Attachment_2_USAIDVietnam_CDCS_Result_Framework.pdf

COUNTRY DEVELOPMENT COOPERATION

STRATEGY FOR VIETNAM

2014 – 2019

"President Barack Obama welcomed President Truong Tan Sang of the Socialist Republic of Vietnam to the

White House on July 25, 2013. During their meeting, the two Presidents affirmed their commitment to opening a new phase of bilateral relations between Vietnam and the United States" ... "As we increase consultation, increase cooperation, increase trade, and scientific and education exchanges, ultimately, that’s going to be good for the prosperity and opportunities of the people here in the United States, as well as good for the opportunities and prosperity of the people of Vietnam."

Joint Statement by President Barack Obama of the United States of America and

President Truong Tan Sang of the Socialist Republic of Vietnam

The White House

July 25, 2013

Public

November 8, 2013

U.S. Agency for International Development in Vietnam 15/F, Tung Shing Tower 2 Ngo Quyen Hanoi, Vietnam

This page is intentionally left blank.

CDCS 2014 - 2019 USAID/VIETNAM - ii - Public

COUNTRY DEVELOPMENT COOPERATION STRATEGY (CDCS)

FOR VIETNAM

2014-2019

CDCS 2014 - 2019 USAID/VIETNAM - iii - Public

Table of Contents

I. DEVELOPMENT CHALLENGES AND OPPORTUNITIES

A. Foreign Policy Context

B. Economic Conditions

C. Governance

D. Health and Human Development

E. Climate Change, Environment and Biodiversity

F. Gender

G. Vietnam’s Development Priorities & Donor Coordination

II. DEVELOPMENT HYPOTHESIS

A. Summary Development Challenges and Opportunities

B. Goal and Development Hypothesis

C. Linkages among the Goal Statement, Development Objectives, and Intermediate Results

III. THE STRATEGIC RESULTS FRAMEWORK

DEVELOPMENT OBJECTIVE #1 (DO1): GOVERNANCE ENHANCED TO FACILITATE BROADER-BASED,

SUSTAINABLE GROWTH

DEVELOPMENT OBJECTIVE #2 (DO2): CAPACITY STRENGTHENED TO PROTECT AND IMPROVE HEALTH

AND WELL-BEING

SPECIAL OBJECTIVE #1 (SpO1): LEGACIES ADDRESSED TO ADVANCE THE U.S.-VIETNAM PARTNERSHIP 42

ANNEX: Key Terms and Acronyms

Table of Figures

FIGURE 1: USAID’S COLLABORATION WITH VIETNAM

FIGURE 2: KEY CHALLENGES AND OPPORTUNITIES IN THE EDUCATION SECTOR

FIGURE 3: SUMMARY OF DEVELOPMENT CHALLENGES, OPPORTUNITIES, AND PRIORITIES FOR VIETNAM ... 20

CDCS 2014 - 2019 USAID/VIETNAM - 1 - Public

I. DEVELOPMENT CHALLENGES AND OPPORTUNITIES

Vietnam defies easy characterizations. An enormous, diverse, resource-rich country and a key partner of the United States, Vietnam faces both unique opportunities and steep challenges in 2013. While economic growth, membership in key multilateral organizations, and its strategic geographic position provide Vietnam with the opportunity to be a global player on issues of strategic importance to the U.S., the country lags far behind its peers on key socio-economic development indices, and challenges have limited Vietnam’s ability and credibility to assume the role of full and responsible partner.

A. Foreign Policy Context

U.S.-Vietnam diplomatic and economic relations remained essentially frozen for more than a decade after the war ended in 1975. Bilateral relations took a major step forward in February 1994, when President Clinton ordered an end to the 19-year old U.S. trade embargo on Vietnam.

The following year, the United States and Vietnam settled diplomatic and private property claims opening liaison offices in Washington and Hanoi. We had a U.S. ambassador at Post by April 1997.

In March 1998, President Clinton granted a waiver from the Jackson-Vanik amendment that smoothed the way for Overseas Private Investment Corporation (OPIC) and Export-Import Bank support for U.S. business in Vietnam. In December 2001, the U.S. and Vietnam signed the Bilateral Trade Agreement (BTA) which paved the way for Vietnam’s successful negations and accession to the World Trade Organization (WTO) in 2007.

Since 2002, common strategic and economic interests have led the United States and Vietnam to improve relations across a wide range of issues. These were matched by a number of expansions of development assistance cooperation with Vietnam, such as the addition of Vietnam as a focus country of the President’s Emergency Plan for AID Relief (PEPFAR) in 2004 and the establishment of a USAID/Vietnam Representative Office in 2007. Starting in 2010, the two countries accelerated this process, effectively forming a partnership on several fronts. U.S. Government officials identify Vietnam as one of the emerging partners they are cultivating as part of the rebalancing of U.S. priorities toward the Asia-Pacific region.

Additionally, the Obama Administration encouraged Vietnam to be a “full partner” in the ongoing Trans-Pacific Partnership (TPP) free trade agreement negotiations and has given a higher priority to cleaning up sites contaminated by dioxin, a by-product of the Agent

Orange herbicide used by U.S. troops during the Vietnam War.1 Over the past several years, the two sides signed a memorandum of understanding on Vietnam’s participation in the Megaports Initiative on non-proliferation through the installation of radiation equipment at ports.

