Ethnic Minority Plan

Vietnam HIV/AIDS Prevention Project Ethnic Minority Plan (EMP)

VIETNAM HIV/AIDS PREVENTION PROJECT

Ethnic Minority Plan

May, 2010

TABLE OF CONTENTS

ABBREVIATIONS

Executive Summary

I. Project Introduction

II. Socio-Economic Situation of Ethnic Minorities in Project Locations

2.1. General view

2.2. Socio-economic features and population structure in project areas

The 32 project provinces stretch along the country with complicated topography and harsh climate.Total population of the provinces is approximately 40 million people. Basics economic activities are agriculture and husbanry. Poverty rate are different within provinces with highest rate in north uplan provinces and lowest rate in urban and lowland provinces.

2.3. Ethnic minorities in project areas:

There are about 49 ethnic groups living in the project areas. With the exception of the Cham, Khmer and the Chinese, most of remaining ethnic minority groups live in upland areas.

2.4. Basics socio-economic features of some major ethnic minority groups in the Project areas

Though having been benefited from various development projects implemented by both Vietnam government and International agencies, most of ethnic minorities in the project areas hold high poverty rate, with high dependence on agricultural production.

III. Policy Framework

3.1. WB’s policies toward ethnic minorities

The WB has its own policy toward the indigenous/ethnic minority people (OP4.10). It calls upon projects to invest into ethnic minority areas, and to fully respect the preferential rights of the affected ethnic minorities. At the same time, it is expected to mitigate the adverse impacts on the ethnic minorities and promote those activities that aim at bringing benefits and preserving their traditional cultural values. The WB requests that the local people should be sufficiently informed and freely participated in the Project, and the Project should receive the support from most of the affected ethnic minority people. The designed Project must ensure that the ethnic minority people receive the social and economic benefits are culturally appropriate, and gender and inter-generationally inclusive.

3.2. GoV’s policies

During the last ten years, GoV has implemented number of projects aiming to provide better health care service for the people, especially ethnic minority people. Relating to HIV/AIDS prevention, the GoV has designed and implemented a national action plan with 8 strategies aiming to bring about better HIV/AIDS intervention program.

IV. Constraints that cause Limited Access to HIV/AIDS prevention for Ethnic Minorities

4.1. Geographical and transportation

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4.2. Customary practices

4.3. Poverty

4.4. Language and educational background

4.5. Migration

4.6. Urbanization

4.7. Cross border issues

4.8. Tourism

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V. Community Consultation

*Activity principles

Ensuring the participation of the ethnic minorities in the project in order to speed up the smooth project implementation. Disclosure of project information for ethnic minority people is an important part of project preparation and implementation. Making consultation with them, and ascertaining their active participation in the project. These will mitigate the risk of conflicts and project delays. They will also enable the Project to design the resettlement and rehabilitation program as a comprehensive development one, which meets the needs and priorities of the displaced, and thereby maximizing the economic and social benefits of the investments.

*Methods of community participation and consultation

The project implementation activities must be consulted with the ethnic minority specialist, especially the one who has experience in project activity areas (healthcare, insurance, etc.)

-The CPMU must have close cooperation with the PPMUs, especially those with high and diversified concentration of ethnic minorities.

-The PPMUs will monitor the implementation process in order to make sure that equal healthcare services will be provided for ethnic minorities, and financial and legal support will be made available for districts in their provinces.

-The DPC must establish the efficient cooperation with other departments/programs in the district, especially those related to ethnic minority development activities.

VI. Ethnic Minority Plan (EMP)

The goal of this EMP is to ensure better HIV/AIDS preventions for people in the project areas, especially ethnic minorities. This EMP is prepared with careful consideration of the cultural practices of the ethnic minorities, and the constraints that prevent the effective implementation of HIV/AIDS prevention activities in each region

VII. Organization and Implementation

As for the performance of the ethnic minority development plan, the CPMU and PPMUs will start up the implementation of project components and carry out the supervision exercise in order to make sure that the project activities are kept on right track.

-With regard to those districts which have high concentration of ethnic minority population, documents in their languages should be published, and the engagement of people who have the knowledge of local ethnic minority languages should be made in order to make sure that the communication and consultation with local people will be done during their check-up and treatment exercises in the health facilities.

-Qualified doctors will be sent to organize training activities and capacity building for ethnic minority medial workers working in district-level hospitals where there is a high need for the transfer of medical techniques, especially in those districts where there is a high concentration of ethnic minority population.

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VIII. Monitoring and Evaluation

-Monitoring the implementation of the ethnic minority development plan is a part of monitoring activities within all project components.

-An independent supervision agency with qualified and experienced specialists must be in place in order to provide monitoring and evaluation of project activities related to social and ethnic minority development aspects.

The CPMU and PPMUs will undertake monitoring and evaluation of project components. As for provinces which have districts with more than 50% of its population as ethnic minorities, the cooperation should be done in order to provide the monitoring of ethnic minority-related activities.

