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MA. Nguyen Van Tan
Director General
General Office on Population and Family Planning
Ministry of Health, Vietnam
Promoting migrant-sensitive heath policies and programs: Lesson learnt from Vietnam
CONTENTS
http://www.gopfp.gov.vn
Migration in Vietnam: Status and Characteristics 1
Challenges in Health Care Provision to Migrants 3
Standpoint and Solutions 4
Migration Legislation and Policy 2
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
1984-1989
1994-1999
2004-2009
2009-2014
Di cư 2.5 4.6 6.8 5.7
Dân số 5+ 54.3 69.0 78.5 83.3
2.5
4.6 6.8
5.7
0.010.020.030.040.050.060.070.080.090.0
100.0
Migration
Population 5+
- A total number of domestic migrants (both intra-provincial and inter-provincial) increased from 4.6 million (1994-1999) to 6.8 million (2004 to 2009) and up to 5.7 million people (2009-2014); - Clear relationships are seen between migration and economic development. During the period 2004-2009 the economy saw a substantial level of development; during the period 2009-2014 the economy was faced with a lot of difficulties.
Source: Vietnam GSO, 2015
Quantity and Migrant Rates, 1999-2014
4.6
6.5
8.6
6.8
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
1984-1989 1994-1999 2004-2009 2009-2014
1. INCREASING TREND IN DOMESTIC MIGRATION
2. INCREASING RURAL-URBAN MIGRATION
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
Like many other countries, most of
the population in Vietnam live in rural
areas.
During the period 1999-2009 it was
observed that there was a rapid
increase in rural-urban migration (from
27,1% in 5 years prior to 1/4/1999 to
31,4% in 5 years prior to 1/4/2009).
However, during the period of 2009-
2014 the migration flow declined to
29%, but the urban-urban or urban-
rural flows increased. This was
because of the impact of the
economic crisis in 2008, leading to
urban-rural or urban-urban migration
to search for employment
opportunities.
37
33.8
28.8 27.1
31.4 29.0
9.7 8.4
12.1
26.2 26.4
30.1
5
10
15
20
25
30
35
40
1999 2009 2014
NT-NT NT-TT TT-NT TT-TTRural-rural
Rural -
Urban-Rural
Urban-Urban
Source: Vietnam GSO, 2015
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
The average age and median age of migrants is always lower than non-migrants (Vietnam GSO, 2015).
Source: Vietnam GSO, 2015
3. “Rejuvenated” migrants
Intra district Intra provincial Intra country Non-migrants
Male
Female
4.6
6.5
8.6
6.8
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
1984-1989 1994-1999 2004-2009 2009-2014
-The proportion of female migrants out of the total migrants increases faster than men, from 42.7% (1989) to 53.7% (1999), to 56.5% (2009) and to 58.9% (2014) of the total number of migrants. The largest group of migrants is the female migrants under 25 years old. (GSO & UNFPA, 2001), working in service sector, trade and industry. - In 2014, the number of migrants had declined but the proportion of female migrants tended to increase.
Source: Vietnam GSO, 2015
4. Womanized trend among migrants
42.7
53.7 56.5
58.9
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
1989 1999 2009 2014
Rates of migrants, 1999-2014 Rates of female migrants, 1999-2014
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
Trong đó: KT1: person whose residence registration is in the district level where he/she lives KT2: person whose residence registration is in another district in a province where he/she lives. KT3: person whose temporarily registers residence of more than 6 months KT4: person whose residence registration is less than 6 months
5. Temporary migrants
12.1 11.8 11.9
4.1 8 6.3
37.8
31.1 34.0
46 49 47.7
0
10
20
30
40
50
60
Nam Nữ Chung
KT1 KT2 KT3 KT4
Migrants are both male and female and mostly migrate in less than 6 months - Residence registration as KT4: 47.7% - Residence registration as KT43:34.0%
In which migrants with residence registration are less than 6 months are mostly young and unmarried (64,9%)
Source: Vietnam GSO, 2006
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
MIGRATION IN VIETNAM: STATUS AND
CHARACTERISTICS
-Female migrant workers have not been trained professionally; only 10% are trained at secondary level, and the rest just graduated high school. -Mainly work in the private sector, or in the industrial zones
Source: Vietnam GSO, 2015
6. Migrants with low education, lack of technical expertise
64.9 58.8
72.6 66.7
6.6 6.2 6.0 6.2 5.9 6.8 5.6 6.1
16.2
24.7 21.9
15.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Di cư trong huyện
Di cư trong tỉnh
Di cư trong nước
Di cư
Không có trình độ CMKT Sơ cấp Cao đẳng Đại học trở lên Elem. College University and
Intra district Intra provincial
Inter provincial Migration
Non expertise
No law, ordinance that refers directly , spefifically to migrants.
