Vietnam has experienced significant reductions in, and low levels of, child mortality in comparison with international standards given its low per capita income. This report from the World Bank examines how the move towards a market-orientated economy since the mid 1980s has affected child survival, giving special attention to poorer households. Under the policy known as Doi Moi, Vietnam began to encourage international trade, investment and development assistance. A reduction in the scale and quality of public health services provoked concerns about the policy’s effects on poorer households.
Has Vietnam’s reduction in child mortality been sustained under Doi Moi? What are the socio-economic differentials in child survival? The authors review the evidence from a variety of sources on recent trends and present new evidence drawing on the Vietnam Living Standards Survey (VLSS). What factors are behind recent changes in levels and inequalities of child mortality? The authors construct an empirical model and undertake a decomposition analysis to assess factors behind these changes. Is the reduction of infant and child mortality by two-thirds over the period 1990 to 2015 (an international development goal) realistic? How might the Poverty Reduction Strategy Paper currently under preparation incorporate such a goal?
The paper’s key findings are:
- The reduction in child mortality has been sustained at a continuous rate.
- Reductions in child mortality have been heavily concentrated among the better-off in the more recent years of Doi Moi, compared with 1990 when no there was socio-economic differentiation.
- Factors behind the differential decline in child mortality include changes in health service coverage and in women’s educational attainment among the poor.
- On the basis of the late 1990s, lack of progress among the poor will jeopardise the achievement of international development goals for child mortality, already very challenging even under optimistic assumptions about income growth et cetera.
In this context,
- Improvements in services, particularly women’s education and birth-related health services targeted at the poor, are helpful.
- A greater impact would be achieved through measures to narrow the gap between the poor and the better-off in terms of the impacts of various determinants of child survival.
