VIETNAM NATIONAL UNIVERSITY, HANOI
VIETNAM JAPAN UNIVERSITY

BUI THI HOA

IMPACT EVALUATION OF SOCIAL
ASSISTANCE POLICY FOR THE ELDERLY:
CASE STUDY IN GIAO AN COMMUNE, GIAO
THUY DISTRICT, NAM DINH PROVINCE

MASTER’S THESIS

Hanoi, 2018


VIETNAM NATIONAL UNIVERSITY, HANOI
VIETNAM JAPAN UNIVERSITY

BUI THI HOA

IMPACT EVALUATION OF SOCIAL
ASSISTANCE POLICY FOR THE ELDERLY:
CASE STUDY IN GIAO AN COMMUNE, GIAO
THUY DISTRICT, NAM DINH PROVINCE

MAJOR: PUBLIC POLICY

SUPERVISORS:
Prof. KATSURA RYOTARO
Prof. BUI THE CUONG

Hanoi, 2018


ACKNOWLEDGEMENT

First and foremost, I would like to express my heartfelt gratitude to my advisor,
Professor Ryotaro Katsura, Professor Bui The Cuong. I was privileged and
fortunate to be under his supervision. I appreciate all his continuous support, great
contributions of time, ideas, and marvelous guidance with the immense knowledge
and thorough understanding.
I would like to extend my gratitude to all the professors from the program of Public
Policy: Professor Okamoto Naoshi, Professor Hiroichi Kawashima, Doctor Nguyen
Thuy Anh, Doctor Vu Hoang Linh for their useful orientations and their willing
advices during doing this research amidst their busy schedules. This thesis cannot
be fulfilled without their valuable comments and great advices. Importantly, I
honestly appreciate to all the supports from Vietnam Japan University.I also want
give a thousand thanks to all the VJU friends for the happy time, companionship
and encouragement.
Last but not least, I would give my thankfulness to my parents andmy husband for
their support and beloved attention.

Student

Bui Thi Hoa

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ABSTRACT


There is increasing recognition among the government and donor organization that
evaluation of public intervention or national program should feature in the social
policy decisionmaking process. In Vietnam, the terminology of impact evaluation is
quite not popular, and the policy makers often focus on assessing the input of
policy/program. Therefore, this study assesses the impact of social assistance policy
for the elderly in term of two sub-polices: social monthly allowance and health care
policy, by conducting a survey (110 respondents) in Giao An commune, Giao Thuy
district, Nam Dinh province. The result from this survey shows that, although the
social assistance policy helps the recipient to improve their life, the level of
improvement is still low. For instance, this policy just has impact on enhancing the
nutrition condition, but not significant impacts on guaranteeing the minimum living
standard or decreasing the expenditure on health care. Based on the evidences from
the survey, policy implication is also suggested.

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TABLE OF CONTENT

ACKNOWLEDGEMENT ........................................................................................ i
ABSTRACT ............................................................................................................ ii
LIST OF TABLES .................................................................................................. v
LIST OF FIGURES ................................................................................................ vi
CHAPTER 1: INTRODUCTION ............................................................................ 1
1.1. Research background and problem statement .................................................... 1
1.2. Purpose of study ............................................................................................... 3
1.3. Research question ............................................................................................. 4
1.4. Scope of the research ........................................................................................ 4
1.5. Structure of the thesis ....................................................................................... 4
CHAPTER 2: LITERATURE REVIEW.................................................................. 5

2.1. Social assistance ............................................................................................... 5
2.1.1. Definition of social assistance .................................................................... 5
2.1.2. Approach to social assistance ..................................................................... 6
2.1.3. Category of social assistance ...................................................................... 7
2.1.4. Role of social assistance ............................................................................. 7
2.2. Social assistance policy .................................................................................... 7
2.2.1. Definition of social assistance policy .......................................................... 7
2.2.2. Purpose of social assistance policy ............................................................. 7
2.2.3. Content of social assistance policy.............................................................. 8
2.2.4. Factor influencing to social assistance policy............................................ 11
2.3. Literature review on social assistance policy for the elderly ............................ 11
2.3.1. Study on the overview of social assistance policy ..................................... 11
2.3.2. Study on impact of monthly social allowance for the elderly .................... 13
2.3.3. Study on impact of health care for the elderly ........................................... 14
CHAPTER 3: METHODOLOGY ......................................................................... 16
3.1 Rationales for using a quantitative and qualitative approach ............................ 16

