• Introduction and Overview
• Government Agencies
• Non-Government Agencies
• Demographic Profile
• Social Protection
• Child, Youth and Family Policy Regimes
• Maternity Benefits
• Early Childhood Education and Care (ECEC)
• Child Education
• Child Health
• Special Groups of Children
• Child Trafficking
• Child Labor
• Notes
• References

(Last updated March 2006)

Introduction and Overview

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Government Agencies

• (MOLISA): The Ministry of Labor, Invalids and Social Affairs (MOLISA) is the lead Vietnamese government agency on labor issues, including job creation and training, labor management relations, wages and hours of work, occupational safety and health, and social insurance. The Ministry is responsible for developing national labor policy, creating labor law and regulations subject to approval by the National Assembly or Prime Minister, implementation of policy and law, and overseeing enforcement at the national level. The Ministry houses the social evils department and the child labor unit.

• Commission for Population, Family, and Children: The Vietnam Commission for Population Family and Children (VCPFC) is a Government institution which has the function of state management on population family and children. It serves as an advisory body for the Government in formulating strategies, plans, programs, projects on population family and children.  Being a coordinating agency, VCPFC works closely with line ministries and mass organizations to carry out the national population family and children program. It also has extensive cooperation with international institutions, government organizations and NGOs in program management and monitoring, research activities and information exchange.

• Ministry of Education and Training (MoET): The Ministry of Education & Training is a Government agency which has the function of implementing State management in the field of education, including pre-school, general, professional high-school, tertiary, post-graduate education and non-regular training, and over public services in these fields; representing the State ownership in enterprises with State investment capital under the Ministry’s management and according to legal provisions.

• Early Childhood Care and Education: The primary responsibility for supervision, formulation of policy and general directions, and the development of programming strategies, guidelines and standards for ECCE is with the Ministry of Education and Training. The Early Childhood Care and Education Department at the Ministry is the lead unit at the central level. The ECCE unit shares responsibility for national coordination of ECCE with the Ministry of Health, the Commission for Population, Family and Children and the Vietnam Women’s Union. They are responsible for both state and non-state ECCE programs.

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Non-Government Agencies

Vietnam is a communist country. However, in the last few years, especially since the initiation of the government's reform program in 1986, the government in Vietnam has sought to encourage a growth of the third sector that is increasingly able to operate without the governmental and/or the Communist Party support.  Most third sector organizations may not resemble similar modern organizations, however, these organizations are not purely government owned or profit oriented organizations, but create public benefits. These third sector organizations are not controlled by the Communist Party or the government, rather the Communist Party and the government are the power centre which the third sector organizations need to negotiate. 

The Government Committee for Organization and Personnel (GCOP) in Vietnam defines nonprofit organizations (NPOs) as association or a voluntary not-for-profit organization of Vietnamese people or groups, uniting people/organizations of the same interest or professions sharing knowledge, resources and working on regular basis for a certain purpose legally accepted.

According to this definition, an association or organization, therefore, should have the following characteristics:

• A formal organizational structure
• Formed voluntarily by citizens or groups of the same profession or interest
• Not belonging to the government system
• Operating on a regular basis
• Not for profit motive

Most NGOs in Vietnam are coordinated by two organizations: first, organizations  formed to contribute to socio-economic development are coordinated by the Vietnam Fatherland Front (VFF); and, second, professional and business organizations are coordinated by the Office of Government Committee for Organization and Personnel.

Though there is no exact number, it is estimated that there are hundreds of NGOs providing social support  such as the Women‘s Union, Red Cross, etc. A number of NGOs for orphans have been formed under the Association for Protection and Support of Disabled People and Orphan Children. These NGOs have to register with the local governments directly or through the umbrella association. These NGOs provide care and support to orphans, disabled people and old people. These NGOs also provide vocational training, involve people in production and provision of service for income and help them to rehabilitate to the community. Financial resources of an NGO may include individual contribution from inside and outside the country, monies from foundations, income from production or services, and international organizations.

