1. SOCIAL EXCLUSION AMONG ETHNIC MINORITY GROUPS Vietnam case

2. 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

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

4. 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

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

6. 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

7. Environment hygiene
Source: MICS 2014

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

9. 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

10. Inequity in Education

11. 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)

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

13. 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

14. 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

15. 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

16. 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
Reluctant to use free services
Will likely be much less of a barrier in the future

17. 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)

18. 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

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

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

21. 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

22. 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