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3.1.1. Qualitative method ................................................................................... 16
3.1.2. Quantitative method ................................................................................. 16
3.2. Sampling design ............................................................................................. 17
3.3. Questionnaire design ...................................................................................... 18
3.4. Survey process ................................................................................................ 18
3.5. Data analysis .................................................................................................. 19
3.6. Study site ........................................................................................................ 19
CHAPTER 4: FINDINGS FROM SURVEY ......................................................... 21
4.1. Situation of implementing social assistance policy for the elderly at Giao An
commune ............................................................................................................... 21

4.2. Finding and discussion.................................................................................... 22
4.2.1. General information of survey sample ...................................................... 22
4.2.2. Impact of social monthly allowance on the elderly ................................... 27
4.2.3. Impact of health care policy on the elderly ............................................... 31
4.2.4. Aspiration of the elderly ........................................................................... 40
CHAPTER 5: CONCLUSION AND IMPLICATION ........................................... 42
5.1. Conclusion...................................................................................................... 42
5.2. Implication ..................................................................................................... 42
5.3. Limitation and further study ........................................................................... 43
REFERENCES ...................................................................................................... 44
Appendix: .............................................................................................................. 48

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LIST OF TABLES

Table 3.1: Selecting the respondents ...................................................................... 18
Table 4.1: Characteristic of the respondent ............................................................ 23
Table 4.2: Education level of older people in treatment group ............................... 25
Table 4.3: Marital status of the elderly in control and treatment group................... 25
Table 4.4: Sex Ratio of the Old-Age Population in Giao An commune .................. 26
Table 4.5: The proportion of participating in economic activity ............................. 27
Table 4.6: Source of income of treatment group .................................................... 28
Table 4.7: Evaluating the impact of social assistance policy .................................. 30
Table 4.8: Assessing the life before and after receiving the social monthly
allowance .............................................................................................................. 31
Table 4.9: Health status of control and treatment group ......................................... 33
Table 4.10: Expenditure for health care ................................................................. 36
Table 4.11: Evaluating the impact of health care policy ......................................... 38

Table 4.12: Evaluate of the elderly about their health status after receiving the
health care policy .................................................................................................. 39

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LIST OF FIGURES

Figure 3.1: The poverty rate of population and the elderly ..................................... 20
Figure 4.1: The number of people receiving social assistance policy from 2014 to
2017 in Giao An commune .................................................................................... 21
Figure 4.2: The expenditure for social monthly allowance from 2014 to 2017 in
Giao An commune................................................................................................. 22
Figure 4.3: Spending of social allowance ............................................................... 29
Figure 4.4: Trends in self-reported health by gender and groups ............................ 32
Figure 4.5: The frequency of going to the health facility ........................................ 34
Figure 4.6: The type of health facility that the people in treatment group often visit...... 35
Figure 4.7: Situation of receiving the health care measures .................................... 37
Figure 4.8: Impact of health care policy on some aspects....................................... 38
Figure 4.9: Aspiration of the elderly ...................................................................... 41

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CHAPTER 1: INTRODUCTION

1.1. Research background and problem statement
In order to improve the living standard, the Vietnam’s government has implemented
a large number of support programs (income redistribution programs) such as cash
transfers and food supply. The social assistance policy for the social protection

