Sao Mai Education Fund Disability in Vietnam

Sao Mai Education Fund
	Disability in Vietnam

Dr. On Tuan Bao, Director, The NCCD Office (National Coordination Committee on Disability)

Poverty, backwardness are assumed core causes of disability in developing countries. Vietnam is no exceptional. Besides, it has not only severe natural and geometrical conditions with frequent natural calamities but also went through decades of wars, of which enduring aftermath are left until today. Consequently, the number of PWDs is rather large.

Yet, in Vietnam, there is not a national, large scale and comprehensive survey on disability that produces reliable estimates of the overall prevalence of disability, age, gender, causes and types of disabilities including information on characteristics, services received and needs of PWDs. Only complete, specific, reliable data on disability including needs of PWDs helps the Government in policy development, programs and projects monitoring, service centers construction to meet the need of PWDs.

In recent years, various organizations in Vietnam have conducted some disability surveys. However, they were often small scales and the collected data is used for specific purposes or requirements of implementing functions and tasks of ministries and areas. It should be mentioned that the definitions and concepts of disabilities, classifications of types of disabilities, variables, indicators, content and methodologies used by various agencies in these surveys were inconsistent, unclear. This leads to underreporting or overreporting of disability data, reflecting incorrectly the situation of disability in Vietnam. Sometimes, estimates of overall prevalence of disabilities in Vietnam from different sources vary widely and are difficult to compare.

MOLISA estimated a total of 5 million PWDs or more than 6 percent of the population of Vietnam including 1.5 million severely disabled persons in need of government and community assistance and support.

By reviewing disability data from surveys (1994-1995; 1998) of MOLISA, studies of MOET and CBR data of MOH, surveys, reports of international organizations, the current situation of PWDs in Vietnam can be reflected in the following sections:

PWDs in rural areas accounts for 87.27% while PWDs in urban area are estimated at 12.73%. Zone 4 has highest disability prevalence rate, followed by Central Coast: 9.05%, Mekong River Delta: 8.35%. The South East Zone has the lowest disability prevalence rate of 5.58%.

Disabled men have higher prevalence of disabilities compared to disabled women and this difference is not much among areas. The overall disabled men comprise about 63.52% while compared to 36.52% of overall disabled women.

Three age groups (16-55, >60, 6-12) have high prevalence of disabilities: i) disabled persons ages 16-55 comprise 61.27% although this group is capable of economic activity; ii) disabled persons age over 60 comprise 17.59%; iii) disabled persons ages 6-12 comprise 8.40%. These rates are accurate for both rural and urban areas. It should be pointed out that among low age groups (0-5, 6-12, 13-15), the prevalence of female disabilities is higher compared to male disabilities.

Persons ages 6-16 in 3 areas of Tay Nguyen (Western Highland / Plateau), the 4^th Zone, and Northern Mountainous area has higher average disability prevalence rate compared to overall disability prevalence rate. Children with disability age 6-12 in Western Highland represent highest disability prevalence rate of 11.56%.

1999 Disability Survey conducted by the Labour and Social Affairs Statistics Center of MOLISA and supported by UNICEF showed that children with disabilities ages 0-17 comprise 3.1% of total chidren ages 0-17 or around 1,000,000 people.

Types of disabilities	Mobility	Sight	Hearing	Speech	Learning	Strange Behavior
Percentage %	35.46	15.70	9.21	7.92	9.11	13.93

The above table shows that motor disability makes up the largest proportion of 35.46%, followed by sight disability (15.7%) and strange behavior (13.93%). Most of disabilities are caused by congenital defects (34.15%), or from diseases (35.75%) or due to wars (19.07%). The rate of men disabled due to wars is much higher than that of women. In Vietnam, the number of person with multidisabilities is rather high, accounting for 20.22% of total PWDs.

The rate of illiterate PWDs in the whole country is 35.58% while that rate of illiterate PWDs in rural area is 36.9%. PWDs who have completed primary, secondary and tertiary schools comprise 25.36%, 21.46% and 5.64% respectively (In particular, a large number of PWDs in urban areas have completed tertiary schools, accounting for 15.89% while only 4.31% of PWDs in rural areas have completed tertiary schools).