International NGOs working in Vietnam collaborate with domestic NGOs to implement projects in various areas including health, HIV/AIDS prevention, poverty elimination, etc. [Philanthropy and Third Sector in Asia Pacific, 2005]

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Demographic Profile

The population of Vietnam grew from close to 80 million in 2001 to 83.5 million in 2005. The population growth rate in 2005 is 1.04% down from 1.45% in 2001. Both the total fertility rate and birth rate declined between 2001–2005 from 2.49 to 1.94 children born/woman. [CIA World Fact Book, 2005]

The population of Vietnam is ageing quickly. The median age of increased from 21.4 years in 1995 to 25 years in 2004. 66.4% of the population are between 15-64 years old, and 5.8% are over 65 years old. The young-age dependency ratio decreased slightly from 0.5 to 0.6 in the last 10 years (1995-2005). The old age dependency ratio has remained constant at 0.1 over the last 10 years (1995-2005). [CIA World Fact Book, 2005]

The majority, 74%, of people in Vietnam live in rural areas (2005). However urban migration is an increasing common phenomenon since the reforms and urban population has increased from 18.9% in 1975 to 26% in 2005.

The Vietnamese government recognizes 54 distinct ethnic groups. The majority ethnic Vietnamese, also called Viet or Kinh, make up about 86 percent of the nation's population. A homogenous social group, the Viet exert influence on national life through their control of political and economic affairs and their role as purveyors of the dominant culture. By contrast, the ethnic minorities, except for the Khơ-me Crôm (Khmer Krom) and the Hoa (ethnic Han Chinese), are found mostly in the highlands that cover two-thirds of the national territory. [CIA World Fact Book, 2005]

According to the 1999 census, the population of Vietnam is composed of the following groups: Kinh (Viet) 86.2%, Tay 1.9%, Thai 1.7%, Muong 1.5%, Khome 1.4%, Hoa 1.1%, Nun 1.1%, Hmong 1%, others 4.1%. [CIA World Fact Book, 2005]

According to the 1999 census, eighty percent of Vietnamese subscribe to no religion. The remainder are predominantly Confucian and Mahayana Buddhist (esp. Mainstream Pure Land schools and Zen-inspired syncretists); with Roman Catholic, Protestant, Cao Đài, and Hoa Hao minorities. The largest Protestant churches are the Evangelical Church of Vietnam and the Montagnard Evangelical Church. Membership to Sunni and Bashi Islam are usually accredited to the ethnic Cham minority, but there are also a few ethnic Vietnamese adherents to Islam in the southwest.  

The religious composition of the Vietnamese population is: Buddhist 9.3%, Catholic 6.7%, Hoa Hao 1.5%, Cao Dai 1.1%, Protestant 0.5%, Muslim 0.1%, none 80.8% (1999). [CIA World Fact Book, 2005]

According to official figures, 86.2% of the population speak Vietnamese as a native tongue. Various other languages are spoken by the several minority groups in Vietnam. The most spoken languages are: Tày, Muong, Khmer, Cantonese, Nung, Hmong, and Tai Dam.

French, a legacy of colonial rule, is spoken by some (mostly older) Vietnamese as a second language. Russian- and to a much lesser extent Czech or Polish- is often known among "baby-boomers" whose families had ties with the Soviet bloc. In recent years, English has become a more popular language to learn and is increasingly used in business, among other things. [CIA World Fact Book, 2005]

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Social Protection

The social insurance system in Vietnam covers old-age benefits, sickness and maternity benefits, and worker's compensation. Participation is mandatory for state employees, as well as workers in domestic private enterprises having more than 10 employees, foreign-invested enterprises, export processing zones, industrial zones, foreign organizations, and international organizations in Vietnam. Employees contribute five percent of their wages towards old-age benefits. Employers are required to pay insurance premiums equal to 15 percent of payroll. Ten percent of the employer's contribution goes toward old-age benefits, with the remaining five percent being divided between sickness and maternity benefits and worker's compensation. [Fritzen, 2004]

Vietnam has a panoply of social welfare programs and initiatives. During the cooperative and collective period, communes took the social and welfare needs of their members in hand. Education and health services were provided as well as assistance and social security when households faced difficult life-cycle changes and shocks. These services were largely financed by the cooperatives with some assistance from the central government.

After the cooperatives were disbanded in 1988, and following cuts in public social sector spending and various privatization and liberalization measures, much of the cost burden of obtaining such services shifted to households. User fees for health care services and all but primary schooling were introduced. Medical costs increased. Overall, the reforms have resulted in vastly increased total education and health out-of-pocket spending. These changes have raised concerns about access by the poor and the specter of rising social differentiation and income inequality. Such concerns have in turn led to attempts to redress rising inequalities. Targeted schooling fee exemptions were instituted, but give limited relief as fees account for only a small share of total school-related expenditures. A compulsory health insurance scheme was introduced in 1993 to cover formal sector workers and current and retired civil servants. This was soon supplemented by another scheme that aims to extend coverage to students, agricultural and informal sector workers on a voluntary basis. However, the better-off are found to be the main participants in the schemes. Poor households continue to be unlikely to be able to insure themselves against severe health shocks.

