promoting migrant-sensitive heath policies and …...100.0 migration population 5+ - a total number...

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


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



CHARACTERISTICS

The average age and median age of migrants is always lower than non-migrants (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.


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


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%)



CHARACTERISTICS


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


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



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.



- 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.


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.


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


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


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


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


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


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


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


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


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


MIGRANTS


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.


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


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.


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



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



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


THANK YOU VERY MUCH !

promoting migrant-sensitive heath policies and …...100.0 migration population 5+ - a total number...

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