A majority of PWDs does not have technical skills, accounting for 97.64%. Only a small proportion of PWDs are trained (1.22% are technical workers, 0.53% have completed technical schools and 0.61% have completed college and university).

It is clear that an increasing attention will be needed to cultural education and vocational training for PWDs, which are the most important factors to help PWDs to integrate in the community.

A majority of PWDs lives with their families, accounting for 95.85%. Only 3.31% of PWDs live alone. 0.22% live in State sheltered houses (Most of them belong to two age groups 15-55: 54.17% and under 15: 28.55%). 0.62% of PWDs live in streets.

58.18% of PWDs have got various kinds of income generating jobs to ensure their independent living, economic self-sufficiency. 30.43% of unemployed PWDs still need jobs. The unemployed PWDs in Red River Delta and SouthEast Mekong Delta comprise of 41.86% and 35.77% respectively. In order to support them to integrate in the economic and social life in the community, job creation must be urgently attached to PWDs supporting programs and projects.

According to survey results, 48.5% of PWDs wish to have access to credit loan for self employment; 23.9% need rehabilitation; 13.56% need job placement, 9.98% want to live in State shelter houses and 4.08% want vocational training.

In total, 66.14% of PWDs need access to credit loan, job placement and vocational training. This proves that a majority of PWDs is emulating for full participation, independent living and economic self-sufficiency.

Mutual support is one of our traditional great values. Vietnamese Government has reiterated our great attention and support for PWDs in all legal regulations. State consistent opinions are clearly presented in legal regulations of Vietnam Constitution of 1959, 1980, 1992 regarding supporting equal opportunities of PWDs.

In response to UNDP international year of disabled persons, Vietnamese Government established Vietnam Committee of Disabled Persons in 1982. In 1992, Vietnam signed the Asia Pacific Statement for full participation and equal opportunities of PWDs.

On 30 July 1998, Standing Committee of National Assembly of the Socialist Republic of Vietnam passed the Ordinance on Disabled Persons, highlighting an important milestone proving the Government's attention to PWDs. The Ordinance on Disabled Persons was put into force from 1 November 1998. This event was then followed by the establishment of the National Coordinating Council on Disability of Vietnam. The Office of the National Coordinating Council on Disability of Vietnam was after that created to assist the Council and MOLISA on disability issues. The Council has 14 members representing relevant ministries including Ministry of Labour, Invalids and Social Affair, Ministry of Construction, Ministry of Health, Ministry of Transport and Communication, Ministry of Culture and Information, Ministry of Education and Training, Committee on Sports and Physical Exercises and Association of the Blind of Vietnam. Vietnam is to host the 9^th Campaign of Asia-Pacific Decade of Disabled Persons in December 2001 in Hanoi.

Although Vietnam is still a poor country with a weak economy, the Government has issued various specific legal regulations to provide spiritual and material benefits to PWDs. All war invalids who have fighted for the country and workers who become disabled due to occupational accidents are provided preferential benefits because of its limited human, material and financial resources. Besides, the Government also has a uniform legal system comprising comprehensive policies regarding all aspects of civil PWDs. They are legally entitled to the following benefits:

Living benefits of all severely disabled persons who have not got income, relatives, or have relatives but they are poor and cannot afford to support them are set at the following monthly rates:

In case the recipients of severely disablement benefits die, the People 's Committee of Commune or District of residing location will organize funerals for them. The level of funeral cost will be decided by the local authorities.

Besides PWDs are provided health insurance card, severely disabled persons who have not got income or relatives, schizophrenia patients or poor PWDs are provided with free of charge health care services or reduced service charge (Inter-ministry MOLISA, MOH, MOF Circular)

Severely disabled persons who have not got income, relatives, or have relatives but they are poor and cannot afford to support them economically or children with disabilities under 15 in poor households are provided free prosthesis and orthopedic devices.