subjects was established since 1945, with the aim to support for the people who
were affected by war, natural disasters, the orphan children and the people with
disabilities. Along with the development of socio-economic, the social assistance
policy was amended to meet the requirement of people as well as to cover more
vulnerable people. To date, this policy is a crucial part of social protection policy.
Social assistance, or in other words, non-contributory social protection (Katja
Bender et al, 2013) is benefits in-cash or in-kind of financed by the state (from
general taxes, not contributory) to secure the minimum living standards for people.
According to the Resolution No. 15/NQ-TW of the Communist Party, the social
assistance policy includes 2 main components: (i) regular social support in
community, and (ii) unplanned social support. The regular social support in
community embraces monthly social allowance, health care and support for
education and vocational training, focuses on people who particularly vulnerable,
such as those over-80 years, people with severe disabilities, people with HIV/AIDs,
and children in single-parent families.
The national social assistance system itself has evolved as a lifecycle system,
addressing risks related to old age, disability, childhood and unemployment.
Investment in social assistance has been relatively limited. In 2015, the investment
for regular social assistance was only 0.31% of GDP (Khondker, 2015), in which
the largest schemes were transfers for people aged 80 and over and for people with
disabilities (Long, G.T and Cuong, N.V, 2014). While Viet Nam’s over-80s social
allowance is the largest scheme, its overall expenditure just covers for 0.09% of
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GDP, lower than many other developing countries, many of which invest more than
1% of GDP (Castel and Anh. P.H, 2014). The coverage of the population by
regular social assistance transfers is also low (Long, G.T and Cuong, N.V, 2014).
There are approximate 2.7 million individuals receive one of the social assistance
allowances, among that, the recipient is elderly accounting for nearly 60 percent.

According to the Decree No. 136/ND-CP about the social support policies for social
protection subjects in Vietnam, the standard of social assistance is 270.000 VND
(~$12) per month. The value of the over-80s allowance is one of the lowest social
pensions in developing countries, at 6.7% of GDP per capita, with many countries
paying at above 15% of GDP per capita.
Vietnam is facing with the trend of aging population. In 2013, the elderly (the older
person who is over 60 years old) in Vietnam reached 10.2 percent of total
population (GSO, 2013), and Vietnam has already entered the “ageing phase”. The
increasing in the number of the older people represents the great achievement of the
government in improving the physical and spiritual life, preventing diseases and
health care. However, rapid population aging has a profound impact on economic,
as well as on the infrastructure and social conditions (UNFPA, 2011) in the context
of a lower-middle-income country as Vietnam. The older people is also a subject of
social protection system, hence, the retirement, pensions, especially the social
benefits tend to extend longer due to there are more people live longer. It requires
the Vietnam government to consider about how to remain the social security system
as well as the social assistance system effectively (Bravo, 2011). On the other hand,
increasing in life expectancy might also result in increasing the treatment costs and
raising the demands for health care systems, because the elderly are typically more
vulnerable to chronic diseases.
Despite a vast number of state budgets spent on social assistance for the older
person in Vietnam, there is still very little known about the actual impact of this
intervention on the target group. More commonly, the policy makers focus on
assessing the input and immediate output of a policy, for instance: How much

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money is spent? How many health insurance cards are distributed - rather than
assessing whether these polices have achieved the intended goals (Paul J. Gertler et

al, 2016). In order to enhance the effectiveness of the social assistance programs for
the elderly, it’s important to evaluate the impact of these programs. Impact
evaluation can increase the effectiveness of the policy by providing helpful
information for decisions as to whether the program should be terminated of
expanded (Cuong, 2014).
According to the research of World Bank (2008), the social protection program in
Vietnam still has the gap in term of limited coverage, weak outreach to
marginalized and vulnerable people, and a high leakage rate. A number of previous
studies posit that Vietnam has not been capable of dealing with these gaps, which in
turn may have negative impacts on effectiveness and efficiency of these programs
and policies. Unless these gaps are closed, they may even exacerbate social
inequality and disparities between different groups of the population.
Therefore I decide to choose the topic: “Impact evaluation of social assistance
policy for the elderly: Case study at Giao An commune, Giao Thuy district, Nam
Dinh province” as my master dissertation.
1.2. Purpose of study
The main objective of evaluating the impact of a policy is to assess the extent to
which the policy has changed outcomes of the policy beneficiaries. Therefore, my
study aims to elucidate the impact of social assistance policy on the senior people
by conducting a survey at Giao An commune, in order to improve the efficiency of
spending public resources as well as to find out the alternative measures to
implement this policy. This study measures the impact of social assistance policy on
the elderly based on some key indicators such as poverty, income, access to health
care service and expenditure for health.

