Regions and Countries

	Table of Contents
p. 11 of 20 BACK | NEXT I. Country Performance Assessment II. Country Operational Strategy III. Sector Strategies A. Agriculture B. Infrastructure C. Social Infrastructure and Environment D. Governance Dimensions of ADB Operations E. Gender Dimensions of ADB Operations F. Private Sector Operations IV. Regional Cooperation V. Donor Activities and Aid Coordination VI. Cofinancing and Catalyzing External Resources VII. ADB’s Operational Program VIII. Economic and Sector Work Program IX. Local Cost Financing

Country Assistance Plans - Viet Nam : III. Sector Strategies

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C. Social Infrastructure and Environment

1. Education

49. Viet Nam has achieved near universal primary school enrollment and a 92 percent adult literacy rate. Facilitating the transition to a market economy by directly addressing the changing skill-mix requirements, expanding access to secondary education, improving the quality of education, and making the system more responsive to market needs are major issues in the education sector. Persistent inequities in education among different socioeconomic groups and geographical regions are another cause for concern. Continuing reliance on the public provision of education and tightening fiscal constraints on public resources are placing increasing pressures on the education system. Gradual decentralization, linked to improvements in management and organizational capacity, and combined with fiscal transfers from the Central Government to poor provinces to ensure quality of services and equity of access, could further improve the quality of education.

50. In the past, ADB has supported lower secondary education through curriculum reform, in-service and pre-service teacher training, and improvement of facilities, and assisted in reforming the vocational and technical education system, while the World Bank and other external aid sources have focused on primary and tertiary education. ADB’s support in the sector will continue to focus on secondary education, given its important role in ensuring employment and socioeconomic improvements. Recent studies have shown that the incidence of poverty declines from 42 percent for primary school graduates to 38 percent for lower secondary graduates, and 25 percent at the end of upper secondary school. In 2000, ADB will assist Viet Nam to develop a Secondary Education Sector Master Plan for 2001-2010. Based on the Master Plan, further TA and loan support will be provided for upper secondary education development. To assist the Government in universalizing quality lower secondary education by 2010, ADB will continue to support the lower secondary education sector, with a focus on further increasing equitable access, improving quality, and strengthening the capacity for decentralized management.

2. Health

51. Viet Nam’s health indicators, such as infant mortality, life expectancy and maternal mortality, are very good given the country’s low income level. Fertility rates have declined sharply in recent years. The availability of communal health centers (CHC) and hospital beds is much higher than that for most other countries in the region. However, several problems still remain. There are wide disparities in health indicators across regions and between urban and rural areas, reflecting in part the different use and quality of health services. The economic transition, with general fiscal constraints and the disappearance of the agriculture cooperative system that supported CHC, has resulted in marked deterioration of primary health care services at all levels. Malnutrition is also very high by regional standards, affecting 39 per cent of all children under five years of age, and approximately 40 percent of all non-pregnant mothers of children under five years of age. Health and nutrition indicators are typically lower among ethnic minorities.

52. One of the biggest challenges facing policy makers in the health sector are inequities in health outcomes and utilization of health services. Overall, the poorest 20 percent of the population receives only 11 percent of all health subsidies, compared to 30 percent for the richest quintile. A second priority is to improve the quality of health care. A third, and emerging significant issue is how to appropriately address the changing burden of disease arising out of the ongoing epidemiological transition, with rapid increase of HIV/AIDS infection, growing illicit drug, declining but still high levels of tobacco use, and a large increase in accident-related deaths. This has implications for both the provision and the financing of health services. The Government will need to mobilize more resources through increased budget allocations and more innovative health insurance schemes. Provision of diagnostic services will need to improve. In addition, the area of preventive medicine, including food hygiene and safety will need greater attention.

