5 - The Private Provider Network in Vietnam

Summary

Due to some of the deficits of the public provider network, the private provider network has been able to profoundly alter the welfare outcome in Vietnam. The private provider network comprises various actors including the family, the household, the voluntary sector and the market. In the light of the current lack of public services, the family has remained a strong social network of trust for most Vietnamese. In many cases this form of risk management through saving and borrowing works better than public services. In fact, in coherent communities, informal risk sharing seems to be preferred to voluntary health insurance. However, especially the poorest households have been unable to overcome the health poverty trap, because they have less access to information and social networks outside their immediate environment.

Many Community-Based Organizations (CBOs) provide risk sharing in case of illnesses through savings schemes. However, in very poor areas such as the isolated ethnic minority villages in the North, among the urban poor, or in the natural disaster ridden Mekong Delta, the availability of community help is limited by a simple lack of means. Non-Governmental Organizations (NGOs) cooperating with mass organizations have been quite active in establishing community-based micro-insurance and savings schemes as well as voluntary health insurance for rural and urban poor. However, due to the lack of proper regulatory guidelines, NGOs such as the two main semi-formal micro-finance institutions, Tao Yeu May Fund (TYM Fund) and the Capital Aid Fund for the Employment of the Poor (CEP), work in a grey area. This guarantees them a certain autonomy, but also exposes them to the arbitrariness of the local administration. Furthermore, many donors and International Non-Governmental Organizations (INGOs) are reluctant to provide money under the current precarious conditions. While INGOs and donors have more financial means than the Vietnamese NGO sector, the fragmentation is quite high and coordination thus difficult to achieve.