The social protection system that has evolved since decollectivization is composed of a number of different initiatives that are centrally mandated but locally implemented, often relying heavily on local resources.3 The social security system provides pensions and other employment-related social insurance payments such as for maternity and disability to formal sector workers. It has covered public servants and military personnel since 1947 and was extended to other formal sector employees in 1995. These social insurance payments are still heavily subsidized by the central budget though they are eventually meant to be funded exclusively from payroll taxes and employee contributions. Social security payments go to members of households accounting for 11.2 percent of the population nationally, with greater coverage in urban (18.3%) than in rural areas (9.4%) as might be expected. [Walle, 2003]

Social subsidy transfers are available to compensate and assist those who contributed and suffered from the wars — disabled veterans, relatives of dead soldiers, and others who contributed to the revolution — from the Social Guarantee Fund for Veterans and War Invalids. Others unable to support themselves — including the disabled, orphans and the elderly — are in theory granted social subsidy transfers under the Social Guarantee Fund for Regular Relief. But, here in particular, scarce central public resources imply that implementation and coverage ultimately depend in large part on local level governments and resources. Social subsidy transfers are often touted by the government as reaching the poor. Yet only 9.6 percent of the population are found to live in households who report receiving social subsidies nationally, and only slightly higher at 10.2 percent in rural areas. Payment amounts are highest for the poorest quintile in urban areas.

The central government also runs a Contingency Fund for Pre-Harvest Starvation and Natural Disasters whose role is to minimize the consequences of natural calamities and other emergencies by dispensing disaster relief to regions and households. Relief is provided by district and provincial authorities with the frequent assistance of Vietnam’s Red Cross and the mass organizations. Field studies indicate that emphasis is placed primarily on surviving the emergency and a common instrument is credit for disaster recovery. Because institutional capacity and finances are limited, the aid tends to be short of what would be necessary to get households back on their pre-crisis development path. Poor households in particular are prone to further impoverishment as a result.

Finally, a number of National Development Programs which aim to reduce poverty have been introduced, though their focus is generally more on promoting growth than on providing protection. National programs cover employment generation, reforestation, school and health fee exemptions, micro-credit schemes and physical infrastructure investments. [Walle, 2003]

In 1996 the government proposed a national Hunger Elimination and Poverty Reduction (HEPR) program to bring all these efforts, as well as their resources under one umbrella. Many government programs have subsequently been consolidated under the HEPR national poverty program in order to better mobilize and coordinate antipoverty   resources. Within this, the government implemented the ‘National Target Program on Poverty Alleviation’ between 1998 and 2000 and has recently prepared a ‘Poverty Alleviation Strategy’ for 2001-2010. These new initiatives do not appear to have entailed much change in policy focus or new funding from the central government. The policy areas have all been emphasized in the past and addressed by past programs and a variety of ad hoc schemes. New poverty mandates and targets are imposed on ministries by HEPR without the benefit of additional funding or reductions in other mandated responsibilities. [Fritzen, 2004]

Throughout all these programs, eligibility criteria, guidelines and norms are largely dictated by the center, while implementation is chiefly the responsibility of the   communes. Poverty and needs are locally determined following national norms but heavily influenced by available local means and resources.

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Child, Youth and Family Policy Regimes

Maternity Benefits

Vietnam provides a statutory paid and job-protected maternity leave for women in the paid labor force lasting 120 days. There is compulsory coverage for government employees and  employees of private enterprises with more than 10 workers  Maternity Benefits cover adoption as well as childbirth.

Female employees are paid 100 percent of their wages during leave for prenatal care and childbirth and also may receive an additional month's wages if it is their first or second pregnancy. Women may take one-day leave for up to three times for prenatal care. Female employees are entitled to four to six months maternity leave, depending on the nature of work.

If it is a multiple birth, the mother is given an extra 30-day leave for each child after the second one. Maternity leave also is granted to female employees adopting a newborn until the child is 120 days old. At the employer's discretion, unpaid maternity leave may be taken for up to 180 additional days. Additionally, women who miscarry are allowed a 20-day leave if the miscarriage occurs during the first three months or a 30 day-leave if beyond three months. Female workers are entitled to receive sickness benefits to take care of their first or second child. The women are to be given 75 percent of their wages for up to 20 days for a child under age three or up to 15 days for a child between the ages of three to seven. Fathers may receive these benefits under special circumstances.

