Social Monitoring Report 01 Semi Annual Report October 2014 VIE: Health Care in the South Central Coast Region – Implementation Results of the Project Ethnic Minority Development Plan Prepared by the Center for Environment and Health Studies, and Center for Community Health and Injury Prevention, for the Ministry of Health, Socialist Republic of Viet Nam, and Asian Development Bank. This social 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. A JOINT VENTURE BETWEEN THE CENTER FOR ENVIRONMENT AND HEALTH STUDIES AND THE CENTER FOR COMMUNITY HEALTH AND INJURY PREVENTION Ngo Tuan Dung Sarah-Jane Clarke Nguyen Thi Toan Pham Duc Muc Vuong Tien Hoa Ninh Van Minh Nguyen Thien Nga Nguyen Thi Thu Thai Thi Thu Ha The joint venture between the Center for Environment and Health Studies and the Center for Community Health and Injury Prevention would like to express our gratitude to the Central and Provincial Management Units of the Health Care in the South Central Coastal Region Project for their provision of secondary data, and the coordination and support from our experts in developing the province-level EM action plans. Thanks also goes to the Central Project Management Unit and the Asian Development Bank for their technical and financial support for this activity. 2 Table of contents 1. Introduction 6 1.1 Background 6 1.2. Objectives 8 2. Methodology 9 2.1. Review of secondary data 9 2.2. In-depth interviews 9 2.3. Consultations with related partners 9 3. Implementation Results 10 3.1. Update and analyze the implementation results of the Project EM development plan according to each Project output 10 3.2. Updated results of implementing strategies according to indicator framework 26 3.3. Analysis of Project strengths, weaknesses, lessons learned and concerns related to EM 28 4. Conclusion 32 5. Recommendations 33 6. References 34 Annex 35 Annex 1. UPDATED PROJECT RESULTS ON EM IN INDICATOR FRAMEWORK 35 Annex 2: Provincial summary 41 3 List of tables Table 1: Total number of health workers and number of EM health workers trained by the project in each province by June 2014 13 Table 2: Percentage of EM participating in IEC activities implemented by PPMUs 21 Table 3: Number of iEC films translated into minority languages 22 Table 4. Percentage of women using all reproductive health care services by ethnic group, in 33 villages, 2013 23 Table 5: Updated achievements of key monitoring indicators, 31 June 2014 27 Table 6: Remaining activities and task assignment towards the end of the Project 31 List of Figures Figure 1: Proportion of population that is ethnic minority, by province. 6 Figure 2: Largest ethnic minority populations in the South Central Coast region, by percentage of total population 7 Figure 3: Propotion % of utilization of surveyed outpatient services and health seeking behavior of EM in the Project provinces over the last 4 weeks in 33 poor and EM comunes in 11 districts, 2013 12 Figure 4: Proportion of EM health workers trained and granted scholarships by the Project in each province 14 Figure 5: Percentage of training courses at all levels within the Project provinces that included EM participants 15 Figure 6: The number and percentage of EMs attending VHW training courses organized by the Project 18 Figure 7: Proportion of surveyed VHWs in 33 communes trained by the Project and others courses, 2013 18 Figure 8: Characteristics of VHWs in 12 districts with high EM populations in six Project provinces, 2013 19 Figure 9: Percentage of EM from 11 districts in 6 Project provinces who were satisfied with VHW, 2013 20 Figure 10: Percentage of people with HI cards by ethnic group in survey sites, 2012 25 4 Abbreviations ADB Asian Development Bank CHC Commune Health Center CPMU Central Program Management Unit DHC District Health Center DOH Department of Health EMDP EM Development Plan FGD Focus Group Discussion EM EM HF Health facility HI Health insurance HRD Human resource development HW Health worker IDI In-depth interview IEC Information, education, communication MCH Maternal and child health MOH Ministry of Health PPC Poiial People’s Coittee PPMU Provincial Program Management Unit PSC Provincial Steering Committee ToT Training of Trainers VHW Village health worker 5 1. Introduction 1.1 Background Implementation background Viet Nam is home to 54 different ethnic groups. The majority ethnicity is Kinh who make up approximately 86.2% of the out’s population. The other ethnic groups are small - and sometimes very small - in number and are officially ko as ethi ioities (EM). The South Central Coastal Region is one