IX. Cost Estimation

-The costs of EMP activities are estimated and embedded within project activities.

-The costs of training activities will be calculated in detail when these activities are conducted.

-In order to make cost savings, EMP-related training and communication activities will be incorporated into other project training and communication activities.

I. INTRODUCTION

1.1. Project Introduction

Project Background

(i). The number of people in Vietnam living with HIV/AIDS has rapidly increasedin recent years, and reached an estimated 254.387by the end of 2009. HIV/AIDS has been founded in all 63 provinces/cities, from urban to rural and upland areas. High rate of HIV/AIDS is present in nothern provinces which lye along border line with Laos and have high population of numerous ethnic minority groups. In these provinces, drug uses and prostitution are two main causes of HIV/AIDS increas.IDUs comprise 52 percents of registered HIV cases, highlighting the concentrated nature of Vietnam's epidemic.

(ii). A study of 7 provinces found that 90 percent of IDUs had had no access to sterile injection equipment in the previous six months; behavioral surveillance has found that as much as 44% of IDUs reported sharing injecting equipment at the last injection. HIV/AIDS transmission through unprotected sex is increasing annually and a low rate of condom use during intercourse persists. In addition to that, an increase in IDUs among female sex workers constitutes an emerging challenge.

(iii). For this reason, harm reduction as a prevention strategy is considered a key tool in the fight against HIV. The 2005-2006 Integrated Biological and Behavioral Surveillance (IBBS) reveals that HIV prevalence is highest among IDUs, ranging from 23% to 66%, with significant variation by province. SWs also exhibit high HIV prevalence, ranging from 4% to 10%, with HIV prevalence up to three times higher among sex workers who reported injecting drug use. IDU and SWs, particularly SW-IDUs, are ‘core transmitters’ and driving forces in the current HIV epidemic. Populations with high prevalence and large degrees of social mixing such as IDUs and sex workers require greater coverage than low prevalence, low mixing communities. Despite the significant increase in the number of needles and syringes as well as free condoms distributed in Vietnam in the last few years, coverage remains poor at best.

(iv). This project is the continuation of a HIV/AIDS prevention project which started since 2005 with extension from 20 provinces to 32 provinces after receiving financial support from DFID.

(v). IDA Credit for the Vietnam HIV/AIDS Prevention Project, in an amount of US$ 35 million equivalent, was approved by the Executive Directors on March 29, 2005 and became effective on October 17, 2005. The grant is financed in full by DFID and channeled through the Trust Fund arrangement of the World Bank.

IDA project cover 20 Project provinces and cities. The 20 provinces covered by the project include: Lai Ch©u, S¬n La, Yªn B¸i, Cao B»ng, Th¸i Nguyªn, B¾c Giang, H¶i Phßng, Th¸i B×nh, Nam §Þnh, Thanh Ho¸, NghÖ An, Kh¸nh Hoµ, §ång Nai, TP. Hå ChÝ Minh, An Giang, BÕn Tre, Kiªn Giang, HËu Giang, TiÒn Giang, VÜnh Long

(vi). DFID had previously supported government HIV/AIDS program through bi-lateral project (GBP 17.3 million, from 2003-2008) for Behavior Change Communication (BCC), Harm Reduction (HR), Sexually Transmitted Infections (STI), and Capacity Building in 21 provinces, of which 8 coincided with WB-supported provinces(but covered different communes).

(vii). For the second phase of DFID support (GBP18 million, from 2009-2012), DFID and the Bank teams discussed and agreed to have a joint project. The proposed arrangement was strongly appreciated and supported by the government. The joint project will maintain the original IDA Grant funded project's Development Objectives and implementation arrangements. The joint project coverage will be extended to additional districts within the original IDA covered provinces and 12 additional provinces which were under the first phase of the DFID project. The 12 additional provinces are: L¹ng S¬n, Qu¶ng Ninh, Hµ Néi, Hµ TÜnh, HuÕ, §µ N½ng, B×nh ThuËn, T©y Ninh, Bµ rÞa-Vòng tµu, CÇn Th¬, §ång Th¸p, Sãc Tr¨ng.

(viii). With these resources, the total project provinces will be 32 out of 63 provinces of Vietnam. The proposed activities are fully consistent with the existing project development objective, which is to halt the transmission of HIV/AIDS among vulnerable populations[1] and between these groups and the general population. The additional financing would complement ongoing activities by mitigating the social and health-related consequences of drug injecting, particularly the risk of contracting HIV/AIDS for vulnerable groups.

(ix). The joint project will create opportunities to strengthen the successful implementation of the original project in 12 new provinces; promoting a coherent and streamlined response to scale up coverage, quality and impact of harm reduction services; streamline coordination at the national and provincial level; move to one program approach with a more coherent administrative arrangement for VAAC; and create a joint program arrangement with which other agencies can align in future.