Female employees who are at least 7 months pregnant or are raising a child under 1 year of age cannot work overtime, at night, or in distant locations. [US Social Security Administration, 2002]

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Early Childhood Education and Care (ECEC)

Pre-school education in Vietnam caters to children from 3 to 6 years of age. It is not compulsory, and is offered by both the public and the private sectors. Vietnam, Like all other Southeast Asian countries Vietnam stresses the role of parents and families in providing early childhood care and education. However, in recent years it has increased attention to preschool-aged children.  

In 1999, a law was enacted regarding preschool education, establishing responsibility for programs for 0-6 year olds under one ministry, that of Education and Training, and with links to the Ministry of Health and to women's organizations. The supply of Early Childhood Care and Education (ECCE) programs is inadequate in rural areas and among poor children. 

As in many other countries, early childhood care and education (ECCE) policies and programs are targeted primarily on the 3-5 year olds. Eight percent of 0-3 year olds but 45 percent of 3-5 year olds have access to ECCE in Vietnam. About 76 percent of 5 year olds are enrolled in kindergartens. Access and quality vary dramatically between urban and rural areas. The supply of ECCE is clearly inadequate, but especially for the 0-3 year olds. Access in general is limited, there are no fees in state service centers and fees are reduced in semi-state services. The programs are overwhelmingly public or publicly subsidized (90% of the total early childhood services receive some form of support from the central government); only 1 percent are private. 

There are basically three kinds of ECCE programs through which children under six years of age are provided with the appropriate early learning experiences, or through which parents are supported as caregivers. These are: 1) childcare or day-care centers, crèches and nurseries for 0-2 year olds; 2) kindergartens for 3-5 year olds; and 3) Preschool Education which provides pre-primary education for 5 year olds. Children enter school at the age of 6.  

For the first three years of a child’s life, it can be assumed that there are still extended family members such as grandparents to help out; figures show that 87 per cent of children under three years old are cared for at home. There is then a major shift towards childcare outside the home starting at age three-and-a-half to four. It is reported that only 45 per cent of three- to six-year-olds are cared for at home.

Childcare centers and home-based childcare services are also available and designed to provide childcare support. There are various options available to parents depending upon their work schedules as well as resources. Centers are open five to six days a week, and children can spend either full or half days in childcare centers or home-based care. Children can be fetched later in the afternoon instead of a rigid schedule that would compel parents to cut their working hours short.

Day-care centers offer various options aside from the full-day programs; there are also children who spend only half days in the centre (morning or afternoon) depending on the family’s needs. There are also day-care centers which care for children with parents who work night shifts. This flexibility is uncommon in the region and Vietnam is one of the first to encourage such a diversity of options. 

In principle, childcare centers are expected to provide things to play with and learning materials that are appropriate for infants from three months to three years of age. They are also expected to organize group activities for music, movement and storytelling in order to support young children’s physical, psychosocial, cognitive and language development. However, these are not yet typical throughout the country, primarily because of a combination of two factors: inadequacy of teacher training, and limited funding and material resources allocated to ECCE.

State-run kindergartens generally operate as full-day classes which begin anywhere from 6.30 a.m. in the rural areas to 7.30 a.m. in big cities like Hanoi, to 4 p.m. In rural areas, younger children aged around four years old usually do not return for an afternoon session when they go home for lunch. Private kindergartens may start at 8 a.m. or 9 a.m. and do not necessarily implement full-day schedules so the children spend about three to four hours in the kindergarten.

While kindergarten classes provide children with learning experiences that aim to support their overall development and facilitate their adjustment to primary school, they also offer a full-day childcare programs that provides attention to children’s physical and health needs. Additional health services, e.g. immunization, are supposed to be coordinated by the Ministry of Health. Support for children’s social and emotional development is provided through the experiences gained from group life and the relationships developed with teachers and other children in the school.