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1.3. Research question
The research seeks to answer the main question: Do the social assistance policy

(including two programs: monthly social allowance and health care) cause better
living condition and health in elderly.
1.4. Scope of the research
The research focuses on investigating the impact of social assistance policy for the
elderly at Giao An commune, Giao Thuy district, Nam Dinh province. The data was
collected from 2014 to 2017.
1.5. Structure of the thesis
The thesis includes 5 chapters:
Chapter 1: Introduction
Chapter 2: Literature review
Chapter 3: Methodology
Chapter 4: Findings from survey
Chapter 5: Conclusion and implication

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CHAPTER 2: LITERATURE REVIEW

2.1. Social assistance
2.1.1. Definition of social assistance
Social assistance is known based on some aspects: feature, role, approach and so on.
Although most of the updated documents have not yet provided the whole definition
of social assistance, there were some documents explained the terminology closed
to social assistance.
According to the Ministry of Labor Invalids and Social Affair, Social protection is
the policies, activities of the government and communities in order to help the
vulnerable subjects/groups to ensure the minimum living condition as well as to
help them to integrate to community and contribute to the development of society.
In the definition of UNICEF (2006), Social work is the motivation for changing in

society, motivation for tackling the problems and motivation for empowerment. The
principle of human right and social equality are the core value of social work.
Another organization define that social welfare is a component of GDP, which is
used to meet the demand of citizens in term of physical and spirit. Social welfare
includes of expenditure for pension, social insurance, scholarship and subsidy for
education, health care services and so on.
In the research of Nguyen Hai Huu (2007), Social security is a system of schemes,
policies, measures of the government and community in order to help all of the
citizens to respond to the risks and shocks in economic, which lead them to the
accident, decrease in income or fall into poverty.
Dinh Nguyen Van (2008) said that, Social relief is the support in kind of financial
from government and community for the people who face with the difficulties, risks
such as: natural disaster, disabilities, older …. His opinion on social assistance was
that “it is a support from community by cash or other appropriate measures in order
to help the recipients integrate to society”.
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From the above definition, it can be said that, social assistance is not only the
responsibility of government, but also of society, not only for a certain group, but
also for other vulnerable groups. And, more important, social assistance is a pillar/
component of social security system. Hence, social assistance can be defined as
“Social assistance policy is the measures and solutions of the government in order
to help the social protection subjects to overcome difficulties in the immediate and
in long term. This guarantee of government is implemented through providing the
monthly financial support, health care services, education and other social
assistance services”.
2.1.2. Approach to social assistance
Human right approach
This approach considers the human as the center of policy; hence the government

should have the measure to help the people who cannot implement their rights and
to help them to ensure the basic condition for their life. The responsibility of
government is to guarantee the safe for all of the member in society when they have
to face with some challenges such as: decrease in income, get the shocks in
economic … Base on this approach, the social assistance was planned to ensure the
food, clean water, safe house, access to health care services, access to education,
communication …
Risk management approach
According to this approach every people in society has to face with risks. The risks
lead the people to decrease in income, loose the caregiver or affect to the livelihood.
Social assistance is the measure to manage and prevent the risk.
Universal approach
According to the viewpoint of this approach, all members in society have the
demand on ensuring the social security. Therefore, providing the social assistance
for all subjects, no need any requirement as well as the priority criteria. The good
point of this approach is that the criteria to select the subject is simple, therefore the

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management cost is low. However, the disadvantage of this approach is the low
level of support, and this leads to not ensure the minimum living standard. This
approach just consider about the coverage rate, not focus on the quality of the
support.
2.1.3. Category of social assistance
Regarding to the way of implementation, there are two kinds of social assistance,
including regular social assistance and un-planned social assistance.
Regarding to the subjects of social assistance, it consists of the elderly, the people
with disability, the orphan children, and other vulnerable subjects.
Regarding to the place of subject, including support in community and support in

