Community Engagement In Combating Covid-19 Among Migrant Workers In Industrial Zones In Vietnam In 2020#Sự Tham Gia Của Cộng Đồng Trong Phòng Chống Covid-19 Vai Trò Của Công Nhân Nhập Cư Tại Các Khu Công Nghiệp Ở Việt Na

RESEARCH REPORT COMMUNITY ENGAGEMENT IN COMBATING COVID-19 AMONG MIGRANT WORKERS IN INDUSTRIAL ZONES IN VIETNAM IN 2020 Bui Thi Thu Ha La Ngoc Quang Bui Thi My Anh Hoang Minh Duc Han

RESEARCH REPORT

COMMUNITY ENGAGEMENT IN COMBATING COVID-19

AMONG MIGRANT WORKERS IN INDUSTRIAL ZONES IN VIETNAM IN 2020

Bui Thi Thu Ha

La Ngoc Quang Bui Thi My Anh Hoang Minh Duc

Hanoi University of Public Health, Vietnam

January, 2021

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TABLE OF CONTENTS

I INTRODUCTION AND OBJECTIVES 1

II METHODOLOGY 2

2.1 Study design 2

2.2 Conceptual theoretical framework 2

2.4 Participants 3

2.5 Sampling 4

2.6 Data collection 4

2.7 Data management and analysis 5

2.8 Ethical approval 6

2.9 Quality assurance 6

III LITERATURE VIEW 7

3.1 Epidemiology of COVID-19 7

3.1.1 Global trend 7

3.1.2 Vietnam 7

3.2 Preventive measures for COVID-19 7

3.3 Health risk communication 9

3.4 Migrant and COVID-19 9

3.4.1 Migrants in global centet 9

3.4.2 Migrants in Vietnam 10

3.4.3 Migrant and their vulnerability during COVID-19 10

3.5 Governmental supports for migrants during COVID-19 14

3.6 Effective intervention for COVID-19 15

3.7 Progress of Vietnam with vaccine development and clinical treatment 15

3.8 Community engagement 16

3.8.1 Concept of community engagement 16

3.8.2 Application of community engagement approaches in solving local problem 16

IV FINDINGS 18

4.1 Factors influencing migrant workers during COVID-19 18

4.1.1 Demographic information 18

4.1.2 Migrant workers’ employment and working condition 19

4.1.3 Living condition 20

4.1.4 Migrant workers’ health status, Access to health Services during COVID-19 21

4.1.5 Supports to migrant workers during COVID-19 23

4.1.6 Migrant workers’ knowledge, attitudes and practice on COVID-19 prevention 25 4.2 Community engagement in tackling COVID-19 in Vietnam 29

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4.2.1 Committee on COVID-19 control and prevention 29

4.2.2 Health sector’s involvement 35

4.2.3 Related stakeholders’ involvement in COVID-19 prevention 43

4.2.4 Industrial zones and migrant workers 48

4.3 Proposed intervention 54

V DISCUSSION 56

VI CONCLUSION 62

VII RECOMMENDATION 63

REFERENCES 64 ANNEX 1: QUANTITATIVE TOOLS Error! Bookmark not defined ANNEX 2: QUALITATIVE TOOLS Error! Bookmark not defined

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FIGURES AND TABLES

Table 1: Sampling frame for qualitative data collection 4

Table 2 Analysis of variables 5

Table 3 Demographic information of migrant workers 18

Table 4 Occupational working environment 19

Table 5 Employment, salary and economic responsibility 19

Table 6 Living condition of migrant workers 20

Table 7 Health status of people living in the same house 21

Table 8 Migrant worker’s health status in two industrial zones 21

Table 9 Mental symptoms and health risk behavior of migrant workers 22

Table 10 Relationship between having mental symptoms and health risk behavior 22

Table 11 Health care support during COVID-19 23

Table 12 Information received on COVID-19 23

Table 13 Sources of guidelines received on COVID-19 prevention 24

Table 14: Supports received during COVID-19 24

Table 15 Migrant workers’ knowledge on COVID-19 symptoms 25

Table 16 Migrant workers’ knowledge on COVID-19 transmission ways 25

Table 17 Migrant workers’ knowledge on COVID-19 prevention 26

Table 18 Migrant workers’ correct knowledge on COVID-19 prevention: symptoms, transmission, prevention methods 26