In 2002, the Vietnamese Government announced Decision No. 161 on Preschool Education Development (referred to hereafter as the Decision), which, among other measures, specified target groups for government investment in early childhood. Since then the government has made efforts to concentrate state services mainly in the poorest areas, and transformed state services in advantaged areas into semi-state services. Evidence of this can be seen from this increase in the number of communes with at least one early childhood service by 17% in the Mekong River Delta region, one of the poorest regions as against the national level increase by 5% between 2003-04. Similarly, during this period the number of total early childhood services increased by 8% at the national level, whereas the increase in the extremely difficult communes was 28%. [UNESCO, 2005]

In 2004, over 2.1 million children, mostly aged four and five, were enrolled in kindergartens, a figure which represents a little more than half of the total population of three- to six-year-olds. State-run kindergartens account for the largest percentage of children’s ECCE participation rates, specifically for the four- and five-year-old age groups, and are quite sufficiently established in most parts of the country, with the exception of several rural areas, mostly in the south and central areas, as well as in the remote mountain villages of the north. There are also more non-state ECCE programs run by local communities or private individuals in the northern provinces compared to the central and southern parts.

ECCE policies and programs are integrated administratively under one ministry (Ministry of Education and Training), but the delivery system still appears to be fragmented. There are nurseries for children aged 3 months to 3 years and kindergartens for 3 to 6 year olds. In addition to providing care and education for these very young children, the programs are designed to provide cognitive, physical, and social stimulation and prepare children for first grade. Current policies are aimed at increasing the supply and coverage rate in kindergarten to 70-80 percent, developing family day care homes for the under 3s, and stimulating public support and increased investment.

Vietnam is promoting an integrated administrative approach with one government Ministry, the Ministry of Education and Training, holding primary responsibility for children from birth to age 8, but it is not yet implemented. The goals of the ECCE initiatives in Vietnam are:

• a. to make parents more informed about child development and good parenting

• b. to establish low-cost community-based programs linked with health care services

• c. to establish safe ECCE programs

• d. to increase the supply of programs for the 0-3s and for the rural population.

The current trend is to encourage the development of private ECCE programs but the government funds programs in the disadvantaged communities [UNESCO, 2004].

The four central level agencies divided responsibilities for the management of ECCE as follows: 1) the MoET is responsible for developing programs and standards, supervision, monitoring of the implementation of Early Childhood Care and Education programs and for promoting parent education on ECCE; 2) the Ministry of Health attends to the health and nutrition components including immunization for all children under five, disease prevention, nutrition education, food supplementation and other interventions to reduce malnutrition; 3) the Commission for Population, Family and Children is responsible for overall child-focused policy which, of course, includes national ECCE policy; and 4) the Vietnam Women’s Union is responsible for parent education to enhance their knowledge of parenting practices. Together with the MoET, they are responsible for promoting the importance of children’s participation in ECCE programs among parents. They also have a special focus on children under three years who are presently underserved or in programs of poor quality compared to three- to five-year-olds.

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Child Education

The national educational system in Vietnam consists of five sub-systems: Pre-school education, General Education (with the structure 5-4-3-4), Vocational-Technical education, Higher education, and Continuing education.

Kindergartens and pre-school education are provided sequentially to 3-4 year olds and 5 year olds respectively with the objective of making children ready for primary education..  From 6 years old children are admitted to primary education (5 years) leading to the certificate of primary education. After that most of them continue to the basic secondary education (4 years) and some of them may be admitted to vocational training for 1 year.  Finishing upper secondary education usually at the age of 18 or after 12 years of schooling pupils have to take the national school leaving examination. With a diploma from upper secondary school or diploma of general education (Tu Tai) a student can take part in the entrance exams of higher education institutions. For under-graduate level there is either short-term higher education (3 year) or long-term higher education (4-6 years) of regular full-time education or part-time education (and in-service education of continuing education). For post-graduate level there are Master’s programs (2 years) and doctoral programs (2-4 years).

Five years of primary education is compulsory and net primary school enrollment ratio was a high 95.36% in 2005, up from 88.5% in 1999. Completion rate of primary education (from first to fifth grades) rose to 99.82% in the 2003/04 year from 63% in 1999. Male and female school life expectancy was estimated to be 10.8 and 10.4 years respectively.  

In 2002, youth literacy rate (15-24 years) reached 94.5%, slightly higher than 94.1% in 1990. In general, primary education has been extended with remarkable success to all regions of the country. In the beginning of the 2001-2002 school years, the lowest universal primary education rate was over 90%.  

The female net primary enrollment ratio was also a high 92% in 2002/2003. Net Primary school enrollment ratios in Vietnam are among the best in the world and higher than other Asian countries including Thailand, Indonesia, and Cambodia.