the welfare-house.
2.1.4. Role of social assistance
Social assistance is a management instrument of government; therefore, it has some
role such as: ensuring the social security for society, redistributing the income in
society and preventing and addressing the risks.
2.2. Social assistance policy
2.2.1. Definition of social assistance policy
Social assistance policy is a component of Vietnam’s overall social security and
poverty reduction system. Social assistance policy is the measures and solutions of
the government in order to help the social protection subjects to overcome
difficulties in the immediate and in long term. This guarantee of government is
implemented through providing the monthly financial support, health care services,
education and other social assistance services.
2.2.2. Purpose of social assistance policy
The general purpose of social assistance policy is to address the problem of
equality, stability and sustainable development in politics and socio-economy. The
detail goal of this policy is to help the social protection subjects to have a stable and
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safe living condition, to integrate into society and to contribute to the development
of society.
2.2.3. Content of social assistance policy
Assistance forms are also diversified, include the monthly allowance (by cash),
nurturing fees in the social protection centres; supporting healthcare and medical
cost, education, accommodation, and clean water.
Vietnam provides non-contributory social assistance cash transfers to different
categories of the population. Social assistance cash transfers are available under
Decree No.136/2013/ND-CP to orphans, children and adolescents deprived of
parental care, elderly living alone, people above the age of 80 without a pension,

severely disabled unable to work, mentally disabled and poor single parents (see
Box 1).
According to the Decree No.136/ND-CP, the standard of social support is 270.000
VND per month, and the following six groups are entitled to monthly social
assistance benefits:
Box 1: The social subject of social assistance policy
1. Children under 16 years old having no nurture source subject to one of the cases prescribed as
follows:
a) Being abandoned and not yet adopted;
b) Being orphans;
c) Being orphans whose mother or father has died and the remaining parent is missing as stipulated
by law;
d) Being orphans whose mother or father has died and the remaining parent is receiving the care
and nurture benefits at the social protection establishments or social houses;
Being orphans whose mother or father has died and the remaining parent is serving prison term in
jail or is exercising the decision on handling of administrative violation at the reform schools,
compulsory educational establishments and compulsory detoxification establishments;
e) Both mother and father are missing as stipulated by law;

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g) Both mother and father are receiving the care and nurture benefits at the social protection
establishments or social houses,
h) Both mother and father are serving the prison term in jail or is exercising the decision on
handling of administrative violation at the reform schools, compulsory educational establishments
and compulsory detoxification establishments;
i) Mother or father is missing as stipulated by law and the remaining parent is receiving the care
and nurture benefits at the social protection establishments or social houses,
k) Mother or father is missing as stipulated by law and the remaining parent is serving prison term

in jail or is exercising the decision on handling of administrative violation at the reform schools,
compulsory educational establishments and compulsory detoxification establishments;
l) Mother or father is receiving the care and nurture benefits at the social protection establishments
or social houses and the remaining is serving prison term in jail or is exercising the decision on
handling of administrative violation at the reform schools, compulsory educational establishments
and compulsory detoxification establishments;
2. Persons between 16 and 22 years subject to one of the cases specified in Clause 1 of this Article
are in high school, vocational school, professional school, college and university of first degree.
3. Children infected with HIV of poor households and persons infected with HIV of poor
households without monthly pension, social insurance allowance, monthly preferential allowance
for revolutionary contributors and other monthly allowances.
4. People of poor households who are not married; are married but the wife or husband has died or
is missing as stipulated by law and is raising children under 16 years or child from 16 to 22 years
old and these children is in high school, vocational school, professional school, college and
university of first degree (hereafter referred to as poor people who are raising children)
5. The elderly people subject to one of the following cases:
a) The elderly people of poor households do not have any person with obligations and rights to
serve them or have person with obligations and rights to serve them but this person is receiving the
monthly social allowance.
b) The elderly people from 80 years or older not subject to the provisions under Point a of this
Paragraph have no monthly pension, social insurance allowance or social allowance;
c) The elderly people of poor households do not have any person with obligations and rights to
serve them; have no condition to live in community, meet the conditions to be admitted to the

9


social protection establishments or social houses but there are other people who wish to take care of
them in community.
6. Disabled children and disabled people eligible for social allowance as stipulated by law on

disabled people”.