Other poor PWDs are entitled to an assistance amount worth 50% of prosthesis and orthopedic devices.

Children with disabilities have access to inclusive education in schools or go to special schools or receive education in sheltered houses or in their families. Talented children with disabilities are received in proper specialized schools.

Displaced children with disabilities who are received into State sheltered houses are entitled to free education, monthly living benefits of 100,000VND and provided with necessary books and learning equipment.

PWDs going to vocational training schools, public colleges or universities are entitled to:

§ A reduction of 50% of tuition fee in case of disablement percentage of 31% - 41%.

§ Exemption of 100% of tuition fee in case of disablement percentage of over 41%. If they are not salary earning employees or they are not given scholarship or they are not provided other allowances, they are entitled to monthly living benefit of 100,000VND.

PWDs going to State owned but self accounting voctional training facilities are asssisted by 50% of tution fee.

+ Vocational training schools and production establishments for PWDs are encouraged by the Government.

All economic sectors and PWDs themselves are encouraged to set up vocational training schools or business and production establishments for PWDs. If these VT schools have over 70% of disabled students attending regular classes and if these establishments employ over 51% of employees, they are recognized vocational training schools and production and business establishments for PWDs and enjoy the following preferential benefits:

§ They are funded by Disability Employment Fund to retrain their disabled employees, to expand their production, to employ more disabled workers or to set up their business.

§ They are provided soft credit loans from Municipal or Provincial Disability Employment Fund to finance vocational training projects or production expansion schemes.

§ They are granted land use rights or allowed to hire land at convenient locations for their business operations.

+ Organizations, individuals in all economic sectors providing vocational training services or employing PWDs are treated preferentially according to Labour Code.

+ Self-employed PWDs are provided soft loans and assisted by local authorities in technology transfer, production process and technique and product consumption.

+ PWDs do not have to pay job broking fee when served by Employment Service Centers.

+ Labour Code regulates that all business in all economic sectors must employ 2-3% of disabled workers or pay an administration fine equivalent to State minimum salary multiple by the number of PWDs that the business should employ.

§ The Government creates favorable conditions for PWDs to develop their art and sport telents.

§ Art and sports centers must create favorable conditions for PWDs to participate cultural and sports activities.

§ PWDs have access to newly constructed or upgraded public accomodation, equipment, means of transportation, telecommunication including motor disabled persons, vision disability according to the Construction Code.

Despite of financial constraint of State Budget, the Government at all levels has attached its responsibilities to implementation of PWDs protecting policies. Thanks to joint efforts of all organizations, individual PWDs and all society, Vietnam has achieved encouraging results in providing care, education and training, rehabilitation, job placement to PWDs. The life of PWDs therefore has been improved. On the other hands, limited resources, lack of infrastructure, technique and qualified staff also hinder smooth implementation of PWDs protecting policies. Followings are achievements and shortcomings:

Vietnam has established social securities system focusing on human development, poverty reduction, social integration, improvement of living standards of general population including displaced single elder people, PWDs, orphans, (disadvantaged persons).

The Government has established a system of social protection centers and encourages organizations, individuals to construct social protection centers for disadvantaged persons. Severely disabled persons who have not income or relatives are accepted to live in these centers. There are 220 social protection centers throughout the country, including 14 social protection centers for PWDs only and 16 social protection centers for PWDs and other disadvantaged people. According to MOLISA statistics, 1,305,000 persons were severely disabled persons, of which 502,726 PWDs or 38.52% of severely disabled persons were entitled to social benefits. 493,194 PWDs were entitled to community living benefits. Only 9,532 PWDs equivalent to 1.9% of total number of PWDs were institutionalized. In 1999, the Government spent 661.7 billion VND for social benefits for severely disabled persons. In general, the levels of benefits for PWDs are low enough to meet food and clothe requirements.

The infrastructure of all social protection centers (electricity, water, road, living, dining, clinic, club…) are far from common standards; only 10% of social protection centers have good infrastructure and equipment.