Most of the provisions of the law (Constitution, laws, ordinances, ...) and the policy of the State on migration issues and migrants are expressed in general principles, applicable to all organizations and individuals in the country.
There is no discrimination against migrants
The freedom of movement and residence: are specified in the Constitution, the Law on civil status, household registration.
The right to medical care and health protection: health policy, health care (law protecting people's health care, Health Insurance Law).
The right to education, intellectual development: policies on education and training
Employment rights of workers: policies on labour and jobs
Right to residence and to legitimate property ownership: policies on construction, housing, and land use.
Right to enjoyment of socio-economic services: Policies on electricity, water, loans, poverty reduction
LEGISLATION AND POLICY ON
HEALTH CARE FOR MIGRANTS
The Constitution of Vietnam (2013) defines a number of articles on migration. Specifically, Article 23 stipulates: "Citizens have the right to freedom in movement and residence within the country, have the right to going abroad and returning home from abroad. The implementation of these rights prescribed by law: The provisions in the Constitution on education, labour and employment, health, health care, health insurance ... applies to all subjects, regardless of the migrants.
RIGHTS TO FREEDOM OF MOVEMENT AND RESIDENCE
RIGHT TO HEALTH CARE AND HEALTH PROTECTION
Law on protecting people's health care (1989): Identifying Vietnamese citizens to have the right to health protection. Health protection as the rights and obligations of citizens in general, irrespective of socio-economic characteristics, occupation or their relatives. The State to take care of people's health and to make this work in the plan of socio-economic development and the state budget. The law also defines the responsibilities of the Ministry of Health, People's Committee at all levels, individuals and employers in the protection of people's health care, regardless of the migrants. Health Insurance Law: Goals towards universal health insurance coverage, ensuring risk-sharing among the insured and without discrimination against migrants.
The Law requires that children under 6 get free medical care
LEGISLATION AND POLICY ON
HEALTH CARE FOR MIGRANTS
LIMITATION IN POLICY ON HEALTH CARE FOR
MIGRANTS
No law nor ordinance that refers directly to migrants.
No ministry ever assigned to be responsible for management of
urban migration, therefor there has been shortage of an overall
strategic planning and formulation of a comprehensive policies on
migration, planning of industrial zones that limit the access to
social services for migrants.
Some policies guiding the implementation of laws and
ordinances ... issued strict regulations, required conditions and
procedures to ensure the state management of the residence
registration. Thus migrants can hardly benefit from social services
in particular from health care and other social services in general
(such as culture, education, labour, employment, etc ...).
When formulating social policies there is no keen attention to
migrants. Budget allocation mechanism for social services is
based on household register management, so migrants met with
difficulty in access to social services.
LEGISLATION AND POLICY ON
HEALTH CARE FOR MIGRANTS
- Migrants have better knowledge on STDs thanks to increasingly extended communications work. However, 1/3 of migrants have limited knowledge on the causes of STDs.
Source: Vietnam GSO, 2006
LIMITED KNOWLEDGE AND BEHAVIOURS IN HEALTH CARE AMONG MIGRANTS
81.8
83.3
81.5 82.2
81.7 82.8
81.5 82.0
84.1
82.1 82.6
83.4
80.0
82.0
84.0
86.0
15-29 30-44 45-59 Tổng
Lậu Giang Mai Viêm gan BGonorrhea Syphilis Hepatitis B
Migrants who have knowledge on STDs
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
- Migrants who have high level of knowledge on HIV/AIDS. The main sources of information are through TV (96.5%), Radio (68.5%) and press (61.1%). - However, their knowledge on the causes of infection is low (63.1%), lower than non-migrants (64.9%).
