Challenges to Rural Poverty Reduction in Viet Nam - Oxfam Blogs

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Participatory poverty monitoring in rural communities in Viet Nam 84 Calculation of the level of assistance for some target groups is complicated, particularly inter-ministerial Circular No. 24/2010/TTLT-BLĐTBXH-BTC dated 18 August 2010, guiding the implementation of Decree 67 and Decree 13. Many commune cadres in mountainous ethnic minority areas do not know how to calculate the level of assistance for people or households eligible for more than one type of assistance. There is limited openness and transparency in the implementation of social assistance policies. Most respondents at the monitoring points do not know the details of social assistance policies. People in ethnic minority areas who do not speak or write Vietnamese cannot complete application forms. Many ethnic minorities reported the wrong age in their ID cards and in permanent residence books, and lack required documentation such as birth certificates, and certificates attesting to their wartime contributions. Procedures to obtain “disability” certificates to be eligible for social assistance are also complicated. Lack of local funding for the management of social assistance recipients under Decree 67. For example Tuong Duong district-Nghe An has more than 5,000 social assistance recipients; in 2011 alone, more than 1,700 cases were reviewed under Decree 13. Due to a limited local budget, the district Department of Labour, Invalids and Social Affairs faced many difficulties covering management costs. Decree 54 states departments receive 1.92% of the total disbursement as management fees. Mountainous districts do not have the adequate resources to provide occational aid to households in need. According Decree 67, the “district has to cover the cost” with support, if necessary, from the province, of providing occational aid to households experiencing risks or who have other urgent requirements such as burial costs. However, some districts, particularly the more remote lack the necessary resources. 3.3. Insurance Voluntary social insurance policies are not yet popular in rural areas. Farmers and those working in the informal sector lack understanding of voluntary social insurance policies, and the level of periodic contribution is still high. Health insurance policy for all. Poor, ethnic minority people in disadvantaged areas, and children under six-years-old can benefit from health insurance subsidies introduced as part of the Health Insurance Law. However, very few near-poor households buy voluntary medical insurance cards (with a 50% or sometimes 80% subsidy). The largest proportion (30% in 2011) near-poor households buying health insurance is in Duc Huong commune, Ha Tinh. Providing and distributing medical insurance cards and informing people of the benefits of health insurance is problematic. Few grassroots cadres sufficiently understand available health insurance to advise local residents. An alternative would be village population and health collaborators who could help persuade villagers to buy health insurance, and issue medical insurance cards to children under six years old. There are also delays in issuing medical insurance cards in mountainous communes for a number of reasons: delay in the listing of beneficiaries by communes; names, particularly of ethnic minorities, are recorded incorrectly; long distances from remote villages to commune center; children under six-years-old don’t have birth certificates; and delays transferring the list of poor households from Labour, Invalids and Social Affairs agencies to social insurance agencies. The services of selling health insurance, including selling subsidised health insuarance for the near poor, are not yet user-friendly. The benefits of health insurance for the poor are limited. The poor still face extra
Five-year Synthesis Report Part 2: Challenges to Rural Poverty Reduction in Viet Nam costs for medical examination and treatment in higher-level hospitals (including travel, accommodation and food). Patients also have to pay a proportion of the cost (5% for poor households, 20% for near-poor households) according to the new Health Insurance Law. This regulations make difficulty for the poor, near poor patients in ethnic minority areas. In Vi Xuyen district-Ha Giang, the district People’s Committee has to pay the district hospital 50 VND million for the “joint payment of cost” scheme for poor and near-poor ethnic minorities. 85 The quality of healthcare services provided to patients using medical insurance cards is poor. In the deltas, most people go to district and provincial hospitals for health check-ups and treatment, putting pressure on hospital resources. Patients are also concerned about the ethics of some medical doctors. 3.4. Community-based social security Direct and immediate community support is important to the poor. At most monitoring points, the most popular community support measures for the poor who face difficulties are visits, spiritual encouragement and food provision (grant or lending) (Table 3.3). In many places, clan members, mass organizations and the wider village community raise money for households in difficulty. In some mountainous ethnic minority areas communities hep out by providing labour (Thuan Hoa-Ha Giang, Ban Lien-Lao Cai, Xy-Quang Tri, Phuoc Dai-Ninh Thuan, and Cu Hue-Dak Lak). TABLE 3.3. Support measures undertaken by relatives, villagers, mass organizations and local authorities for households facing risks, 2011 Commune Support measures to help people who face risks in the last 12 months (%) Cash Food In kinds Labour Training, showing how to do business Vocational training, seeking jobs Information House visits, Spiritual encouragement Thuan Hoa 44 25 0 38 0 0 13 38 0 Ban Lien 50 30 10 40 10 20 30 60 0 Thanh Xuong 11 0 0 33 11 0 56 100 0 Others Luong Minh 7 85 5 17 2 0 29 55 2 Duc Huong 40 35 10 15 40 5 15 60 5 53 44 0 56 100 0 41 78 0 Xy Cu Hue 0 0 0 50 0 0 0 50 50 Phuoc Dai 37 67 4 15 15 0 4 33 0 Phuoc Thanh 46 79 29 0 0 4 0 58 0 Thuan Hoa 57 43 0 14 14 29 14 14 14 Average 35 56 7 24 11 3 22 57 3 SOURCE: Household interviews In remote communes, community based social security institutions remain strong. Many community-based support activities are effective. Villages raise and manage common funds in cash or kind. Funds are used for many purposes such as payment for village positions, welcoming guests, parties and support for activities of mass organizations and community (art and sport activities, Mid-Autumn Festivals, Great
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PARTICIPATORY POVERTY MONITORING IN
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PREFACE 1 7 In early 2007, Viet Nam
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ABBREVIATIONS AND TERMS 10 ActionAi
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12 EXECUTIVE SUMMARY The last five
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14 and improve monitoring and evalu
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16 TABLE 1. The monitoring points C
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18 transparency, and accountability
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20 TABLE 2. Characteristics of the
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Part 1 Poverty Trends and Key Theme
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Participatory poverty monitoring in
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