Majority of PWDs have poor health ( 80.67% have average to poor health, of which 35.92% have very poor health). PWDs suffer from chronic diseases. 22.73% of PWDs have heart troubles, 14.2% have respiratory diseases. A small number of seriously disabled persons are provided health insurance cards by the Government or charitable organizations. A majority of PWDs has few opportunities to receive health treatment. Many PWDs can not receive timely primary medical treatment resulting in later chronic diseases. Therefore, their disability becomes more serious.

The Institute of Orthopedics and Rehabilitation under MOLISA was established 1989. The Institute is responsible to study, manage and provide orthopedic devices to PWDs. Moreover, Vietnam Rehabilitation Association has just been established.

According to Dr. Thomas Kane 's "Disability in Vietnam 1999" Report, at present, Vietnam has 20 rehabilitation centers (14 centers are run by MOLISA, 3 by DOLISA and 3 by MOH) and 54 provincial hospital with rehabilitation-physiotherapy departments. MOH 's CBR program is now in effective operation. At the same time Vietnam had approximately 80 sanatorium centers under the management of ministries, provincial authorities and 34 hospitals belonging to army medical service system with rehabilitation service. MOH reports more than 360 doctors working in the rehabilitation field in institutes, central hospitals, provincial and sectoral hospital and sanatoriums…All three Central Medical Technical Secondary Schools have rehabilitation departments and together are training 50-80 new physical therapists.

All 20 rehabilitation centers have prosthetic and orthotic workshops. There are also two private organizations and several hospitals that produce prosthetic and orthotic devices. Within 10 years, many non-government organizations have implemented many programs and projects to make prosthetic and orthotic devices including World Vision International (WVI), Vietnam Assistance for the Handicapped (VNAH), Vietnam Veterans of America Foundation (VVAF), International Committee of the Red Cross (ICRC), Handicapped International (HI), Geselleschaft Technische Zusammenarrbeit (GTZ), Nippon Foundation (NF), United State Agency for International Development…

According to statistics from Institute of Orthopedics and Rehabilitation (MOLISA), from 1991 to 1998, a total of 134,907 prosthetic limbs were produced in Vietnam. Data provided by Dr. Thomas Kane indicated that in 1998 and 1999 only, 22,884 orthotic devices were produced in Vietnam. However, these products were of low quality, inconvenient to users and not durable. And the practical production of prostheses in Vietnam is far from meeting the demand for prostheses; According to reports of National Assembly of Vietnam, produced prostheses meet only 15-20% of PWDs demand.

About 18.92% shetered houses run by MOLISA and 50% of diasbled person protection centres has rehabilitation department. According to some experts, the medical and rehabilitation areas have deteriorated in terms of infrastructure and equipment and have been in short of doctors and technical workers.

§ The education system is presently capable of receiving 40-50% of children with disabilities into special and inclusive education schools. The inclusive education programs are faced with the following problems:

+ 60% of kindergartens are private owned. Due to high tuition fee, parents of children with disabilities are unable to register for their children to study in this type of school.

+ In State kindergartens, primary school, teachers are not trained to teach children with disability. They tend to refuse disabled children, worrying that the common achievement of their class may be reduced. Moreover, they are not given extra allowance or benefits by the government.

+ Children with mental disease, language disability or hearing disability… are not capable to buy assistance devices to make them convenient in classes.

§ Special schools of MOET, Hanoi National University have cooperated with several international non-government organizations including Radda Barmen, Komitee Twee, Medical Committee Netherlands Vietnam, Pearl S, buck Foundation and Save the Children UK to develop special education and inclusive education programs for children with disabilities. Inclusive education programs have been conducted in 44 districts in 36 provinces with 11,000 classes and 10,000 teachers participating. In 1998, the program received 21,000 CWDs.

§ Throughout the country, 72 special schools served around 6,000 children with disability. MOET is developing separate cirriculum to be used in special schools. However, the rate of enrollment of children with disability in special schools is extremely low, around 2% of total number of children with disability.