=> Migrants are mainly youth, unmarried young people, those who are of limited education therefore they become more vulnerable to infection. It is more important to note that more and more young migrants are young women.
Source: Vietnam GSO, 2006
97.1 96.3 96.6 97.9
95.6 93.6
96.9 97.6 96.0
91.9
96.8
88.0
93.0
98.0
103.0
15-29 30-44 45-59 Tổng
Lậu Giang Mai Viêm gan BGonorrhea Syphilis Hepatitis B
Migrants who have knowledge on HIV/AIDS
1. LIMITED KNOWLEDGE AND BEHAVIOURS IN HEALTH CARE AMONG MIGRANTS
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
- Smoking is common in Vietnam. There is an increase in smoking among male migrants, in the
age group 30-44, from 65.5% (before migration) to 70.1% (after migration). The main reasons
are such as boredom, work pressure, depression.
- Migrants tend to have less drinking than non-migrants, but drinking is still common among male
migrants => Bad habits (smoking, drinking) damage health and cause various diseases
Source: Vietnam GSO, 2006
0
20
40
60
80
15-29 30-44 45-59
43.8
65.5 60.2
48
63.8 61.8
Di cư Không di cư Non migrants
Smoking and Drinking
0
10
20
30
40
50
Uống hàng ngày
Vài lần trong tuần
Một lần trong tuần
Một lần trong tháng
Uống khi liên hoan
6.4
16.2 19.2 15
42.4
11.8
23.5 19.7
12.1
32.4
Di cư Không di cư
A few timeses a
Once a week
Once a month
Drinking in party
Migrants Non migrants
1. LIMITED KNOWLEDGE AND BEHAVIOURS IN HEALTH CARE AMONG MIGRANTS
Migrants
Daily drinking
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
Migrants have better housing than
non migrants, 59.7% of migrants live in
solid house or semi permanent house
compared to 42.9% of non migrants. The
main reason is that migrants moving to
the urban areas enjoy better housing in
cities.
Migrants often rent housing (55%)
compared to non-migrants (8.3%)
(Vietnam GSO, 2006).
=> Because of their lodging the
access to health information is a
particular challenge. Sexual and
reproductive health education to
young migrants is particularly difficult
Source: Vietnam GSO, 2015
25.3
47.0
59.7
42.9
2.9 6.3 1.7 3.7
0.010.020.030.040.050.060.070.0
Di cư Không di cư
Kiên cố Bán kiên cố Thiếu kiên cố Đơn sơ Solid Semi solid No solid Rudimentary
Migrants Non migrants
2. LIMITED LIVING CONDITIONS OF MIGRANTS
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
The rate of migrants living in less than 4m2/person to
10m2 (the lowest standard) is higher than non-migrants.
Highly concentrated lodging by migrants in more
economically developed areas, mostly economic zones
the demand for housing for rent is high when the supply
is limited or the cost is high.
=> Housing condition is inconvenient - living in
small area, lacking facilities, poor hygienic
conditions. That affects badly the health status of
migrants
Source: Vietnam GSO, 2015
2. LIMITED LIVING CONDITIONS OF MIGRANTS
3.6 0.6 8.7
2.3
18.0 11.3
69.2 85.3
0.010.020.030.040.050.060.070.080.090.0
Di cư Không di cư
Dưới 4 m² 4-dưới 6 m² 6 đến dưới 10 m² Trên 10 m²
Non migrants
<4m2 4-6 m2 >10m2
Migrants
6-10 m2
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
Source: Vietnam GSO, 2006
3. Employment opportunities of migrants
Public sector 13%
Small private
business 49%
Private sector 18%
Joint venturei
19%
Unidentified 1%
Migrants having low education level: low skill labor
workforce, 46.4% of migrants do simple jobs (Vietnam
GSO, 2006).