The reasons for these developments can be attributed to the high national priority reflected in policies to foster education  and  strengthen the quality of teaching. More  public  resources  have  been  allocated to  training  and  education.  Budget allocation  for training and education in general and primary education  in  particular,  have  increased  continuously. Training and education expenditure reached 15% of total state budget in the year 2000, 17.4% in the year  2004,  and  is  estimated  to  reach  20%  in  the year  2010. Education  expenditure  for  universal education (primary and lower secondary) reached 52.6% of total educational expenditure.

A gap remains between mountainous regions and the deltas, and between rural and urban in access to  education. In  mountainous  regions,  although the school network has been expanded and school enrolment has increased, the net school enrolment rate  is still  too  low. The number of repeaters and drop-outs  is  high  and  the  quality  of  education  is lower than that of the delta and other regions with more favorable economic conditions. In 2001 about 10 per cent of children between the age from 6 to 14 living in remote areas were not able to go to school.  For children in these regions, the  completion  rate  as  well  as  other  indicators remain low. [Education Policy and Data Center, Vietnam, 2005]

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Child Health

Vietnam's health indices have improved in recent years. However health inequalities are growing between different groups and geographical areas.

Good progress has been made in child survival over past decades. From 1993 to 2003, the infant mortality and under-five mortality rates decreased rapidly by 52.5% and 40.8% (approximately 2 per 1000 live births per year) to the current rates of 21.0 and 32.8 respectively. Vietnam, however, remains among the 42 countries accounting for 90% of under-five deaths in the world, and neonatal deaths represent more than 75% of infant deaths and more than 50% of under-five deaths. Despite a gradual decrease, maternal mortality remains relatively high, mainly among ethnic minorities and in remote areas.

Child nutrition has improved dramatically, with rapid annual reductions of around 2% in both the underweight rate and stunting rate among children under five between 1993 and 2003. However, the current rates are still high, at about 28.4% and 31.4%, respectively, and micronutrient deficiencies are still a significant problem.

Large disparities in health status exist between different geographical regions and population groups. Health indicators in the Central Highlands, the Northern Uplands, and the Northern Central Coast are considerably worse than in the rest of the country. Health status in rural areas is poorer than urban areas, with ethnic minorities and people in mountainous areas lowest on the scale. Maternal and infant mortality among ethnic minority groups can be as much as four times higher than the national average. In remote and mountainous areas, maternal and infant mortality rates are increasing among the poorest 20% of the population.

Vietnam is also facing a host of relatively new health problems. More than 10 000 people die from road accidents every year; the HIV/AIDS epidemic is escalating; and tobacco-related diseases are growing. The number of non-communicable or “lifestyle diseases”, such as cancer, diabetes and heart disease, has risen in recent years. They now account for nearly half of all deaths. Meanwhile, some communicable diseases, such as tuberculosis continue to persist.

Severe acute respiratory syndrome (SARS) was detected in its early stages in Vietnam. Fatality remained relatively low, with five deaths out of 63 cases. The situation contributed to the reinforcement of infection control measures in the country and sensitized health workers and the population to ‘universal precautions’.

The health system in Vietnam is a mixed public-private provider system, in which the public system still plays a key role in health care, especially in prevention, research and training. The private sector has grown steadily since the ‘reform’ of the health sector in 1989, but is mainly active in outpatient care; inpatient care is provided essentially through the public sector. Only 26% of private health facilities participate in primary health care activities. In treatment areas, specialized hospitals and clinics account for only 11.36% of health facilities and are therefore often overloaded. The ratio of nurses to doctors is still very low.

Health care is strengthened by national health programs, especially those for important public health problems. The tuberculosis control program is now considered to be one of the best, with treatment success rates of more than 90%. However, coverage in poor communities and mountainous areas is limited, usually only 50-60%. An extended immunization program is also considered a successful child health care program, with a high reduction in vaccine-preventable diseases, the elimination of polio, and gradual elimination of newborn tetanus. However, current conditions for vaccine maintenance, vaccination timing and safety, as well as high staff turnover, are among the current challenges to ensure the continued quality of child immunization.

Total health expenditure in 2003 was 4.21% of GDP. Government expenditure accounts for only 30%, the majority of which is allocated to treatment, with increasing rates from 71.29% in 1991 to 85.02% in 2000. Budget allocation rates for prevention remain low and continue to decrease. Generally speaking, health insurance policies have not been implemented in the private sector. Pro-poor policies, such as providing health insurance cards for the poor, direct exemption from hospitalization fees, and the establishment of health care funds for the poor, are being actively implemented, but with limited coverage because of budget shortages.