Currently, factors generating U.S. interest in the relationship include growing trade and investment flows, the large ethnic Vietnamese community in the United States, the legacy of the Vietnam War, increasing interaction through multilateral institutions, and the perception that Vietnam is

Congressional Research Service Report: U.S.-Vietnam Relations in 2011: Current Issues and Implications for U.S. Policy.

Figure 1: USAID’s Collaboration with Vietnam

1989 – Disabilities programming through Patrick Leahy War Victims Fund and the Displaced Children and Orphans Fund 2001 – U.S.- Vietnam Trade Agreement

(BTA) signed and Support for Trade Acceleration (STAR) Project Initiated 2004 – Vietnam becomes 15th PEPFAR Focus Country 2005 –Agreement for Economic and Technical Cooperation signed 2007 – USAID/Vietnam Representative Office established 2010 – USAID/Vietnam reaches full Mission status

CDCS 2014 - 2019 USAID/VIETNAM - 2 - Public becoming a “middle power” with commensurate influence in Southeast Asia. U.S. goals with respect to Vietnam include opening markets for U.S. trade and investment, furthering human rights and the rule of law within the country, cooperating in multilateral diplomatic forums to uphold international legal principles in and around the East Sea including freedom of navigation, and maintaining if not expanding U.S. influence in Southeast Asia. Vietnam plays a key role in the Obama Administration’s rebalance towards the Asia-Pacific as an emerging partner in Southeast Asia.

The rebalance to the Asia-Pacific reflects a profound recognition that the future security and prosperity of our nation will be largely defined by events and developments in the region. Home to two-thirds of the world’s population and the world’s fastest growing economies, the region offers growing opportunities and challenges for U.S. strategic interests. At a time when the region is building a more robust security and economic architecture to promote stability and prosperity, sustained U.S. commitment is increasingly essential. U.S. leadership will help shape regional architecture and will pay dividends for our security and prosperity well into the twenty first century, just as our post-World War II commitment in Europe helped to build a comprehensive and lasting transatlantic network of institutions and relationships.

B. Economic Conditions

In spite of remarkable achievements, Vietnam continues to face significant challenges, notably principles for rule of law and human rights, poor regulation quality, widespread corruption and low accountability, inadequate infrastructure, and limited human and institutional capacity. If not properly addressed, these challenges will impede Vietnam's efforts to achieve its goal of becoming an industrialized country by 2020.

Macroeconomic Conditions and Trade: Bilateral trade in 2012 was approximately $25 billion, $20 billion of which was exports to the United States. The United States is recognized as Vietnam’s largest single export market, although the European Union as a whole registered similar trade numbers in 2012. U.S. exports to Vietnam grew 5 percent in 2012. U.S. exports accounted for just 4 percent of Vietnam’s total imports, even while the United States accounted for 18 percent of Vietnam’s total exports at last count. Vietnam’s inflation rate was relatively stable in 2012, down to 7 percent after spiking to 23 percent in August 2011.2 Monetary tightening helped stabilize macroeconomic conditions but also contributed to a GDP growth rate of just 5 percent for 2012, Vietnam’s slowest rate of growth since 1999. Businesses are hurting not only for lack of credit but also for lack of domestic demand. Growth in exports has been robust, almost all of which has come from foreign-invested firms. Vietnam's economy faces challenges related to its weak banking system, high levels of nonperforming loans, and borrowing costs. Vietnam’s economy has traditionally been heavily reliant on official development assistance (ODA) and concessionary lending from international financial institutions. As the country’s need for infrastructure build-out surpasses its ability to provide funding, however, public-private partnerships (PPP) may provide alternative financing solutions.

Building on Vietnam’s accession to the World Trade Organization in 2007 and its deepening economic integration within the region, the Government of Vietnam (GVN) is currently negotiating the proposed TPP free trade agreement. The GVN’s top objective in the TPP negotiations is increased access to the U.S. market, particularly for textiles/apparel and footwear. The GVN seeks a solid market access package to balance the range of TPP obligations Vietnam would assume, See Economist Intelligence Unit, http://www.eiu.com/index.asp.

http://www.eiu.com/index.asp

CDCS 2014 - 2019 USAID/VIETNAM - 3 - Public including labor, environment, state-owned enterprises (SOEs), and protection of intellectual property rights.

Labor: The Vietnamese government will need to create a more enabling environment for operation of associations and enable collective bargaining to successfully close the TPP labor chapter. The congressionally-mandated Trafficking Victims Protection Reauthorization Act (TVPRA) list brought increased attention to the use of child labor and forced labor in Vietnam.3 The U.S. Department of Labor and Department of State fund eight labor-related projects in Vietnam with the overarching goal of improving working conditions for Vietnamese.