The joint project consists of three components with some modifications as below:

Component 1: Implementation of provincial HIV/AIDS Action Plans (USD 12.34 million).

Support will be provided to the 20 provinces and cities currently covered, and will be expanded to an additional 12 provinces. The provinces will be allocated block grants based on specific criteria to determine the size of each year's base allocation. Proposed activities are expected to reflect the diversity of provincial needs as well as the different responses needed in each location.

Component 2: National HIV/AIDS Policy and Program (USD 5.6 million).

This component will strengthen capacity at the national and provincial levels, and promote the development of innovative, effective prevention through condoms promotion and needle exchange programs. Opiate substitution therapy in the form of methadone maintenance therapy will also be scaled up with the technical support of WHO.

Component 3: Project Management (USD 7.0 million). This component will provide support to establish 12 provincial Project Management Units (PPMUs) in the 12 additional project provinces. It will also provide support to the institutions that will manage and implement the project, such as the Central Project Management Unit (in the Ministry of Health), Provincial AIDS Steering Committees and other implementing agencies.

Project objectives

Objective of the Project is to assist Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations and between vulnerable populations and the general population, thereby assisting Vietnam in the implementation of its National Strategy on HIV/AIDS Prevention and Control.

The project also aims to reduce stigma and discrimination towards vulnerable groups such as PLWA, IDU, SWs, and to increase access to HIV/AIDS care and support for vulnerable populations resident in rehabilitation centers

Project Direct Beneficiaries

The project beneficiaries will include the following three groups:

(i). Support programs designed to halt transmission of HIV/AIDS among vulnerable populations (PLWHA, IDU, CSW, and their clients and sexual partners) and between these vulnerable populations and the general population

(ii). Healthcare service providers: Staffs from provincial- and district-level healthcare service providers, especially district hospitals and DPHCs, will be provided necessary training on HIV/AIDS prevention and related professional knowledge. 32 participating project provinces , with supports from the project, is expected to have the policies and capacities to utilize block grants to design, implement and monitor HIV/AIDS programs which promote harm reduction (increased opiate substitution, clean needle-syringe and condom use) to reduce HIV transmission among vulnerable populations (IDU, CSW, their clients and families)

(iii). Administrative agencies: Funding will be provided for administrative organizations (Provincial Health Departments, District Health Centers, Rehabilitation centers) to help them manage better HIV/AIDS related activities.

II. SOCIO-ECONOMIC SITUATION OF ETHNIC MINORITIES IN PROJECT LOCATIONS

2.1. General review

(i). There are around 49 ethnic groups living in the project areas. Most of the groups live in upland areas.

(ii). Ethnic minority groups are concentrated mainly in two mountainous geographical regions. They can be found in the 11 north mountain provinces (Northern East and North West) that encompass 31 ethnic groups. They are also in the Central Coastal and CentralHighlands, covering 19 provinces with 18 ethnic groups. The Central Highlands also host many newly settled ethnic minority groups. The Hoa, Khme, and Cham, who reside in the coastal and lowland areas, mix with the Kinh group in the South Coastal and Mekong River Delta provinces

(iii). Population growth in the mountainous regions is higher than the national population growth rate, which is 2.1 percent. In the Northern region, the population growth rate is 2.3 percent and in the Central Highlands it is 3 percent. For several ethnic groups, the population growth rate is much higher than the national average.

(iv). There is great diversity among the ethnic minority groups in terms of their size, language, lifestyle, customs and beliefs, social organization.

(v).Literacy is lower among ethnic minorities comparing to that of the Kinh. The literacy ratio for ethnic minorities is estimated to be 73 percent compared to 90 percent for the total population. Primary education is available for 90 percent of the total population while for ethnic and poor it is much more limited. At secondary and higher education levels, gender disparities still exists due to cost, fees, and sociocultural barriers.

(vi). Among ethnic minority communities. Women are assigned the traditional “women’s work” such as taking care of domestic chores, reproductive and family care and activities related to hygiene and sanitation.

(vii).Vietnam is a success story for poverty reduction and development. The country has made great strides in reducing the overall poverty rate, from nearly 60 percent of the population in 1993 to 16 percent in 2006 (based on Vietnam Household Living Standards Survey (VHLSS) data). However, despite the impressive overall gains, ethnic minorities have experienced lower rates of poverty reduction than the general population. In 2006, ethnic minorities accounted for only 14.5 percent of the total population, but they made up 44.7 percent of the poor and 59 percent of the hungry. In that year, ethnic Vietnamese and Chinese households experienced a poverty rate of only 10 percent, while all other minority groups averaged a 52 percent poverty rate (VHLSS 2006). These figures, based on national survey data, may not show the real depth and severity of poverty among some especially vulnerable minority groups. More localized qualitative studies indicate an income gap between ethnic groups, with entrenched and serious poverty among some populations