SOCIAL EXCLUSION AMONG ETHNIC MINORITY GROUPS Vietnam case

Introduction Total population: 91.7 millions A lower – middle – income country: GDP constitute of 22% agriculture, 41% industries, and 38% services Among 10 “fast-track” countries making progress to achieve MDGs 4 and 5a

Introduction Marginalized groups and Equality of opportunity in Vietnam: Ethnic minority groups People with disabilities Migrants Gender equity and fertility Source: World Bank (2016)

Introduction Vietnam is home for 54 ethnicity, 84.7% are Kinh ethnic group Ethnic minority groups, except Hoa people Mainly located in remote of Northern Highlands, Central Highlands, and Southern Mekong Delta Experience social exclusion/inequity of public services: health, education, government services

Health inequity Health care seeking and utilization: particularly in maternal and child health services; Environment hygiene Health outcomes

Health care seeking and utilization Less inequitable in family planning, exclusive breastfeeding, and immunizations Most inequitable in multiple service contacts and required significant support from the health system Antenatal care Skilled birth attendance Health institution delivery Source: MICS

Environment hygiene Source: MICS 2014

Health outcomes Being at higher risk of having communicable diseases, malnutrition, maternal and child mortality Source: (Lee et al., 2016a)

Inequity in Education Little inequality in reading and math proficiency in upper-secondary school overall compared to other nations among: Gender Wealth Urban and rural Moderate levels of inequality in mean years of schooling

Inequity in Education

Others Government Services Less well covered by social programs aimed at the poor, like the health care fund for the poor, government poverty reduction programs (World Bank, 2009) Less utilized of legal services, particularly among women(ISEE, 2010)

Determinants of inequity Source: Malqvist et al., 2012)

Determinants of inequity Culture and societal value Structure determinants gender languages education occupation and income (poor) Intermediate determinants Psychosocial factors: stereotyping of ethnic minorities Public system factors Distance to public facilities Poor public services Services lacking of culture-adaptation

Culture and societal value Traditional belief and practice Birth is a natural and normal process, Being ill is “the god will” Early marriage and child bearing, the more children, the more happiness and virtuous Customs during pregnancy and delivery

Structure determinants Gender Women are in much lower status than men Girls are likely to stop schooling first, Girls are less likely to receive treatment than men Husband, parents – in – law are more likely to be decision makers

Structure determinants Languages Main barrier for ethnic minorities in participating in educational system 70% of ethnic minority children cannot speak or understand Vietnamese as they enter school in 2007 - 2008 Reluctant to use free services Will likely be much less of a barrier in the future

Structure determinants Education The most critical barrier (World Bank, 2009) Knowledge about danger signs and disease patterns Understanding of health system structures Ability to adapt to change Uneducated increased risk of not receiving antenatal care in the ethnic minority group, with an OR of 2.95 (95% CI 1.70– 5.12)

Structure determinants Household economic Ethnic minority/poverty? 15% of population but account for 70% of the extreme poor unaffordability of health service expenses and others such as eating, visiting and travelling not receiving skilled birth attendance 25.5 time higher among poor women from ethnic minority groups compared to nonpoor Kinh/Chinese women

Structure determinants Multiple vulnerabilities Source: Goland et al., 2012a Source:

Intermediate determinants stereotyping of ethnic minorities national treasure, rich cultural diversity “Backwardness”

Intermediate determinants Public System factors Distance to public facilities: Travel times 21 vs. 36 minutes to district hospitals, and 16 vs.11 minutes to commune health station Poor public services Unavailability of services, Services lacking of culture-adaptation

Affect Social mobility and economic development have lower social mobility, less likely to move up into a higher income bracket, 49% vs. 19% move out from bottom quintile in 2010 – 2014 intergenerational elasticity for Vietnam is 0.36 inter-generational cycle of poverty amongst ethnic minority