2002年-世界发展银行全球_Poverty_and_Survival_Prospects_of____________Vietnamese_Children_under_Doi_Moi_42页_2mb

Summary of "Poverty and Survival Prospects of Vietnamese Children under Doi Moi"

Core Content

This working paper by Adam Wagstaff and Nga Nguyen Nguyen examines the impact of Vietnam's economic liberalization policy, Doi Moi, on child survival, particularly focusing on the trends in child mortality and socioeconomic inequalities in Vietnam from the 1980s to the early 2000s.

Main Points

1. Child Mortality Trends Under Doi Moi

• Vietnam has achieved substantial reductions in infant and under-five mortality rates, which are among the lowest in the developing world, despite its relatively low per capita income.
• The reduction in child mortality has been sustained under Doi Moi, but the benefits have been concentrated among better-off children.
• The infant mortality rate (IMR) appears to have fallen below the target of 30‰ set by the Vietnamese government for the year 2000, likely reaching this level in the mid-1990s.
• Direct estimates from the 1998 Vietnam Living Standards Survey (VLSS) suggest that the IMR was around 25‰, and under-five mortality rate (U5MR) around 35.8‰, with standard errors indicating some uncertainty in these figures.

2. Socioeconomic Inequalities in Child Survival

• Socioeconomic inequalities in child survival have emerged under Doi Moi, a change from the early 1990s when such inequalities were not apparent.
• The 1993 and 1998 VLSS data show that while child mortality rates have declined overall, the reduction has not been evenly distributed across the population.
• Better-off children have experienced more significant improvements in survival, whereas poorer children have not seen substantial gains.
• The 1997 Demographic and Health Survey (DHS) and 1998 VLSS data both indicate that inequalities in child survival have increased in recent years.

3. Causes of Changes in Child Mortality

• The authors estimate a survival model to identify the factors contributing to the differential decline in child mortality.
• Key determinants include:
  • Health service coverage: Reductions in coverage among the poor have been observed, but not among better-off.
  • Women's education: Lower educational attainment among poor women is associated with higher child mortality.
  • Income and living standards: Better-off households have higher resources and better access to health services, which have improved child survival.
• The model suggests that the decline in child mortality is not uniform across socioeconomic groups and that the lack of progress among the poor could jeopardize Vietnam's ability to achieve international child mortality targets.

4. Future Projections for Child Survival

• The paper explores how child survival prospects are likely to evolve over the next 15 years.
• It uses the survival model to project mortality rates based on assumptions about income growth, improvements in water and sanitation, and health service quality.
• The authors argue that policy interventions aimed at narrowing the gap between the poor and better-off may have large beneficial effects on child survival.
• Expanding health service coverage, improving water and sanitation, and enhancing educational opportunities for women are highlighted as critical policy measures.

Key Information

• Data Sources: The paper uses data from the 1993 and 1998 Vietnam Living Standards Surveys (VLSS), the 1997 DHS, and the 1999 Census.
• Methodology: The authors employ both indirect and direct estimation methods for child mortality, and use a Weibull survival model to estimate the determinants of child survival.
• Policy Implications: The findings suggest that without targeted interventions, the progress in child survival may not be sustained for the poor, and that Vietnam may struggle to meet the international development goals for child mortality by 2015.
• Conclusion: While Doi Moi has led to overall improvements in child survival, these gains are unevenly distributed. The paper emphasizes the need for policies that address the specific needs of the poor to ensure equitable progress in reducing child mortality.

Structure of the Paper

1. Introduction: Overview of Doi Moi and its impact on child survival.
2. Recent Trends in Child Mortality: Analysis of mortality rates using both direct and indirect methods.
3. Changing Inequalities in Child Mortality: Examination of how survival rates have become more unequal over time.
4. Modeling Child Survival: Description of the econometric model used to estimate the determinants of child survival.
5. Decomposing Sources of Change: Application of decomposition analysis to understand the drivers of the differential decline in child mortality.
6. Projections for the Future: Estimation of child survival trends up to 2015 based on policy assumptions and economic projections.

This paper contributes to the World Bank's broader research on health and poverty, highlighting the importance of addressing inequalities in health outcomes to achieve sustainable development goals.