Poverty: The adoption of an “open door” policy, market-based reforms, and integration to international markets have promoted high economic growth and created economic opportunities for the poor in Vietnam. The average poverty rate, calculated using a “basic needs” poverty line, has decreased from 58 percent in 1993 to 14.5 percent in 2008. It was estimated that about 28 million of people have been lifted out of poverty. The poor is characterized by heavy dependence on subsistence agriculture, low education and job skills, exposure to natural disasters, small land holdings or landless, physical or social isolation, and limited access to market and credit.

The growth has not benefited the population equally. The poverty rate in rural areas is considerably higher than that of the urban areas (18.7 percent compared to 3.3 percent in 2008).

The poverty rate is also falling much more rapidly for the majority Kinh/Hoa group (from 53.9 percent in 1993 to 9 percent in 2008) than for the ethnic minority groups (from 86.4 percent in 1993 to 50.3 percent in 2008). In addition, the official poverty line is based on 1990s standards, which would show a higher rate of poverty if updated to reflect increased living costs. This disparity and inequality derived from the unequal distribution of incomes as well as different capacity and levels of participation of these groups in the economic development process. To tackle remaining poverty, besides developing and applying appropriate economic structure and policies at the national level, interventions must be made directly with the poor at the local level.

The worldwide economic downturn and Vietnam’s prolonged macroeconomic instability and high inflation in recent years have resulted in an economic slowdown which increases the risks of falling back into poverty for people whose incomes are near the poverty line and causes further burden on the poverty and hunger that still persist in many parts of the country. Some regions have a much higher poverty rate than other regions, such as the Northern Mountains and the Central Highlands with their significant ethnic minority populations, representing an emerging concern in recent years.

Education: The shortcomings of the Vietnamese higher education system are myriad, while the demands of the highly competitive global economy require a mix of knowledge, skills, and abilities that are not consistently being developed by Vietnam’s higher education system.

U.S. Department of Labor’s List of Goods Produced by Child Labor or Forced Labor, September 2012.

The poverty rate in Vietnam’s rural areas is considerably higher than that of the urban areas. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 4 - Public

USAID conducted assessment work that identified tertiary workforce development as a strategic goal, falling in line with some of Vietnam’s most pressing needs. Priority areas include more access for underserved and disadvantaged groups, improved quality of tertiary education and improved relevance and quality of work force development programs.

As Vietnam’s industrial economy grows, there is a clear need to develop an approach for a high quality, flexible, multi-tiered, and industry-driven training for young people in general skills and areas of specialization relevant to current industry needs, including opportunities for self-employment.

Although the GVN’s stated objectives for the reform of the higher education sector are bold and far-reaching, their ability to operationalize their strategic goals by addressing broad governance issues (i.e. legal and financial frameworks, institutional capacity building, developing autonomous institutions and programs, accreditation and testing, etc.) remains a challenge, especially while simultaneously promoting local higher education institution-level modernization. No matter what standard one applies – supporting the achievement of next-stage economic growth, meeting labor market needs, providing access to underserved populations, fostering valuable research, generating a culture of innovation, collaborating effectively with the private sector – Vietnam’s higher education institutions are inadequate and there are significant opportunities for educational development assistance.4

Figure 2: Key Challenges and Opportunities in the Education Sector

Challenges Opportunities

Low matriculation in secondary and tertiary education and difficulties balancing the demand for higher student enrollment with quality assurance standards

Curriculum development and professor training

Training and remuneration of professors Tying educational goals to industry needs

Weak curriculum development based in theory with little focus on applied instructional methods, innovation, and creative thinking

Private sector engagement

Poor management structure Leadership training and development

Gap between education standards and workforce needs and weak linkages between universities and industry

Outreach to underserved populations such as women, minority groups, and low-income students

Weak educational governance, legal and financial frameworks, institutional capacity building, developing autonomous institutions and programs, accreditation and testing

Reinforce concepts of academic freedom and autonomy

Small lecturer to student ratio 1:28

Lack of modern laboratory and research facilities

Vietnam Education Assessment, Dec 2008

A mechanical lab in Ho Chi Minh City University of Technical Education. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 5 - Public

C. Governance

The United States has strongly supported Vietnam’s international economic integration over the past ten years, and USAID assistance has been critical to the development of the legal and regulatory framework for a market economy in Vietnam. Focus in the governance area has broadly included the areas of public administration reform, improvements to the rule of law and strengthening the legislative branch, specifically the National Assembly (NA). USAID has worked in these areas through the Support for Trade Acceleration (STAR) I, II, and Plus projects, and the Vietnam Competitiveness Initiative (VNCI) I and II projects. These projects have yielded concrete changes in Vietnam’s regulatory and legal environments, which have been critical to the implementation of the BTA and WTO commitments. In addition, the Legislative Research Program (LRP) has specifically supported the NA’s Institute of Legislative Studies (ILS) to improve its service quality, human resources, and management capacity.

As with the BTA in 2001 and WTO Accession in 2007, the successful conclusion of the TPP, currently under negotiation, promises to fuel further transformative growth by dramatically increasing market access. It is expected to spur further action on the difficult economic reforms that still face Vietnam if it is to complete the transition to a fully functioning market economy. Vietnam would benefit economically more than any other TPP partner due to increased U.S. market access.