The content of social assistance policy including three sub-policies: (i) the social
monthly allowance, (ii) the health care policy and (iii) the education and vocational
support policy. This study will examine the impact of the social monthly allowance
policy and health care policy for the elderly.In 2015, more than 2.643.000 people in
the targeted group have received the monthly cash transfer and the supporting
(subsidy) for health insurance card, in which, the elderly accounts for 56 percent.
Social monthly allowance policy
Social allowance is the amount of money that the government allocates monthly to
the policy beneficiary to buy food and other necessary expenses for their life. The
level of social allowance is calculated based on the minimum expenditure to
maintain the daily life of the subject. This allowance also includes the cost for the
caregiver in case of the beneficiary cannot self-care.The different beneficiary
groups will have the different in the level of allowance. The level of allowance is
adjusted by the development of socio-economic and the available of state budget.
This program was implemented in 2004 to provide a minimummonthly benefit of
VND 65,000 (about $US 4) to all elderly people aged 90 and overwho did not have
a contributory pension and not eligible for other special socialallowances. In April
2007 (under Decree No.67/2007/ND-CP), the minimum eligible agewas reduced to
85, and the minimum monthly benefit was increased to VND 120,000(about $US
7). In 2010 (under Decree No.13/2010/ND-CP), the minimum eligible age
wasreduced to 80, and the minimum monthly benefit was increased to VND
180,000 (about$US 9). In 2013, the social assistance policy was amended by the
Decree No. 136/2013/ND-CP, and the minimum monthly benefit was increased to
VND 270,000 (about $US 12).
Health care policy
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The policy of caring for the elderly health is implemented through: (i) issuing freely
the health insurance card for the people over 80 years old; (ii) prioritizing medical
examination and treatment for the old people; (iii) disseminating the common
knowledge in term of disease prevention and self-healthcare; and (iv) coordinating
with the higher level of health facility in periodical health checkup.
The health insurance policies are concerned about how to mitigate households’ lost of
welfare in case of unexpected health expenditure or lost of labor income because of a
member’s sickness, maternity leave, unemployment, disability, old-age or death.
2.2.4. Factor influencing to social assistance policy
Analyzing the factor which has impact on social assistance policy is necessary in order to
find out the causes and lessons learn from the success or failure to improve the policy.
The number of beneficiary is an important factor that affecting to social assistance
policy. If the coverage of this policy is not too much, the policy will be designed to
increase the level of support. However, if the policy covers all the members in
society while the budget is limited, the level of support will be designed to reduce.
This factor has significant impact on the effectiveness and efficiency of policy.
The demand of beneficiary is one of the factors influencing to the implementation
of policy. A success policy focus on the demand of the recipient, it means that the
policy will provide toward the need of the beneficiary.
Another factor is capacity of the people who will get the support from government.
The capacity includes (i) the capacity to ensure the individual demand by
themselves, (ii) and the capacity to access to the policy.
Besides, the politic, legal documents and culture also have the impact on social
assistance policy on some aspects.
2.3. Literature review on social assistance policy for the elderly
2.3.1. Study on the overview of social assistance policy
Social assistance policy is an important pillar of social security system in Vietnam.
Focusing on the regular social support program – a component of social assistance
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policy, the study of Toan (2010) and Cuong (2013) provide an overview of the
implementation of this policy. In their researches, the education support program,
monthly social support program and health care program for all the protection
subjects were examined. Both studies show that, although social assistance policy
have a significant impact on the beneficiaries, it still has some shortcomings such as
low coverage, low level of support and the criteria to choose the recipient is not
consistent.
According to the same study of Kidd Stephen et al (2016), there are some
challenges that social assistance system in Vietnam is facing, such as high
proportion of disability, inequality, aging society and climate change. Their study
also demonstrates that many older people experience poverty and poverty rates are
higher among older women. In other research, Giang (2012) also shows the current
state and the challenges that the social protection policy (for the vulnerable groups)
facing. His study emphasizes on examining the delivering and accessibility of the
people in vulnerable group in term of health insurance, retirement pensions and
social assistance. The paper finds that the transfer of services and financial support
are still unequal between groups, in which the advantaged groups have better
utilization of services than disadvantaged groups. The strengths and weaknesses of
current social assistance system are also seen in Evan’s study (2011). This study
explores the issues of implementation and performance of the current program
design, especially the issues of budget allocation, implementation and monitoring.
The evidence from the study of Evan and Harkness(2008) reports that, currently, the
social protection program in Vietnam is scattered and the Vietnam government
tends to improve the inequality by the state transfers. However, these supports are
quite not proportionate. For instance, the recipient of such transfers mostly is the
people in formal sector, with higher level of education achievement, often living in
urban areas and getting the pension. In contrast, other vulnerable groups such as the
poor, the disability or the older people are rarely the beneficiaries of this
government protection and examines the consequences of the current policies for a