§ Vocational training for PWDs in Vietnam is conducted through two vocational training schools run by MOLISA and 14 vocational training schools run by provincial authorities with combined capacity of 1,500 enrollment per year. According to MOLISA statistics, in 1993-1996, these vocational training schools have trained 3,500 students. And 72 special schools also have pre-vocational training program.

§ Vietnam is shifting its national economy to market economy, creating new difficulties for job placement for PWDs. In order to solve job placement for PWDs, the Government has developed a lot of protecting policies, creating favorable conditions for disability business and production establishments.

§ According to reports of 19 out of 61 provinces, through out the country, 360 disability business enterprises was established, of which 27 enterprises are State owned. Thai Binh province has largest number of disability business enterprises, up to 109 enterprises. 15,406 PWDs are working in these 360 enterprises, including 12,331 PWDs. Report of 1999 showed that 171 out of 360 enterprises produced an output of 148.24 billion VND.

§ Reports of 17 out of 61 provinces on providing loans from the National Employment Fund to disability enterprises to set up business or expand production as instructed in Decision No. 15/TTg by Prime Minister showed that as of March 2000, the National Employment Fund lent a total of 45.73 billion VND to disability business enterprises.

§ The Ordinance on Disabled Persons requires all enterprises in all economic sectors to employ 2-3% of disabled workers. Reports of 28 out of 61 provinces and cities indicated that out of 605,941 employees of enterprises, there were 17,296 disabled persons, making up 2.83% of total employees. In many provinces, this percentage is higher including Thai Binh Province (6.9%), Quang Ngai province (4.2%), Quang Ninh province (2.4%) and particularly Nam Dinh province (12.44%). However a majority of employed PWDs is war invalids or became disabled due to occupational accidents and they have worked in these enterprises for a long time and before the promulgation of the Ordinance on Disabled Persons. Many big and newly established enterprises refuse to employ PWDs or employ only few PWDs. It is difficult to impose administration fine for enterprises, which employ less than 2-3% of disabled workers as regulated by the Ordinance on Disabled Persons.

Although the Ordinance on Disabled Persons, inter-ministries Circular by MOLISA, MOF, MPI have provided guidance on the establishment of Disability Employment Fund, until now provincial authorities are not capable of setting up this Fund. PWDs and their families have not received any loan yet. And they can not apply for loans from the National Employment Fund, which only provide soft loans through the Blind Association of Vietnam to assist PWDs to expand household economy. In 1991-1999, the Blind Association of Vietnam received total 44.79 billion VND from the Fund and satisfied 41,151 applications of blind people. On average, one person received 1,088,440 VND. The model of micro finance effectively improves the life of blind people and grasped them out of poverty. With high rate of loan repayment and effective use of loans, the micro credit model should be widely reapplied in the future.

The Ordinance on Disabled Persons offers tax exemption to disability business and production enterprises including income tax, interest tax, land tax and agricultural land use tax. In practice, many disability business and production enterprises do not apply for tax exemption because they are fear of heavily routine procedures and papers and their requests are slowly responsible authorities attended. At the same time, there remain conflicts between regulations of legal documents. For example according to the Law on VAT which were in effect on 1 January 1999, disability business and production enterprises must pay VAT. This leads to difficulty and confusion in implementing regulations.

The Sports Association of the Handicapped of Vietnam was established in 1994. Sports and Culture Clubs of PWDs are booming in big cities with exciting activities. More and more PWDs are participating in physical exercises, sports, cultural performance. Many of them have taken part in international and domestic tournaments and competions. In April 1997, Sports and Physical Training Committee organized the first Cultural Performance and Sports Festival of PWDs. Many disabled atheletes won high medals, bringing honour to their homeland. Recreational and sports activities become a bridge for PWDs to integrate in the community and build trusts and equal attitude towards PWDs in the society.

However, because of financial constraint, the Government can not invest to construct separate recreational and sports facilities for PWDs.