of five regions in the country with a high proportion of EM. In this region, approximately 7.4% of the population is EM. Of the eight project provinces – Binh Dinh, Binh Thuan, Da Nang, Khang Hoa, Ninh Thuan, Phu Yen, Quang Nam and Quang Ngai – the proportion of EM population ranges from 0.5% in Da Nang to 23.5% in Ninh Thuan (Figure 1). Figure 1: Proportion of population that is ethnic minority, by province. In 1,024 communes of 84 25 23.5 districts in the South Central Coastal region, 20 there are 423 remote communes with a high 15 13.3 proportion of EM, 10 8.1 accounting for 38.2% of the 7.4 Percentage (%) Percentage 5.9 5.3 population, as well as 223 5 2.3 communes classified as 0.5 poor. In the eight provinces 0 Ninh Quảg Quảg Bình Phú Yên Khánh Bình Đà Nẵg of South Central Coastal Thuậ Ngãi Nam Thuậ Hòa Địh region, the most populous EM groups are Cham, Hre and Raglai (1.4-1.5% of the total population of the region). Other EM including Bana, Co Tu, Cor, Ede, Gie Trieng, Hoa, Tay and Xo Dang make up much smaller percentages (all below 0.7%) (Source: Statistics, 2009). 6 Figure 2: Largest ethnic minority populations in the South Central Coast region, by percentage of total population 2 1.5 1.5 1.4 1 0.6 Percentage (%) Percentage 0.5 0.4 0.3 0.3 0.3 0.2 0.2 0.2 0.1 0 Cham Hre Raglai Xo Dang Co Tu Cor E De Ba Na Khac Gie Hoa Co Ho Tay Trieng EM in the South Central Coastal region normally live in remote and mountainous areas with difficult living conditions and little economic development. They face many barriers to accessing health services due to significant poverty, limited knowledge of health care services, an inability to speak the majority Kinh language, long distances and time-taken to travel to hospitals and other health centres, and a preference of traditional approaches to health, such as delivering babies at home. In addition, the health system in mountainous areas is sub-optimal and lacks medical equipment. EM health sector workers are limited in quality and quantity, especially at district and commune levels as well as in management positions. These vulnerabilities are further exacerbated by EM failing to fully benefit from development projects and programs. Objective of the Health Care for South Central Coastal Region Project and its EM Development Strategy The Health Care for South Central Coastal Region Project is led by the Ministry of Health (MOH), financially and technically supported by the Asian Development Bank (ADB) and was implemented in eight South Central provinces from 2009 to 2014. The goal of the Project is improve the quality of health care while improving access to and use of health services of the people, especially the poor, ethnic minorities, women, and children, thereby contributing to improving the health status of the people in the eight South Central Coastal provinces. To ensure that any potential negative impacts to EM due to the Project are resolved according to the ADB Policy on Indigenous Peoples and relevant Vietnamese regulations, the Project developed a common strategy for developing and supporting EM in the eight provinces. Its objectives were: (i) provide guidelines to evaluate potential impacts on EM, with evaluations completed by each province during the implementation process; (ii) support the preparation of specific actions to resolve such impacts; (iii) propose interventions to improve basic health services for EM people, including at village level; (iv) propose interventions focused on gender to meet the needs of EM women and children; (v) ensure EM participate in training activities at all levels; and (vi) provide guidelines for the 7 development of information, education and participation approaches to meet the needs of EM in a culturally appropriate and sustainable way. Based on the Pojet’s basic EM strategy, the eight provinces implemented activities based on strategic indicators integrated with Project components and outputs. From 2009 to 31 June 2014, the Project achieved tangible results in the improvement of EMs’ access to quality health services, enhanced the capacity of EM health workers (HW) at different levels and upgraded health facilities in mountainous areas for poor and EM beneficiaries. The Central Program Management Units (CPMU) and the Provincial Program Management Units (PPMU sought technical assistance (TA) through Component C25 to collect and analyze the results of implementation of the Project EM strategy and to support Project provinces to develop sustainable Ethic Minority Development Plans (EMDP) based on lessons learnt from the Project.