12


better reform. This research provides the empirical evidence of the elderly’s need on
social the same purpose, in order to provide the evidence for the plan of expanding
the coverage of social assistance program, the note of WorldBank (2010) indicates
anevaluation of the arrangements for delivering Vietnam’s main social assistance
program, and proposes options for further strengthening in the short and medium
term. This study uses the data collected from Ha Giang Province and Ho Chi Minh
City in July 2010. The finding shows that the current delivery mechanisms for
social assistance are basic, with limited human resources, no caseload management
and no integrated database that would allow tracking of beneficiary numbers.
Therefore, the expected increase in beneficiary coverage implies that program
administration will have to be systematically strengthened and professionalized to
ensure effective implementation.
There are some studies pay attention on the factor that affecting the social assistance
policy. For instance, study of Dung Nguyen Duy (2015) shows that along with the
change in demographic, climate change is also a significant factor influencing to the
implementation of this policy. Another study (Handayani, Sri Wening at al, 2017)
suggests that information and communication technology also affects to social
assistance program due to the demand for more accurate and efficient service.
Information and communication technology provides convenience and faster
service as well as better security for beneficiaries and the public.
2.3.2. Study on impact of monthly social allowance for the elderly
Recently, cash transfers are increasingly considered as the most effective social
protection policy instruments to help the most vulnerable group by breaking the
intergenerational transmission of poverty, preventing exposure to short term shocks,
contributing to human capital development and reducing the inequality. Evidence
from some countries indicates that such programs have had positive impacts in

poverty reduction, education, health, and nutrition (UNICEF, 2009).
The research of Giang (2011) shows a prospective assessment of the potential
impacts of expanded cash transfer programs for various types of elderly people on
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old-age poverty reduction, by using the data from the Viet Nam Household Living
Standards Survey. The finding of this study indicates that a cash transfer program
would influence in reducing the poverty rate among the old-age group. Especially,
this results shows that, given a limited resource, the elderly living in rural area
would be most effective for poverty reduction, and that a program which providing
lower benefits to a higher number of recipients would be better in reducing poverty
incidence than a program that providing higher financial support to a lower number
of recipients. The same was found in study of Sothea Oum et al (2010). Additional
finding by this study also suggests that the cash transfer program would be
influential in reducing poverty rate among the old-age group. The result in Giang et
al (2013) study also demonstrates that cash transfer would help reduce expenditure
inequality.
Pham and Castel (2010) carried a research in order to assess the potential impact of
cash transfer (social allowance) – a new program of social assistance designed in
the Decree No. 67/2007/ND-CP. This study aims to estimate how many people and
families could benefit from the new policy if it had enough resource to be fully
implemented without any restriction. The result of their research indicates that a
large share of the extremely poor would remain excluded from this policy.
2.3.3. Study on impact of health care for the elderly
The program Health support for the old person aims to provide them with the access
to high quality health care services. It includes three main components: (i) provision
of the health care card for the elderly; (ii) exemption and education of health care
fees for the elderly; and (iii) provision of medicines, health facilities, and human
resources for health centers in localities. However, recently, the study of Giang and

Bui(2013) show that although the health insurance and health-care services have
been expanded in Vietnam over the past decade, the most vulnerable groups among
older persons have lower access rates and a greater financial burden. In concordance
with previous research, Evan (2011) found that the coverage for elderly by health

