Internal migration plays a very important role in the socio-economic development of Viet Nam Viet Nam
BACKGROUND
This review of RH care interventions for migrants is meant to provide a picture of the support they are receiving so that programme managers can have information to design better projects and interventions to meet the RH needs of migrants as well as ensure their RH rights.
In order to draw lessons and experiences from past RH projects, the United Nations Population Fund (UNFPA) funded a project with the Institute for community health and development (LIGHT) within the framework of the UNFPA projects run by the Ministry of Health to review RH interventions for migrants between 2000 and 2008 and make recommendations for improving the health in general and reproductive health in particular of migrants.
RESULTS OF REVIEW
The review of 24 intervention projects for migrants has shown that there are four main groups of beneficiaries including: migrant children (7 projects), migrant workers in industrial zones (4 projects), spontanous migrant workers (7 projects), and high-risk migrants (6 projects).
Group 1: Migrant children (including street children not living their families, street children, child workers, street children who have rejoined their families)
In big cities like Hanoi , Ho Chi Minh, Hai Phong and Da Nang
It is easy to notice that most of the intervention projects were focused in the two biggest cities of the country i.e. Ha Noi and HCM City Hue and Da Nang
Groups 2: Migrant workers in industrial zones
Over the past two decades Viet Nam
By July 2009 the research group had collected information on four projects supporting migrant workers in industrial zones. All these four projects are located in Binh Duong, which has the largest number of industrial zones in the country. Hai Phong is the second area to receive support for migrant workers.
Industrial zones usually have a large number of workers. They live in the same area and/or in the same collective accommodation, so it is easy to access them. All industrial zones have trade unions and health services. However, as industrial zones have a large number of workers it is not easy to provide proper health care, especially RH care, for the workers. Migrant workers have fixed work schedules so they have spare time to participate in other activities. In addition, factory accommodation sometimes cannot meet the need of migrant workers so many of them still have to rent accommodation from local residents and have little access to the mass media.
This group may face many risks related to RH, sexual health and HIV/AIDS if timely and proper support is not provided for them.
Group 3: Spontaneous migrants
There were seven intervention projects for this group of migrants. They mainly focus on female migrants. Most of these projects were located in Ha Noi (6 projects) and HCM City
This group includes spontaneous migrants coming to urban centres from the country side for work when there is not much framework. They are usually aged 25-40, most of them are married.
As they have low academic qualifications and almost no vocational training they are usually engaged in simple jobs. Male migrants work as porters at markets, coach stations, motorbike taxi drivers, builders, carpenters, hired labourers, sellers, street vendors, and so on. Some of them run businesses or work as contractors. Female migrants work as fruit or vegetables sellers, helpers at cheap food restaurants or shops, scrap material collectors, owners of cheap food restaurants and so on.
They stay in town for a short period, usually some months, and then go back to their home villages to come back to town again some time later. Some take their children to town to live. These migrants often seek jobs in urban centres close to home, so they can go home when necessary (because of sickness, funerals, weddings, etc.).
Spontaneous migrants in urban centres often rent accommodation close to bus stations and markets from local residents. The rented accommodation has only basic conditions and has poor hygienic conditions.
Group 4: High-risk migrants include:
Long-distance drivers: There is 01 project for long-distance drivers in three provinces/cities i.e. Quang Ninh, Ha Noi andHCM
Long-distance drivers are strong young men travelling through provinces for many days. They spend their life in the truck cabin and roadside inns. Research has shown that they face high risks of HIV infection and STIs. Their unsafe sex practices lead to high risks of HIV infection and STIs among their wives and partners.
Sex workers: There was project support for this group in: Quang Ninh, Hai Phong, Ha Noi, Nghe An, Khanh Hoa, HCM City, Can Tho, An Giang and Lao Cai, with funding from PEPFAR.
Sex workers have a high risk at RH and HIV problems and STIs if they are involved in unsafe sex. Sex workers are mainly concentrated in big cities, holiday resorts and some border provinces. Sex workers move very frequently and they have many sex buyers.
Migrants in border areas: are persons who are trafficked in provinces like Quang Ninh, Nghe An, Tay Ninh, Thanh Hoa and some provinces in the Mekong River Delta.