Table 19 Migrant workers’ correct attitude on COVID-19 prevention 27

Table 20 Migrant workers’ correct practice on COVID-19 prevention 27

Table 21 Relationship between migrant workers’ knowledge on COVID-19 and demographic and health risk behavior 27

Table 22 Relationship between correct knowlede and practice on COVID-19-prevention 28

Table 23 Relationship between KAP and sources of information 29

Figure 1 Conceptual Framework in combating COVID-19 for migrant workers 3

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ABBREVIATION

CDC Center for Disease Control

CHC Commune Health Centre

CRA Cumulative Risk Assessment

DHC District Health Central

FDI Foreignn Direct Investment

FGD Focus group discussion

IDI In-depth interview

IVAC Institute of Vaccines and Medical Biologicals

KAP Knowledge Attitude Practice

MOH Ministry of Health

PDH Province Department of Health

RCCE Risk Communication and Community Engagement

WHO World Health Organization

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I INTRODUCTION AND OBJECTIVES

COVID-19 pandemic is rapidly spread over the planet and is no longer just a global health crisis with mobility dimensions but also a social and economic crisis that is impacting

on the most vulnerable people [1], [2], [3]

Migrant workers are among the vulnerable populations that most impacted by the pandemic [4], [5] as they are: 1) lack of household basic needs such as water, toilets, sewers, drainage, waste collection, space constraints; 2) often work in unsafe working condition and having low paid work; 3) often excluded from public policy, including healthcare and community services The migrant workers become even more vulnerable in emergencies due to lockdown and containment activities, threats of job losses, food insecurity, loss of family income and difficult access to effective surveillance and early-warning systems, and health services [6], [7], [8], [9], [10], [11], [12]

The principal approaches for reducing COVID-19 transmission for migrants are the same in any context, i.e reduced physical contact and improved hygiene, supports of financial and non-financial resources (e.g information, equipment, supportive policymaking) [5] and must be included in national public health systems [13] The community engagement for health was shown effective in dealing with COVID-19 in different countries [14], [15]

The first case of COVID-19 in Vietnam was declared on 23 January 2020 Up to now Vietnam has about 1300 cases with 35 death, and the country in the second wave of COVID-

19 transmission Vietnam’s strict containment measures and integration of resources from multiple sectors including health, mass media, transportation, education, public affairs, and defence have significantly reduced the spread of the epidemic in the country [16]

In Vietnam, the migrants are those living in the destination areas more than one month, are residing independently or with relatives, and who have temporary household registration books, or “tam tru” in Vietnamese Most of migrant in Vietnam are from rural to urban and female [12] The migrants are suffered from high risk of disease, including occupational and injury related diseases However, economic vulnerabilities were reason that contributed to low health service utilization among migrants [17]

The research is aimed to investigate factors associated with COVID-19 pandemic on migrant workers by applying a holistic Cumulative Risk Assessment (CRA) framework [18], using Vietnam as an example Furthermore, the research will use the framework to suggest potential interventions on community engagement for individuals, employers and authorities

to improve the health of migrant workers in the country [19]

The specific objectives:

1 Explore the factors that affect the migrant workers during pandemic COVID-19 in Vietnam

2 Identify the community engagement mechanism in tackling the impacts of COVID-19 for migrant workers

3 Propose intervention on community engagement to mitigate the impact of COVID-19

on migrant workers

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II METHODOLOGY

2.1 Study design

A cross - sectional with mixed qualitative and quantitative study will be adopted This study was conducted at Que Vo (Bac Ninh) and Phuc Son (Ninh Binh), Vietnam The Que Vo and Phuc Sơn located in the north-east area with 60km far from center Hanoi These areas are the large industrialized zone in Vietnam with the national and international factories The companies, where the study was carried out are foreign direct investment (FDI), and producing the electronic devices In the time of social distancing for controlling the COVID-19 pandemic, business services were closed and most migrants lost their job This could lead impacts on community engagement, psychological distress, and other social and public health access