Migrants mostly work in private sector: private firms
(18%); privately owned trade business (49%). Their
wages are normally low, no labor contract signed with
employers therefore they are not covered by social
insurance or health insurance schemes.
=> Access to social services, health care service is
difficult because they are not covered by health
insurance policy, the health care cost is high when
the need for savings to support their families are
high.
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
4. RESIDENCE REGISTRATION SYSTEM – A BARRIER TO HEALTH CARE TO MIGRANTS
Most of migrants (male and female) are temporary, less than 6 months ( registered as KT4 account for 47.7%, KT3 34%). Migrants change their migration destinations very often because of the instability in their jobs
=> Difficult for migrants to access to health care service as well as in health care provision to migrants; The health education and health care to migrants is limited because of the access issue
Charter of Health Insurance (Ordinance
63/29005/NĐ-CP May 16, 2005) stipulates that
the person who has health insurance selects the
health clinic for PHC assigned to the area where
he/she has residence registration.
=> Temporary migrant, worker without labor
contract who have health care needs can not be
entitled to health care service at the area he/she
lives or works
CHALLENGES IN HEALTH CARE FOR
MIGRANTS
STANPOINT AND SOLUTIONS
Quan điểm
Considering migration as a law, indispensable elements and driving forces of socio-economic development.
Integrating migration into the programs and activities.
Creating stable conditions for migrants and improving their access to health services, sexual health care / RH / FP.
Considering the household registration as social management tool to protect residence right, but not a tool to address the health care policy
SOME SOLUTIONS
Government Stipulates children under 6 years old registered under KT3
category (temporarily migrated less than 6 months) be given free
health insurance card by the authorities where they are registered. If
they do not have health insurance card yet their parents can use birth
certificate or birth notification to access free health care for the
children.
Revised Health Insurance Law (2004): The revised law stipulates
compulsory participation in the health insurance scheme (policy
requesting less premium, government subsidization to some groups
of people). This is a solution to move forward to universal health
insurance coverage.
Liberalizing utilization of health clinics where patients can use
health insurance card to allow maximum conditions in access to
health care services. From Jan 2016 patients in different communes
can access health clinics in other communes or those at district level.
From Jan 2021 this policy will apply to all provinces in the country.
Increase the benefits to health insurance beneficiaries: The
benefits will increase in line with a roadmap that has been
worked out.
STANPOINT AND SOLUTIONS
IMPLEMENTATION OF SOLUTIONS
Ministry of Health
Implementing health care
programs: TB prevention and
treatment, HIV/AIDS control program,
S/RH program to be implemented for
immigrants.
Provision of free drug to mental
health patients, TB patients:
Provision of free drugs regardless of
migrant status or not.
In health care and treatment:
there will be no discrimination
against migrants
STANPOINT AND SOLUTIONS
IMPLEMENTATION OF SOLUTIONS
General Office for Population and Family
Planning, Ministry of Health:
Intensify communications (through radio,
population collaborators) to reach migrants in living
quarters, industrial zones (focusing on households,
male and female migrants) on policy, directions and
knowledge on population/SRH/FP.
Model on information and RH service
provision to migrants in Hanoi, HCMC: face to
face communications, IEC material provision,
building communication corners (materials,
contraceptive supplies) in the lodging houses with
the owner’s participation
If we do not well provide health services to migrants, especially young female migrants there will be more unwanted pregnancies, HIV infection cases and STDs. They may pread out to the
community
STANPOINT AND SOLUTIONS
IMPLEMENTATION OF SOLUTIONS
General Office for Population and Family Planning
Project “Ameliorate the population/RH - FP status for
adolescents during the period 2016-2020” with the
following objectives:
Decrease 50% of female adolescents and youth
who have unwanted pregnancies by 2020;
Increase the youth friendly S/RH-FP service points
to 75% by 2020;
Sensitize to have 50% of parents who have their
children at adolescent ages to support, guide,
assist their children in gaining knowledge and in
assessing S/RH-FP services.
If we do not well provide health services to migrants, especially young female migrants there will be more unwanted pregnancies, HIV infection cases and STDs. They may pread out to the
community
STANPOINT AND SOLUTIONS
THANK YOU VERY MUCH !