project locations The Central North region is the home to over 10 ethnic minority groups that mainly are Thai, Hmong, Muong, Kho Mu, Dao, Tho, Chut, O du, Bru-Van kieu, Co tu, etc. Especially, four of these (Tho, Chut, O du, and Bru-Van Kieu), and two small population groups of O du (351 people) and Chut (3,891 people) only live in Central North region. These groups often live under difficult conditions in the border, remote and isolated areas. 4 The Central North Health Support Project Ethnic Minority Plan (EMP) 3. World Bank’s Policy toward Ethnic Minorities (OP/4.10) The WB has its own policy toward the indigenous/ethnic minority people (OP4.10). It calls upon projects to invest into ethnic minority areas, and to fully respect the preferential rights of the affected ethnic minorities. At the same time, it is expected to mitigate the adverse impacts on the ethnic minorities and promote those activities that aim at bringing benefits and preserving their traditional cultural values. The WB requests that the local people should be sufficiently informed and freely participated in the Project, and the Project should receive the support from most of the affected ethnic minority people. The designed Project must ensure that the ethnic minority people receive the social and economic benefits are culturally appropriate, and gender and inter-generationally inclusive. 4. Constraints that cause Limited Access to Public Healthcare Services by Ethnic Minorities 4.1. Geographical and transportation constraints Currently, infrastructure and transportation in the Central North region are not in very good condition. The distance between villages and district centers is, in some cases, about 50-70 km, while roads are not available or under bad condition, especially during the rainy season. The means of transportation is mainly by bike or on foot. 4.2. Customary constraints As the modern healthcare services are uneasily accessible in various residential areas, the belief still plays an important role among ethnic minorities in the Central North and even drives the decision of selecting the treatment methods. While taking care of the mother’s and children’s health, they assume that worshipping the superpower is very important, and offering a worship to wish the support from the superpower will help the patient recover faster than being treated in the health facilities. 4.3. Economic constraint Given the reality of unstable and low income, healthcare is not the first spending priority given by the ethnic minorities in the area. Most of people do not have their money savings, leading to the fact that the traditional treatment is preferable in case one gets sick. They are not interested in the healthcare and education. Most of ethnic minority families cannot afford their treatment, and often believe in taboos and supernatural forces. In addition, the obstacles of geographical distance, transportation and difficult household living conditions prevent ethnic minorities from going to hospitals. 4.4.Language and educational constraints Among 10 ethnic minority groups in the region, most of them have, with the exception of the Muong, Tho, and Chut, difficulties in using fluent Vietnamese. This is an important factor that disencourages local people to visit district or provincial medical centers for healthcare. 5. Community Consultation *Activity principles Ensuring the participation of the ethnic minorities in the project in order to speed up the smooth project implementation. Disclosure of project information for ethnic minority people is an important part of project preparation and implementation. Making consultation with them, 5 The Central North Health Support Project Ethnic Minority Plan (EMP) and ascertaining their active participation in the project. These will mitigate the risk of conflicts and project delays. They will also enable the Project to design the resettlement and rehabilitation program as a comprehensive development one, which meets the needs and priorities of the displaced, and thereby maximizing the economic and social benefits of the investments. *Methods of community