PWDs 's access to public accomodation are limited. For a long time, not much is done to help PWDs access to public accomodation. In 1998, Ministry of Construction enacted some regulations on construction criteria and codes relating to rest rooms, moving paths in all construction projects. However, they are not implemented correctly in practice. After the promulgation of the Ordinance on Disabled persons, municipal authorities of Hanoi, Ho Chi Minh City and Hoi An Town have created encouraging changes in several streets in towns to allow wheelchair users to move more easily.

Recently, with VNAH's assitance, the Ministry of Construction is developing Design and Construction Code of Projects to ensure PWDs access to public accomodation and hopefully, the Code will be issued in 2001.

§ The Blind Association of Vietnam is the biggest organization in Vietnam. It was established in 1969 and expanded its presence to 33 provinces and cities with 261 association branches including 31,895 members. It operates in many areas including consultancy, Braile language training, vocational training, micro finance for members. The Training Centre run by the Association is capable to train 1,000 Braile language teachers and massage workers. 106 production workshops can employ 2,718 workers including 2,336 blind people and earned an output of 8.8 billion VND in 2000. The Association also organized cultural performance and sports events for its members, stabilizing material and spiritual life of its members. The model of Blind Association and experiences should be taken as good examples for other PWDs 's organizations.

§ Recently, a great number of associations, clubs and self help organizations of PWDs are booming in big cities including HCMC Association of Disabled Youth, Bright Future, Hanoi Self Help Club of PWDs, Disabled Student Club, Hanoi Deaf People Club, Hanoi Sports and Cultural Performance Club of Hanoi… In particular, the Audio Library is effectively run by Charitable Women Association of HCMC. Generally speaking, these newly established associations, clubs, groups of PWDs have limited activities: propaganda and mutual assistance.

§ Apart from State organizations, many non government organizations, mass organizations, charitable associations, funds, programs, projects… have initiated activities to assist disadvantaged persons including PWDs. i.e. Fatherland Front of Vietnam, Women Union, Farmer Association, Veterans Association, Farmers Association, Red Cross Association, Association for Protection of PWDs and Orphans, Children Protection Fund of Vietnam, Orange Agents Victims Fund…

§ It is noteworthy that a majority of organizations were established and conduct operations in urban areas while 87.27% of PWDs living in rural area do not have any association to help each other except the Blind Association of Vietnam.

3.1. The Government should conduct a comprehensive survey in 61 provinces, cities with large enough samples to provide valuable information on disability for policies makers. To develop database system to manage disability data within MOLISA.

3.2. The Government should take measures to increase awareness of the whole society on disability issues. It is more important to include them in Action Plan and Socio-Economic Development Strategy and turn into specific policies and regulations, encouraging responsibilities and attitudes of authorities at all levels, general population and PWDs themselves.

3.3. The Government should strengthen capacity for agencies, which involve in policy development, policy implementation and policy inspection including Motherland Front of Vietnam, mass organizations and PWDs ’s organizations in inspection role of the implementation of the Ordinance on Disabled Persons.

3.4. The Government should allocate State budget, contribution of domestic organizations and individuals, and mobilize international assistance for new construction or upgradation of public accommodation in medical care, rehabilitation, academic education, vocational training, recreation and sports center to be accessible for PWDs.

3.5. The Government should expedite the establishment of Disability Employment Fund in all provinces. The pilot evolving preferential credit fund should be developed to ensure access to soft loans for disability business and production enterprises; households and self employed PWDs.

3.6. The Government should enact specific construction regulation early to ensure PWDs’ access to public projects.

3.7. The Government should guide encourage PWDs to establish associations, self help organizations and create favorable conditions for their development.

3.8. The Government should appeal for international assistance in disability area.

No.	Causes of Disabilities	Percent compared with total number of disabled persons
No.	Causes of Disabilities	Percentage	Male %	Female %
1	Congenital	34.15	30.44	40.61
2	Diseases	35.75	29.75	46.11
3	Occupational Accidents	1.98	2.36	1.32
4	Traffic Accidents	5.52	6.75	3.38
5	War-related	19.07	27.07	5.14
6	Other causes	3.55	3.63	3.44
		100	100	100