53. ADB’s ongoing Population and Family Health Project and planned Rural Health Project aim at improving service delivery through training and materials, particularly in disadvantaged areas, and enhancing central and provincial management capacity, including the ability to generate and utilize management information. To determine the possible role and direction of future ADB assistance in the sector, the following studies are being conducted: (i) a study of Human Capital of the Poor: Policy Options for Viet Nam, addressing the reasons for increasing inequities in access to health and education services; (ii) an analysis of the health sector and possible ADB role; and (iii) regional TAs analyzing the health needs of ethnic minorities and HIV/AIDS prevention efforts for mobile populations. Subject to the results of these studies, possible future directions of involvement include support for preventive medicine; control of HIV/AIDS; and promoting early childhood development through integrated interventions in the areas of health, social and cognitive development, and nutrition. Subject to the outcome of the sector analysis, a standby Health Sector Development loan has been scheduled for 2003.

3. Urban Development

54. Infrastructure facilities in urban centers have deteriorated over time due to insufficient operations and maintenance budgets, or have not been able to keep up with expanding demand. The Government has placed emphasis on the provision of water supply and sanitation services to provincial level towns, and with external assistance from a number of sources has nearly completed coverage of all provincial towns. ADB operations in the early part of the program period will focus on the remaining provincial towns and on a few district towns on a pilot basis, assisting the Government to achieve its goal of complete coverage for this level of urban settlements.

55. Given the very high density of population in rural areas, it can be expected that over the coming decades the increasing agricultural productivity and land concentration will result in migration to urban centers. To avoid the destabilizing effect of significant migration to the major cities, Viet Nam needs to develop a network of provincial and district towns which can provide economic opportunity and absorb the population which will be gradually released from farm occupations. As ADB completes the cycle of projects aimed at provision of water supply to provincial towns, it will analyze the potential for supporting the development of secondary towns (with special emphasis on the central region), and assess the potential for supporting low income housing finance. Based on the results of this analysis, the future focus of Bank assistance to the urban sector will be determined.

4. Environment

56. High population density, poverty, and accelerating growth, have placed considerable strains on Viet Nam’s rich natural resource base. ADB assistance will focus on management and development of Viet Nam’s water, forest, and coastal resources. In addition, by promoting a more balanced urban development pattern, it will assist in the prevention of the environmental strains which are normally associated with rapid and concentrated urbanization.

57. As discussed in para. 41, improved water resource management will be promoted through (i) development of sector institutions, including a national Water Resource Council and local River Basin Organizations, to ensure an integrated approach and harmonization of competing demands for irrigation, energy, water supply, industrial development, drainage, and flood protection; and (ii) specific investment with an emphasis on selected river basins. In the Central Region, which is particularly subject to flooding and natural disasters as a result of geographic and climatic conditions, ADB assistance will be provided in the framework of an ongoing broad coordination on disaster prevention and mitigation involving the central Government, the affected provinces, and a number of sources of external development assistance.

58. Watershed protection and sustainable use of forest resources will complement ADB operations in water resource management and poverty reduction. Subject to the results of the ongoing review of the policy environment in the forestry sector, and learning from the implementation experience of the ongoing forestry sector project and other Government and donor programs, future ADB operations in this sector will address combined and interrelated issues of environmental degradation, poverty, and food insecurity. The Central Highlands, which have a significant presence of ethnic minorities, and are experiencing high rates of in-migration and replacement of natural forest cover with cash crops grown in an unsustainable manner, are likely to be the geographic focus of such interventions. Given the complexity of the issues involved, a very thorough and cross-disciplinary approach will be needed in the preparation of ADB operations in this area.

59. Coastal zone management may become the third environmental area of concentration in the proposed program, in line with the program’s strong focus on addressing natural resource management and its linkage with poverty reduction. As fisherfolk are among the poorest in Viet Nam, and their already difficult conditions are under further threat due to the depletion of in-shore fishing resources, future operations in this area will shift away from the past focus on construction or rehabilitation of fishing port infrastructure, facilities, and support services, and towards the management and replenishment of coastal resources, and alternative livelihood options for the populations living in these areas.

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