However, with an economy that is now quite open and integrated into global markets, the quality of economic governance is currently viewed by many to be a significant constraint to Vietnam’s long-term competitiveness and sustainable economic growth. Economic growth has empowered citizens to seek greater government responsiveness, as one analyst notes, “While legislators continue to support an expansive role for the state, they have begun to advocate for a greater degree of government responsiveness and accountability to the people. For the government, ensuring that other important debates take place through official channels will only be more critical for the country’s socio-economic stability in coming decades.”5 As the summary of a recent Harvard seminar for senior Vietnamese government leaders concluded, “to truly achieve long-term stability in Vietnam, leaders must not only implement a list of policy reforms and restructuring changes, but also explore a more expansive philosophical shift towards economic and governance practices.” It will mean, first and foremost, imposing discipline on both public and private sector entities through greater transparency and accountability.” Vietnam must move towards international standards of economic governance, including a clear separation between regulators and market participants, an unswerving commitment to a judicial system that is independent of politics, public finance, and fiscal policy reforms based on clearly enunciated rules and complete transparency.6

D. Health and Human Development

While Vietnam has experienced impressive economic growth over the past decade, a number of vulnerable groups throughout the country have not reaped the benefits. In particular, people with disabilities, orphans, ethnic minorities, and poor, rural households continue to struggle to be included in mainstream society, gain access to adequate social services, and benefit from improved economic opportunities. Development efforts aim to improve human welfare and increase access to quality services, including Vulnerable Populations, Higher Education, and Adoption. Rural areas in Vietnam such as the Central Highlands, where one-third of the population is an ethnic minority, continue to suffer from higher than average poverty rates.

Why Vietnam’s Legislative Debate Matters”, By Phuong Nguyen, CSIS, July 19, 2013.

Harvard Ash Center, 2012.

CDCS 2014 - 2019 USAID/VIETNAM - 6 - Public

To address this disparity, the GVN is working to improve development and delivery of social services, particularly to rural communities. U.S. assistance includes livelihood support targeting vulnerable rural populations in the Central Highlands. Another vulnerable group in Vietnam that benefits from U.S. assistance is people with disabilities, many of whom face significant challenges such as social discrimination, lower quality of life, higher unemployment, and lower salaries than their non-disabled peers. Persons with disabilities have limited access to services, partly due to physical barriers of inaccessibility to schools, offices, and public buildings. USAID/Vietnam programs supported the drafting of the disabilities law and are now supporting its implementation, providing a holistic and comprehensive service model to persons with disabilities for improving their health, education, and economic and social integration needs.

HIV/AIDS

Vietnam has a concentrated epidemic among injecting drug users (IDUs), men who have sex with men (MSM), and sex workers (SW) and their clients. National HIV prevalence rates among the general population of 15-49 year olds is 0.43 percent. The 2009 HIV/STI Integrated Behavioral and Biological Survey (IBBS) Round II and sentinel HIV surveillance estimate that as many as 40 percent of the estimated 220,000 (range: 100,000-335,000) injecting drug users (IDUs) are infected with HIV. Injecting drug use is the leading driver in the transmission of HIV in Vietnam. There is also growing recognition of the HIV epidemic among MSM, with HIV prevalence among MSM in Hanoi and Ho Chi Minh City being estimated as high as 16 percent.

While Vietnam’s economy recently achieved lower-middle-income status, the national healthcare system remains significantly under-developed with inequitable resource distribution.

The GVN does not allocate significant resources to the national HIV/AIDS response, with HIV/AIDS spending representing just 2 percent of total national health spending. By 2015, the country is almost certain to reach its Millennium Development Goals 4 and 5 related to child and maternal health. However, it is unlikely to achieve its targets for MDG 6, combating

HIV/AIDS.

Donor Environment: The PEPFAR program continues to be the largest in the HIV/AIDS sector.

Vietnam’s second-largest source of funding for HIV/AIDS programs is the Global Fund, which was approved for $119 million for HIV/AIDS through 2013. A renewal grant which will continue through 2015 was recently submitted for approximately $92 million. The U.S. Government provides one-third of the total global funding for the Global Fund, thus the effective use of GF monies is closely linked to other USG HIV/AIDS support through PEPFAR.

Challenges: Though Vietnam has a good legal and policy environment providing a framework for the national HIV/AIDS response, there are a number of overlapping policy and regulatory documents. For example, there are considerable policy barriers in establishing and scaling-up effective harm reduction interventions such as Needle and Syringe Programs (NSP) and 100 percent Condom Use Programs (100 percent CUP) at the local level in some provinces.

USAID and PEPFAR supports an outdoor concert to promote Vietnam's national action month for HIV/AIDS.

Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 7 - Public

Vietnam’s technical and management capacity to oversee and expand the HIV/AIDS response remains limited. Vietnam’s health sector is governed at the central, provincial and district levels and remains fragmented. Ministries and departments implementing HIV/AIDS services operate independently, which makes it difficult to efficiently deliver a comprehensive range of services across different government authorities. Stigma and discrimination against people living with HIV and key affected populations is an ongoing challenge, as is the policy of remanding drug users to compulsory centers for mandatory detoxification and “labor therapy”.