The current, most pressing issues are improving the quality of care, rationalizing and training health staff, and increasing public funding for health care through extension of health insurance coverage. Inequity is highest in outpatient and rehabilitation services. A large disparity in access to health care facilities exists across regions and population groups, particularly in mountainous areas and among minority ethnic groups and the poor [WHO, 2003].

HIV/AIDS:

The first case of HIV infection was reported in 1990. In 1993, more than 1,100 new HIV cases were reported in provinces in the South and the South of Center Vietnam. During 1993-1997, the number of HIV cases increased slowly to 8,325 cases. This epidemic has developed rapidly in the period from 1997 up to now. HIV prevalence has risen countrywide, in particular among injecting drug users (IDUs) who have tested with over 50% HIV prevalence in some provinces. In 2000, HIV Sentinel Surveillance has found 20% of all IDUs tested to be HIV positive, over 4% HIV prevalence in female sex workers and about 2% in STD patients. HIV has attained epidemic proportions in these groups and is now reaching the general population, as evidenced by the sharp rise in HIV positive military recruits between 1996 and 2000. In 2002, there were 9,427 new infected cases, 1,279 new cases of AIDS and 715 people died of AIDS. According to Government estimation and projection, HIV prevalence among adults is estimated at 0.4% in 2003, higher than the Philippines and Indonesia, similar to Malaysia, and lower than neighboring Cambodia.

Recognizing the danger of HIV/AIDS, the Vietnamese Government issued several ordinances, decrees and guidance as the legal framework for HIV/AIDS activities in Vietnam. They have included a 1995 ordinance on the prevention and control of HIV/AIDS; an instruction on guidance for the prevention and control of AIDS, also in 1995; a government decree in 1996. The Prime Minister, in 1997, took some decisions regarding the tasks, authority and organizational structure of the National AIDS Committee and other AIDS Committees at different governmental levels and in different sectors. In 2000, he decided to establish the National Committee for AIDS prevention and for drug and prostitution control.

The Prime Minister's directive on HIV/AIDS issued in February 2003 provides a strong policy and program framework for HIV/AIDS work. The Directive assigned clear responsibilities for action on HIV/AIDS to six Ministries (Culture and Information; Public Security; Labor, Invalids and Social Affairs; Planning & Investment and Finance; and Health). In April 2003, the Ministry of Health took the lead in coordination and consultation to develop a National Strategy on HIV/AIDS Prevention and Control for 2004-2010 with a vision going up to 2020. Currently, the 6th draft of the National Strategy is submitted to the office of the Government for approval.

So far there is no evaluation on the implementation and effectiveness of the current HIV/AIDS policies at central and community level. [UNDP, 2005]   

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Special Groups of Children

Child Trafficking

The Penal Code prohibits trafficking in women and children; however, trafficking in women and children for the purpose of sexual exploitation is a serious problem. While reliable statistics on the number of citizens trafficked is not available, there is evidence that the number has grown in recent years. The Social Evils Department of the MOLISA and the Criminal Police Department of the Ministry of Public Security (MPS) are the main government agencies involved in combating trafficking, in cooperation with the Ministry of Justice, the Women's Union, and the Border Guards. The police have established a dedicated anti-trafficking force.

The law provides for prison sentences of 2 to 20 years for each offense for persons found guilty of trafficking women, and for between 3 years and life in prison for each offense for persons found guilty of trafficking children. The Government works with international NGOs to supplement law enforcement measures and cooperated with other national governments to prevent trafficking. It also cooperates closely with other countries within the framework of INTERPOL and its Asian counterpart. The country hosted an international conference in February 2004 on trafficking and human smuggling as part of the Bali Process (the Bali Process brings participants together to work on practical measures to help combat people smuggling, trafficking in persons and related transnational crimes in the Asia-Pacific region and beyond.  It was initiated at the "Regional Ministerial Conference on People Smuggling, Trafficking in Persons and Related Transnational Crime" held in Bali in February 2002).

The country is a source for trafficking in persons. Women are trafficked primarily to Cambodia and China for sexual exploitation and arranged marriages. According to one report, between 1990 and 2000, approximately 20,000 young women and girls were sent to China to become brides, domestic workers, or prostitutes; however, it was not clear how many were victims of trafficking. Between 1995 and 2000, approximately 5,000 women and children were trafficked to and escaped from Cambodia. Some women are also trafficked to Singapore, Hong Kong, Macau, Thailand, Taiwan, the United Kingdom, and the United States. The Government estimated in 2004, that approximately 10 percent of women in arranged marriages with Chinese men may have become trafficking victims. Women and children also are trafficked within the country, usually from rural to urban areas. An NGO advocate estimated that the average age of trafficked girls is between 15 and 17 years of age. .