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cards was weak, and this study suggests that additional efforts need to be made to
reach low income households for access to healthcare.
Focusing on assessing the need of daily care and their socio-economic determinants
among senior people living in rural area, the study of Hoi, L.V et al (2011) founds
that the offspring (including children and grandchildren) are the main caregivers for
the older people. Age group, sex, educational level, marital status, household
membership, working status, household size, living arrangement, residential area,
household wealth, poverty status, and chronic illnesses were determinants of daily
care needs in old age. The same was found in study of Giang Thanh Long et al
(2018). This study explored the factors associated with the perceived health status
of the Vietnamese older people. The study found that there were no statistically
significant differences between older people in their perceived health status in terms
of age group, gender, marital status, and living area. In contrast, however, the study
also found that reading ability, working status, morbidity, activities in daily living,
experience of domestic violence, household income, and satisfaction with housing
conditions were strongly correlated with older people’s perceived health status.
In the study of Kyung-Sook Bang et al (2017) about the health status and healthrelated quality of life of rural elderly Vietnamese, they found that women were
more functional limitations than men, and more than half the respondents requested
more healthcare information, particularly on disease management.
The study of Teerawichitchainan (2010) describes differences in health perception
and reporting among elderly men and women in Vietnam and discusses the
implications of such differentials on health outcomes. Two health indicators, selfrated health and hypertension, are examined. Results demonstrate a complex picture

of how actual health statuses and perception about health can differ among male and
female elders. Evidence suggests gender is but one of several dimensions that
differentiate health in later life. While older women are more likely to be vulnerable
because of their survival to later ages and widowhood, they do not necessarily have
poorer health than men.

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CHAPTER 3: METHODOLOGY

3.1 Rationales for using a quantitative and qualitative approach
3.1.1. Qualitative method
Many researchers have looked into impact of social assistance policy, however,
there is a lack of researches focusing on this field by using the qualitative method.
This study took a qualitative approach to exploring the impact of social assistance
policy for the elderly through going directly to the house of the older people to
observe their daily life and the life condition. Due to in this study, the respondent
tend to underestimate their health status or life condition, hence, it is important to
use the qualitative method to verify the answer of the respondent. Moreover,
through this kind of approach, the research will be provided the real viewpoints,
evidences, stories, hence these data will support for the analysis process.
Qualitative information such as understanding the local sociocultural and
institutional context, as well as program and participant details. Qualitative
information can help identify mechanisms through which programs might be having
an impact; such surveys can also identify local policy makers or individuals who
would be important in determining the course of how programs are implemented,
thereby aiding operational evaluation. But a qualitative assessment on its own
cannot assess outcomes against relevant alternatives or counterfactual outcomes.
That is, it cannot really indicate what might happen in the absence of the program.

Hence, in this study, I also used the quantitative method to evaluate the impact of
social assistance policy for the elderly.
3.1.2. Quantitative method
Quantitative analysis is important in employing the program impacts. A mixture of
qualitative and quantitative methods might therefore be useful in gaining a
comprehensive view of the program’s effectiveness. The quantitative evaluation

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setupinvolved comparisons of outcomes across matched treated and untreated pairs
of communities.
There are two types of quantitative impact evaluations: ex post and ex ante. An ex ante
impact evaluation attempts to measure the intended impacts of future programs and
policies, given a potentially targeted area’s current situation. Ex post evaluations, in
contrast, measure actual impacts accrued by the benefi ciaries that are attributable to
program intervention. One form of this type of evaluation is the treatment effects
model. Ex post evaluations have immediate benefits and reflect reality.
3.2. Sampling design
The program impact is equal to the difference between the average outcome when
the participants did participate in the program and the average outcome of the same
participants when they had not participated in the program. The fundamental
problem in measuring the program impact is that the outcome of the participants if
they had not participated cannot be observed. In this case, the counterfactual is used
to estimate the impact of program. A comparison group (also called control group)
is constructed so that their characteristics are similar to those of the participants in
program (called the treatment group). The difference between the treatment and
comparison groups is that the treatment group participated in the programs while
the comparison group did not.
In this study, the treatment group includes older persons who receiving the social

support, and the control group consists of older persons who are not benefit from
this policy. Total number of the elderly in the case study is 1.454 people, in which,
the figure of the elderly receiving government assistance is 177people. From the list
of 177 people, 70 older people were selected for treatment group, from 80 to 84
years old. For the comparison commune, there are 40 respondents were chosen
randomly from 1.277 older people (1454 minus 177) who do not participate in this
policy, and are from 75-79 years old (See more in table 1). Both the people in two
groups have the same characteristics in term of income, health status and access to
social services.
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