Additionally, the role of civil society organizations and private sector engagement in the national HIV response is limited. Vietnam continues to struggle with involving civil society. Though some progress has been made, there continues to be limited opportunities for dialogue and engagement.

Vietnam’s Health Sector Priorities: Key priorities for Vietnam are to successfully implement the National Strategy for HIV/AIDS Prevention and Control to 2020 with a Vision to 2030. As part of the National HIV/AIDS strategy, Vietnam aims to reduce the HIV prevalence rate in the general population to less than 0.3 percent, reducing the impact of HIV/AIDS on socio-economic development. Other key priorities are to increase understanding of HIV/AIDS, reduce HIV/AIDS prevalence among injecting drug users to below 15 percent reduce prevalence among sex workers to below 5 percent and among MSM to below 10 percent. The GVN also seeks to strengthen the capacity of the provincial HIV/AIDS prevention and control systems.

As donor funding decreases a key priority is to build greater country ownership involving all stakeholders–government, private sector and civil society including people living with HIV/AIDS and other affected populations. A key component of our plan is the development of a transition plan with the government to increase its financial support for HIV/AIDS commodities, including ARVs, methadone and human resources. PEPFAR currently supports 65 percent of adults on ARV treatment in Vietnam, nearly 100 percent of patients on MMT and approximately 5,600 workers, including part-time government health workers.

During the emergency phase of PEPFAR, the HIV/AIDS response was developed as a stand-alone vertical program with limited integration into the existing health care system. As funding declines, it is imperative to integrate this model with the nation’s health system to cut costs and use the government systems such as workforce, supply system and information system for long-term sustainability. One of the biggest challenges for PEPFAR, besides supporting country stakeholders to mobilize funds, is to transition from this vertical model to an integrated model while avoiding disruption of services to Most-At-Risk Populations (MARPs). This requires a good understanding of the decentralized health system in country and the incentives and disincentives at play to deliver quality services within the national health system.

A series of neoliberal health reforms (e.g. legislation of private medical practice, liberation of pharmaceutical industry and introduction of user fees at public health facilities) since the early 1990s has affected the delivery and financing of health services transforming publicly funded and universal health services to a highly unregulated private-public mix system. Integrating a largely donor-funded HIV/AIDS response, which was insular to forces of an unregulated health system, poses significant challenges.

CDCS 2014 - 2019 USAID/VIETNAM - 8 - Public

Disability

Vietnam’s disability population accounts for approximately 15 percent of the population.7 The country has made significant strides in developing policy to ensure the integration of people with disabilities into all aspects of Vietnamese society. However, despite significant progress, key weaknesses exist. For example, the National Coordinating Council on Disability has limited authority to influence ministries beyond the Ministry of Labor, Invalids, and Social Affairs, thus limiting government-wide coordination on the issue. Additionally, disability policies meant to further integrate and advance the needs of people with disabilities are neither adequately enforced once passed into law nor disseminated to local government offices and officials. Additionally, funding and government capacity remain an issue and disability programs that do exist in Vietnam, cover persons with mobility, vision, and hearing impairments, but are new to the issues of developmental disabilities.

There has been a burgeoning movement of self-help groups of persons with disabilities. These groups are a significant source of support and empowerment, and such groups help their members achieve individual self-confidence and personal life satisfaction. However, the development of the movement is hampered by the bureaucratic procedure for obtaining legal status for disabled persons organizations, thus the groups themselves suffer from a dearth of skilled and energetic leadership.

Children with disabilities face significant barriers in the GVN’s ability to provide comprehensive education to its citizens, such as: poorly trained teachers; attitudinal barriers; and lack of resources, adapted curricula, assistive technologies and devices, and the problems of accessibility. Some schools for children with disabilities have been established in cooperation with international NGOs, which have served about 21,000 children countrywide. However, the rate of enrollment of children with disabilities in special schools is only around 2percent of the total number of children who could benefit from such educational opportunities. Although the GVN promotes inclusive education and sees it as a means toward future full inclusion of persons with disabilities, social discrimination, resource constraints and the inflexibility of educational activities have hampered access to education as well as inhibited the social attainment of children with disabilities. In terms of employment, the traditional vocational training programs in Vietnam are limited in general and do not effectively serve persons with disabilities. There is a very high unemployment rate among persons with disabilities. The Vietnamese Law on Disabled Persons encourages businesses to hire individuals with disabilities;

however, the barriers to employment remain high largely due to negative social attitudes toward persons with disabilities’ working capability and the limited education including soft-skills education of persons with disabilities. Many of the employment opportunities for persons with disabilities tend to be centered on traditional low-paid employment (e.g. crafts, woodwork). Persons with disabilities have little if any access to technology training or technology jobs, key components of full integration into society as Vietnam moves more fully into a market economy. While employment options are very bleak for persons with disabilities, they view work as their path to economic independence and social acceptance.

An issue in Vietnam is the dearth of reliable data. The disabilities rate in Vietnam varies from as low as 7.8% (2009

Census) to 15.3% (2006 Vietnam Household Living and Standards Survey).