Of the 24 projects reviewed, 10 projects (more than 1/3) has the duration between less than one year and two years, 10 projects from 3 to 5 years, and four projects over 5 years.
3. Areas of intervention:
- Reproductive health (pre-natal care, safe motherhood, sexual health, STDs and reproductive rights)
- HIV/AIDS prevention
- Gender, gender inequalities, prevention of domestic violence
- Prevention of trafficking persons, including children; prevention of sexual abuse; safe migration; reintegration into the community
- Protection and care of children; children’s rights; education, vocational training; prevention of acquired risks
- Improving lifeskills (lifeskills, labour safety and hygiene; Labour Law)
Of the 24 intervention projects, eight deals with RH, five with HIV/AIDS (some including both RH and HIV); four with the protection and care of children; four with the improvement of living conditions; two with trafficking persons and children, sexual abuse, safe migration; only one with gender, gender inequalities, and domestic violence.
4. Approaches:
a. Training and capacity building
- Training and capacity building for the network of volunteers and peer members
- Improving knowledge and skills of the beneficiaries
- Counseling families, communities and local leaders
- Training to strengthen the capacity of programme and project managers
b. Information, Education and Communication (IEC), and Behaviour Change Communication (BCC)
Forms of communication:
· Most projects used face-to-face communication with the following types:
+ Small group face-to-face communication
+ Topical talks
+ Integration into other intervention activities
+ Cultural exchanges and contests
+ Forums for dialogues
· Indirect communication:
Communication activities also involved the participation and support of local authorities, youth union branches, health and population staff.
Communication contents:
- Information on health, RH and sexual health
- Information on rights and responsibilities of the employee.
c. Provision of RH services
The projects provided the following services: counseling on health, reproductive health; general health and RH examinations; health examination and treatment of STIs; supply of condoms and pills; free and voluntary HIV tests for high-risk persons, etc.
d. Mobilizing local leaders
Like the family and the community, local leaders played a very important role in the intervention projects. However, only 5 of the projects mobilized the participation of local leaders.
The interaction between local authorities and the projects was rather moderate. The local leaders provided favourable conditions for the project to operate but close cooperation between the two sides was not always active during the life of the projects.
1. Intervention projects should have branches at different places in the same city where there are many migrants and there should be a linkage between these places. These projects should be linked to ensure the continuity of information and services form them. There should be a linkage between the place of departure and the place of destination, thus increasing the effectiveness of the intervention.
2. Similar to all other intervention projects, RH projects for migrants should have the duration of at least 4 years to allow for 2 to 3 years to interact with the beneficiaries. This will certainly increase the impact and sustainability, as well as the commitment of local leaders and the sustainability of personnel.
3. There is a need to increase the number of projects focusing on RH care for migrants. At the same time, it is important to integrate more RH contents into other projects for migrants, especially those for teenage migrants.
4. Projects need a training plan to ensure sufficient number of peer educators, refresher training courses to update their knowledge and skills. Monitoring and technical assistance should be on a regular basis. Pay attention to contents and duration of training. It is necessary to introduce appropriate encouragement policies for volunteers and peer educators involved in the projects. It is important to provide a sufficient number of communication materials so that volunteers and peer educators can consult them and distribute them to the beneficiaries. At the same time, hotlines should be set up to provide counseling for migrants.
5. Training courses for migrants should focus on STIs prevention, STDs, HIV/AIDS, gender equality, prevention of sexual abuse, domestic violence, giving priority to life skills with full information about migrants' rights, responsibilities and support.
6. Forms of RH service provision for migrants should be diversified. Modes of service delivery are varied to be appropriate for migrants. RH service provision should include the participation of local health facilities, private health facilities. Consider health insurance for migrants and facilitate migrants who have health insurance.
7. It is necessary to develop advocacy plans for local and community leaders, landlords and employers to support RH activities for migrants to ensure the sustainability of projects.
8. RH information and care plans and programmes for migrants should be integrated into the formulation of health, education and development plan of the commune, sub-district, district, city and enterprise concerned
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