Provincial- and national-level authorities have made combating trafficking in women and children a priority. In September 2003, the Deputy Prime Minister held a high-level meeting of all relevant agencies to assess anti-trafficking efforts and to chart a course forward. As a result of that meeting, MPS coordinates the Government's interagency anti-trafficking efforts.

The promise of marriage is described as a common pretext for forcing women and children into prostitution in countries such as Taiwan and China. (Women and children from poor families in Taiwan and China are told that they are being sent to Vietnam to be married to a person and are then forced into prostitution.) Poor women and teenage girls, especially those from rural areas, are most at risk for being trafficked. MPS and UNICEF research indicates that trafficking victims can come from any part of the country, but were concentrated in certain northern and southern border provinces as well as the central province of Thanh Hoa. Some are sold by their families as domestic workers or for sexual exploitation. Individual opportunists and informal networks, as well as some organized groups, lure poor, often rural, women with promises of jobs or marriage and forced them to work as prostitutes. False advertising, debt bondage, confiscation of documents, and threats of deportation are other methods commonly used by the traffickers, spouses, and employers. The Government stated in 2004, that organized criminal groups were involved in recruitment, transit, and other trafficking-related activities.

Corruption is a serious problem at all levels, but is particularly severe among street-level police and border agents. Official institutions, including the MOLISA, the Women's Union, the Youth Union, and the Committee for Population, Family, and Children, have active programs aimed at prevention and victims' protection. These programs included warning women and girls of these dangers, repatriation programs, and vocational training for teenage girls in communities considered vulnerable to trafficking. Government agencies work closely with the International Organization for Migration and other international NGOs to provide temporary shelter, some medical services, education, credit, counseling, and rehabilitation to returned trafficking victims. [US Department of State, 2004]

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Child Labor

Child labor is a problem. The Labor Law prohibits most child labor, but allows exceptions for certain types of work. The law sets the minimum age for employment at 18 years of age, but enterprises may hire children between the ages of 15 and 18 if the firm obtains permission from parents and the MOLISA. The ILO reported in 2001 that approximately 20,000 children between the ages of 8 and 14 years worked part-time or full-time in violation of the Labor Law. That estimate may be low, since many more children aged 6 to 18 work in the informal sector, usually on family farms or in family businesses not within the scope of the Labor Law.

By law, an employer must ensure that workers under 18 years of age do not undertake hazardous work or work that would harm their physical or mental development. Prohibited occupations are specified in the Labor Law. The Labor Law permits children to register at trade training centers, a form of vocational training, from 13 years of age. Children may work a maximum of 7 hours per day and 42 hours per week and must receive special health care.

There are reports that enterprises, including companies with foreign investment, have discovered underage workers in their employ. According to reliable sources, this usually occurred because the worker presented false identity documents. Once discovered, the children lost their jobs, but in many cases the companies paid for their schooling and promised to reemploy them once they were of age.

In rural areas, children work primarily on family farms and in other agricultural activities. In some cases, they begin work as young as 6 years of age and are expected to work as adults by the time they were 15 years of age. In urban areas, children also work in family-owned small businesses. Migration from rural to urban settings exacerbated the child labor problem as unauthorized migrants are unable to register their households in urban areas. This means that their children cannot attend public schools and families have less access to credit. A study of child labor in Ho Chi Minh City found cases in which parents in poor families entered into "verbal agreements" with employers, who then put their children to work; the children's salaries were sent directly to the parents.

Government officials have the power to fine and, in cases of Criminal Code violations, prosecute employers who violate child labor laws. While the Government has committed insufficient resources to enforce effectively laws providing for children's safety, especially for children working in mines and as domestic servants, it has detected some cases of child exploitation, removed the children from the exploitative situations, and fined the employers. International donor assistance targets the problem of child labor. In addition, a child labor unit was established within the MOLISA.

The law prohibits forced and compulsory labor by children; however, thousands of children work in exploitative situations and are trafficked both domestically and internationally for the purpose of sexual exploitation. [US Department of State, 2004]

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Notes

* Research and Report by Manita C. Rao
 

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