Vietnam’s disability population accounts for about 15 percent of the population. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 9 - Public

Disabled persons have limited access to services, partly due to the physical barriers in place at schools, offices, and public buildings. Provincial policies concerning the rights of persons with disabilities are poorly developed and enforced leading to lower access to education and employment. More than 30 percent of children with disabilities are not participating in any education program and a very limited number of persons with disabilities have earned vocational training certificates and have gained skills leading to employment. Persons with disabilities are subject to high unemployment (over 56 percent) and those that are employed often see salaries lower than that of their non-disabled peers. Low levels of education, poorly designed physical structures of many workplaces, a lack of assistive devices, and negative attitudes about employees with disabilities are key barriers to the employment of persons with disabilities in the area.8

Pandemic Influenza and Other Emerging Threats

Vietnam is one of four countries globally with endemic highly pathogenic avian influenza (HPAI) causing regular outbreaks in poultry (over 3,000 outbreaks and more than 40 million poultry culled to-date) and dangerous human cases (123 of which 61 have been fatal). The HPAI virus continues to evolve and pose a public health, animal health and economic threat.

Almost three-quarters of all new, emerging, or reemerging diseases affecting humans at the beginning of the 21st century originated in animals, including HIV and SARS. The speed with which these diseases can emerge and spread presents serious public health, economic, and development concerns. It also underscores the need for the development of comprehensive disease detection and response capacities, particularly in those geographic areas where disease threats are likely to emerge. In this regard, Vietnam is considered a “hot spot” for avian influenza (AI) and the emergence of other diseases.

The Ministry of Agriculture and Rural Development (MARD) along with the Ministry of Health (MOH) lead the national effort under a 2011-2015 multi-ministerial plan, which USAID helped develop. In addition to the 20 million private sector farmers and producers who are affected by HPAI, key development partners include the World Bank, ADB, FAO, WHO, UN, EU, AusAID, JICA, mass organizations, various institutes, universities and associations. For USG, USAID has been the largest contributor in this area (totaling over $50 million since 2005) followed by U.S.-CDC and NIH.

Vietnam is often considered a global success in terms of addressing HPAI, reducing poultry outbreaks and human cases drastically from 2004 to present. Key factors in these successes include a national multisectoral coordination structure, strengthened surveillance system, greater diagnostic capacity in human and animal health laboratories, infection control and other regulations established, launching of an expansive food safety law, pandemic preparedness plans tested and improved, growing awareness and understanding of zoonotic diseases, substantial progress on meeting International Health Regulations, a framework for coordination with the GVN

Vietnam Disability Assessment Final Report, USAID, May 2005.

Vietnam is considered a “hot spot” for avian influenza and the emergence of other diseases. Photo: USAID Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 10 - Public with pockets of strong donor coordination, and the creation of a strategic and long term One Health university network (looking at the animal-human-environment interface), among other achievements.

Despite these successes, HPAI remains endemic and many challenges remain, most notable of which is a farming and food supply system conducive to fostering the emergence of a lethal animal virus or pathogen to become easily transmitted among humans. Within this context are multiple concerns to Vietnam: the continued mutation of viruses and lack of a suitable poultry vaccination;

fledgling and externally driven epidemiology programs in animal and human health; limited coordination between sectors and donors; weak biosafety and quality assurance and control in laboratories across the country; a lack of understanding of the role wildlife plays in disease emergence and how to address it; and the difficult to control cross border transmission of diseases by traded and smuggled animals. In addition, Vietnam’s farming system is composed of millions of small scale farms, slaughterhouses and markets which are difficult to reach and improve, yet the demand for protein from animals is growing exponentially. MARD’s capacity has improved in this area but the system remains weak and unable to adequately address the challenges of existing and emergent diseases. Finally, the importance of remaining vigilant for HPAI needs to be balanced with the need to address broader system strengthening efforts addressing both normative diseases and emerging pandemic threats while bolstering Vietnam’s economic and social development.

Tuberculosis

Vietnam ranks 12th among the World Health Organization’s list of 22 countries comprising 80 percent of the global TB burden. It is estimated that Vietnam has 180,000 new TB cases per year and 29,000 annual TB deaths; approximately 80 deaths every day9. The TB case detection rate is 54 percent far below the global target of 70 percent 10. Approximately 100,000 TB patients are provided with TB treatment services each year and 43 percent of these patients were tested for HIV/AIDS, with 8 percent reporting positive11. Each year there are 3,500 new cases of Multi-Drug Resistant TB12 (MDR-TB).

Challenges in the TB sector include inadequate funding and capacity for human resources to detect and treat TB at all levels, especially at the district and commune levels and in prisons. Case detection is still low due to the use of passive case finding. Many patients seek services in the private sector and referrals from private clinics and pharmacies to the public sector are weak.

Resistance to first-line TB drugs is increasing and there is growing prevalence of TB, MDR-TB and TB/HIV in closed settings.

