The Assessment Social Impacts Report IPP380 V3 MINISTRY OF HEALTH Public Disclosure Authorized Central North Health Support Project Public Disclosure Authorized The Social Impact Assessment Report Public Disclosure Authorized October.2009 Public Disclosure Authorized Table of Contents The Assessment Social Impacts Report Chapter 1: INTRODUCTION..................................... 1 1.1. The project background............................... 1 1.2. The objectives and contents of the report of the social impact Assessment.................................. 6 Chapter 2: SOCIAL IMPACT ASSESSMENT FRAMEWORK.............. 10 2.1 Legal and Policy Framework........................... 10 2.2 Determining stakeholders in social assessment and coordination............................................. 14 2.3 Social impact Assessment framework................... 15 Chapter 3: THE SOCIO-ECONOMIC SITUATION OF THE PROJECT AREA 16 3.1. The Socio-economic situation of the project area.... 16 3.2. Healthcare situation................................ 24 3.3.Diseases burden...................................... 26 3.4. Accessibility and utility by local people of health services................................................. 29 Chapter 4: THE IMPACTS OF THE PROJECT TO ETHNIC MINORITY... 34 4.1. Identify the level of positive impacts of the project to the poor, near poor and ethnic minority people........ 34 4.2. Socio- Economic condition of some Ethnic minorities in the Project areas........................................ 41 4.3. Identify the level of negative impacts of the project’s activities to the living and healthcare to the poor, near poor and ethnic minority people.......................... 47 4.4. Propose the solution to minimize or avoid the negative impacts of the project to the vulnerability targets...... 48 4.5. Constraints that limit ethnic minority people to access public health care services....................... 48 Chapter 5: THE RESETTLEMENT................................ 50 5.1. The planning and reclaiming land for constructing the PHCs..................................................... 50 5.2. How the project have been affected on cultures, religions and beliefs.................................... 55 5.3 Procedure of issuing the land use certificate........ 55 5.4. The project impacts to the living and production of the households............................................... 56 5.4 Results of consultation of affected households....... 57 Chapter 6: THE CONSULTATION OF THE STAKEHOLDERS OF PLANNING THE SOCIAL IMPACT ASSESSMENT............................... 60 6.1. Ideas and viewpoints of the stakeholders during preparing the project workplan........................... 60 6.2. Proposing the workplan of social impact evaluation during the project implementation in the local........... 63 CONCLUSION................................................. 66 The Assessment Social Impacts Report The Assessment Social Impacts Report List of Tables Table 1.1- List of 30 District Preventive Health Centers for project investment ....................................... 4 Table 3.1. Some features on natural and socio-economic situation of six provinces of the Project ............... 16 Table 3.2. Monthly income per capita by sources of income quintile ................................................ 17 Table 3.3. Socio-economic situation of district selected of project Thanh Hoa province .............................. 18 Table 3.4. Socio-economic situation of district selected of project Nghe An province ................................ 19 Table 3.5. Socio-economic situation of district selected of project Ha Tinh province ................................ 20 Table 3.6. Socio-economic situation of district selected of project Quang Binh province ............................. 21 Table 3.7. Socio-economic situation of district selected of project Quang Tri province .............................. 22 Table 3.8. Socio-economic situation of district selected of project Thua Thien Hue province ........................... 23 Table 3.9. Percentage of illness or injuies in year 2006 by province ................................................ 24 Table 3.10. Malnutrition in weight by age among children under 5 years (%) in Central North and 6 provinces 2007 ....... 25 Table 3.11. Mortality pattern in the six selected provinces 25 Table 3.12. Percentage of illness or injuies in year 2006 by urban rural, region, income quintile, sex, age group and ethnic .................................................. 27 Table 3.13. Rate (%) Sick cases not treatment during 4 weeks before survey ........................................... 29 Table 3.14. Percentage of in-patient treatment in year 2006 by type of health facilities, region, sex, age group ...... 30 Table 3.15. Distribution of rounds of medical consultation and treatment during 4 weeks before the survey (%) .......... 31 Table 3.16. Use of public hospitals in 6 project provinces. 32 Table 4.1. Percentage of people having treatment in the last 12 months in year 2006 by urban rural, region, income quintile and sex ........................................ 34 Table 4.2. Percentage of out-patient treatment in year 2006 by type of health facilities, urban rural, region, sex, age group and ethnic ........................................ 35 Table 4.3. Percentage of in-patient treatment in year 2006 by type of health facilities, urban rural, region, sex, age group and ethnic ........................................ 36 Table 4.4. Percentage of people having treatment in the last 12 months in year 2006 by age group and ethnic .......... 37 Table 4.5. Percentage of poor, near poor and ethnic minority of districts prioritised for project investment ......... 38 Table 5.1 List of the PHCs prepared the document of land certificate ............................................. 54 The Assessment Social Impacts Report Table 5.2 The households and people affected by the project 56 The Assessment Social Impacts Report ACRONYMS EG Ethnic group FS Food Safety GH General Hospital HC Health Center HD Health Department HI Health Insurance HMIS Health Management Information System HS Health services HW Health worker MoH Ministry of Health NCR North Central Region NHS National Health Survey GoV Government of Viet Nam PC People’s Committee PH Preventive Health PHC Preventive Health Center PMU Project management Unit PPMU Provincial Project Management Unit SC1 Specialist Class I TM Traditional medicine WB World Bank The Assessment Social Impacts Report Chapter 1: INTRODUCTION 1.1. The project background 1.1.1. Introduction The Central North Health Support project is designed to follow the government’s regional approach to health system development by targeting the northern region of the central coastal area, referred to as Central North region. The region, with a population of 10.7 million, is the second poorest among the eight regions of Vietnam; 25% and 30% of the population is classified as poor and near poor respectively (2006). Average per capita income in the Central North is 317,000 VND (2004) compared to the national average of 445,000 VND (2004). The inhabitants of the region (approx. 85% of them) live in rural areas and make their living from self-employed agriculture and fish farming; the share of self employment is 79.5% in the total employment structure according to 2004 data. Overall, the health status of the region is poor. Average Infant Mortality Rate is 22 (ranging from 15 to 36) compared to the national average of 16, and Maternal Mortality Rate is 200 compared to the national average of 75. The leading causes of morbidity are associated with respiratory conditions and diseases of the digestive system. With its regional focus and design, the Central North region project is fully aligned with the government’s strategy to strengthen the health systems in disadvantaged regions by relying on three pillars: (a) reducing demand-side barriers to health services for the economically vulnerable population, (b) improving the quality of pro-poor health services, and (c) reducing the shortage of competent health care professionals in underserved areas. The project will reduce demand barriers by increasing affordability of health insurance to the near poor population by providing significant subsidies towards health insurance premiums, above what is currently offered by the government. This will be complemented by a strong Information and Education Campaign, social marketing, and a number of incentive mechanisms to increase enrollment of the target population in the health insurance scheme. In order to improve the quality of pro-poor health services, the project will invest in district hospitals and DPHCs in the most disadvantaged districts, thereby making basic health care available at a lower cost and closer to the communities. Most of the investment will go into equipping hospitals with most basic medical equipment and refurbishing the DPHCs. This will be combined with a Results Based Financing pilot to test some innovative mechanisms to promote better performance, accountability and client-orientation of health services. The project will address the human resource constraint in the Central North region by training specialists that are in short supply and creating stronger local medical training institutions for more sustainable results. 1 The Assessment Social Impacts Report 1.1.2 Legal justification On April 14th, 2009, the Prime Minister released document 551/TTG-QHQT giving approval for the World Bank supported