The primary goals of the Vietnam National TB Program for 2011-2015 are to decrease TB prevalence by 50 percent compared to reference estimates from 2000, and to prevent an increase in MDR-TB prevalence from the levels reported in 2010. Other priorities include increasing case detection, expanding new diagnostic techniques, strengthening engagement with private health providers, and increasing reach to populations who may have difficulties accessing TB services, such as people in closed settings, children and people living with HIV. A final key priority is to strengthen the TB health system ensuing adequate financing, a skilled work force and a functioning TB supply chain.

Global Tuberculosis 2011, WHO (2011).

The STOP TB Strategy, WHO (2006).

Review of The National Tuberculosis Control Program for the period 2007–2011 and Development plan for the period

2011–2015, The National Tuberculosis Control Program (March 2012).

Anti-Tuberculosis drug resistance in the world, Fourth Global Report, WHO (2008).

CDCS 2014 - 2019 USAID/VIETNAM - 11 - Public

E. Climate Change, Environment and Biodiversity

Climate Change

Over the past last decade, Vietnam has experienced rapid economic growth and has risen to the status of an emerging economy. Meanwhile increased pollution and unsustainable use of natural resources are important growing concerns for the country, intensified in the face of climate change.

Vietnam is a relatively small emitter now, but unless measures to promote green development are implemented, projected future emissions from energy production, agriculture, transportation and industry are significant. For example Vietnam’s carbon dioxide emissions are expected to grow by more than three-fold between 2012 and 2030. Vietnam’s forests remain under pressure, while restoring those offers opportunities to sequester carbon.

From the global perspective, Vietnam is among the five most vulnerable countries to climate change, and at the highest risk of facing flooding, sea level rise and food crisis. The country’s large population centers and key agricultural sectors are exposed to rising sea levels and increased storm risks in low-lying deltas and on its long coastline.

Increasing temperature and worsening droughts and floods threaten food security, livelihoods, and lives. Adaptation and disaster risk reduction measures will be central to Vietnam’s economic growth progress. A USAID-funded assessment has shown that only a small minority of Vietnamese enterprises have in place measures to prepare for disasters, such as business continuity plans, highlighting the strong need to safeguard assets and secure livelihoods.

Due to extreme vulnerability to climate change impact, the GVN views climate change as one of its central development challenges and has identified climate change as a priority area for development assistance. GVN’s climate change National Target Plan focuses largely on adaptation. It prioritizes water, agriculture, marine and coastal systems as most sensitive, and in particular prioritizes the need for adaptation action in the Mekong and Red River Deltas. The National Strategy for Climate Change Adaptation, ratified in 2011 has objectives to ensure there is enough food and water, while reducing poverty and gender inequality and protecting natural resources; enhance the stakeholders’ awareness, responsibility, and capacity to cope with climate change; and have Vietnam contribute to the international community’s efforts to deal with climate change.

"President Obama and President Truong Tan Sang welcomed increasing bilateral cooperation to reduce greenhouse gas emissions in Vietnam through promotion of clean energy, energy efficiency, and sustainable forestry, and to strengthen Vietnam’s resilience to climate change, rising sea level and natural disasters, including through the United States Agency for International Development’s (USAID) Clean Energy Program and Forests and Deltas Program."

Joint Statement by President Barack Obama of the United States of America and President Truong Tan Sang of the Socialist Republic of Vietnam The White House July 25, 2013

Forest degradation in Vietnam. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 12 - Public

Vietnam was identified as a priority country for the U.S. Government’s Enhancing Capacity for Low Emission Development Strategies (EC-LEDS) program. Separately, President Obama and his European Union counterparts launched a Development Dialogue at the President's first US-EU Summit in 2009. They agreed to increase coordination at both the policy and field level in a few specific areas – including food security, climate change, and health –identified eight pilot countries where coordination would be intensified. Vietnam was one of three countries targeted with respect to climate change. Further, Vietnam passed the Green Growth Strategy in 2012 that reflects Vietnam’s commitment to sustainable growth and transform Vietnam into a low carbon economy.

Agent Orange/Dioxin Contamination

One of the most significant remaining Vietnam War legacy issues is Agent Orange. Former U.S.

airbases, including Danang, Bien Hoa, and Phu Cat have been referred to as dioxin "hot spots" due to high dioxin concentrations remaining decades after large volumes of Agent Orange and other defoliants were handled at these sites during the Vietnam War. High-level U.S. foreign policy objectives in Vietnam include resolving the Agent Orange issue, and in 2008, the USG and the GVN agreed, as their top priority on remediation efforts, to focus on Danang.

An environmental assessment conducted in 2009 at Danang determined the size and scope of the contamination and weighed all containment and remediation options. After intense discussions on the cleanup approach, a thermal treatment remediation strategy was selected and agreed upon by both the GVN and USG. Approximately 73,000 cubic meters of contaminated soil and sediment is present at the Danang Airport site and requires remediation. The implementation was officially launched in August 2012. The remediation strategy involves constructing a large containment structure on airport grounds, excavating and transporting the soil and sediment to the containment structure in two phases, and heating the soil and sediment to high temperatures that destroy the dioxin. The technology has been successfully demonstrated in the United States and in other countries.

The GVN has recently developed its nation-wide dioxin remediation program and expects support to increase Vietnam’s capacities for environmental assessments and remediation activities.

Biodiversity

The geographic diversity of Vietnam, together with its dense network of rivers and tropical monsoon climate, provides favorable conditions for a diverse and abundant plant and animal assemblage. The country is in fact one of the most biologically diverse, with 10 percent of the world’s mammal, bird, and fish species found here. There are more than 275 species of mammals, 800 species of birds, 180 species of reptiles, 80 species of amphibians, 2,470 species of fish, and 5,500 species of insects. The country also exhibits the highest degree of endemism among countries of the Indo-Malayan region.

A high number of plant species have been domesticated in Vietnam and are thus culturally and

Areas at Danang International Airport have been referred to as a dioxin “hotspot” due to the high dioxin concentrations in soil and sediment. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 13 - Public economically important. Many of these crops have supported agriculture in the country (and the region beyond) for thousands of years. New strains are continually being selected through crossbreeding to increase yield or to select for traits that reduce production costs (e.g., pest resistance, drought tolerance). The preservation of genetic diversity – for domesticated species of both plants and animals – will be increasingly important for helping to maintain resiliency in the face of projected climate change.

Tropical Forests

As of 2005, approximately 37 percent (12 million

ha) of the country’s total land area was classified as forested land, including roughly 10 million ha of natural forest and two million ha of plantation forest. Natural forest vegetation has declined dramatically in quantity and quality during the past 50 years. Government recognition of this trend led to new efforts at forest protection in the mid-1990s and has resulted in an increase in forest cover in recent years. However, a majority of recently reforested area is in monoculture plantation forest; intact primary forest remains today only in small, isolated remnants in the high mountains. Vietnam has a system of protected areas – which it designates as ‘special-use’ forests – including 126 sites with a total area of approximately two million ha. The country has five Ramsar sites, two UNESCO Natural World Heritage Sites, eight UNESCO Biosphere Reserves, and four ASEAN Heritage Parks. With these efforts, Vietnam has placed each of its major forest ecosystem types under protection. Despite these encouraging efforts, deforestation continues at rates not reflected in official statistics and illegal logging continues with large tracts of forests being lost.

Social and Economic Context

Agriculture, aquaculture, fisheries, forestry, mining, tourism, and water (in support of all of these and to generate hydropower) are major contributors to Gross Domestic Product (GDP) in Vietnam.

The country’s population is the world’s 13th largest, and is growing by 1 million annually. A majority of these people live within two economically important regions – the Red River and Mekong deltas.

It is estimated that the urban population will increase by 45 percent by 2020. This rapid urbanization has increased pressure on tropical forests and biodiversity. Furthermore, Vietnam’s industrial sector has grown rapidly in recent years. Industrial activities and the construction of infrastructure are two significant causes of increased pollution.

Although the urbanization and industrialization rates are rapid, nearly three-quarters of the population (and 90 percent of those below the poverty line) live in rural areas heavily dependent on agriculture, non-timber forestry products, and fishing. The GVN recognizes the need for farming and grazing land as the biggest driver of natural resource consumption. The conversion of land has and will continue to impact biodiversity and tropical forests within the country. Many poor people who live in remote and high diversity areas depend on natural resources for their livelihoods. These same people often have a low awareness regarding the importance of tropical forests and biodiversity conservation.

Tropical forests in Vietnam. Photo: USAID/Vietnam.

CDCS 2014 - 2019 USAID/VIETNAM - 14 - Public

Government Programs and Other Efforts

The GVN has laid a good foundation for understanding the global and national significance of its biodiversity and forests, and has set itself on a path towards meeting its obligations as a member of the WTO and as a responsible partner among countries of the Indo-Malay peninsula. The GVN has made continued strides to develop and refine national policy, legislation, and the institutions responsible for developing and implementing regulations pertaining to the conservation of tropical forests and biodiversity. Vietnam has also signed on to or ratified all of the major international and regional conventions and agreements towards protection of the environment and biological resources.

Considerable donor investments are being made in Vietnam to protect biodiversity, tropical forests, and the environment in general. The GVN engages the Forestry Sector Support Partnership to fund and implement sustainable forestry and biodiversity conservation activities. Many donors are also implementing biodiversity programs which focus on agro-biodiversity, the establishment of Gene Management Zones and Protected Areas, and combating the illegal wildlife trade. In addition, more than 15 bilateral and multilateral donors are carrying-out climate change activities which will in turn protect the country’s forests and biodiversity.

F. Gender

While Vietnam has made strong normative progress towards achieving gender equality on many levels, significant disparities remain, especially at a sub-national level and in rural and remote areas, especially for ethnic minority women and their children. Vietnam passed the Law on Gender Equality in 2006 and the Law on Preventing and Combating Domestic Violence in 2007. Equal rights for men and women including the right to work, to equal wages, property rights, inheritance and the right to choose a marriage partner or divorce are guaranteed under various laws including the Labor Code, the Land Law, and the Marriage and Family Law. However, discriminatory provisions do exist in some laws, such as an unequal retirement age in the Labor Code with 55 for women and 60 years for men, which restricts women’s opportunities.

Implementation of…