Que Vo industrial zone was established in 2002 by Kinh Bac urban development joint stock corporation in Bac Ninh province Que Vo industrial zone is located in key economic triangle center of north area Hanoi, Hai Phong and Quang Ninh provinces, with a large area of

640 ha Industrial zone occupies an important position in the economic, culture, commercial, traffic development with the center location is Bac Ninh province and the surrounding north areas in Thai Nguyen, Bac Giang, Vinh Phuc, Quang Ninh, Hai Duong

GOERTEK VINA Co., Ltd - a subsidiary of GOERTEK Group in Shandong, China- was established in 2013, is one of the largest companies in Que Vo industrial zone with a total area of 472,000m2 This company specializes in manufacturing products for Samsung Vietnam such as headphones, earphones, microphones After 7 years of establishing and development

in Vietnam, GOERTEK VINA has gradually become one of the largest foreign enterprises in Que Vo industrial zone, with more than 47,000 workers

BUJEON VIETNAM Electronics Co., Ltd is another company in Que Vo industrial zone with 100% Korean investment This company has 8,000 employees, specializes in manufacturing electronic components and is a partner enterprise of famous mobile phone companies in the world

Phuc Son industrial zone is located in Ninh Phuc commune with a total area of 142 ha, belongs to the industrial complex of Ninh Binh province and was established in 2004 Phuc Son is a multi-industrial zone, focusing on investing in synchronous and modern technical infrastructure system, meeting the most stringent requirements and standards of investors, especially for foreign investors with variety of products such as manufacturing modular cameras and electronic components, producing safety glass doors, plastic doors with steel core, mechanical and metal manufacturing, etc To date, Phuc Son industrial zone has 10 companies with a toal of 13,214 labors, in which 13,065 domestic workers MCNEX VINA Co., Ltd is one of a largest company in Phuc Son industrial zone, 100% invested by Korea, specializes in manufacturing modular cameras and electronic components with the size of 8,000 workers

2.2 Conceptual theoretical framework

The multiple factors in different domains can interact with each other resulting in cumulative risk that can then be used to inform new risk management approaches, exposure reduction and prevention strategies The Cumulative Risk Assessment (CRA) model assumes that factors arise from four dynamic interactive domains: the workplace (occupational); ambient environment (household); individual (behavior); and community (local community, health facilities) (Figure 1)

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Figure 1 Conceptual Framework in combating COVID-19 for migrant workers

*(The framework developed and adapted from Fox [18] and Aladmad [20])

2.3 Duration

The study was carried out from Sept, 2020 – Feb, 2021 in Que Vo, Bac Ninh and Phuc

Son, Ninh Binh industrial zones

2.4 Participants

The migrant included those are in the temporary registration system (tam tru) in the local authority area, where the Que Vo and Phuc Son industrial zones located However, the system may not include non-registration/undocumented migrants, we required heads of

resident groups “tổ dân phố”, who seemly know all of people reside in their management area,

to provide information of non-registration/undocumented migrants

Community was defined as a group of people who live in the same local geographical area or who have some other non-spatial element of shared social identity, such as a similar trade or group membership [21] In this study, we focus primarily on geographically-defined communities (migrant workers): (1) industrial zones, (2) local government of the industrial zone located, of local migrant’s residence, (3) health facilities of the industrial zones located and local migrant’s residence, other related stakeholders involved in the taskforce group of COVID-19 prevention and control in the local areas

Governmen

t policy, IT, face mask, hand- washing, distancing, information

Community: agency involved (authority, health facilities, police, informal), tasks and activities

COVID 19 prevention

and control

Health service delivery

Job related:

payment, loss job,

Health care access, insurance, COVID-19 services

Individual: demographic,

KAP on COVID-19;

behavior (smoking, drinking); economic status

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2.5 Sampling

Quantitative survey: 445 domestic migrant workers in Que Vo and Phuc Son

industrial zones were selected, 219 and 226, respectively Convenient sampling approach were used Sample size: with a 95% confidence level (z), the maximum population variability (p =

q = 0.5),

Qualitative study: Purposive sampling to recruit diverse stakeholders The sampling

frame is provided in Table 1

Table 1: Sampling frame for qualitative data collection

(Bac Ninh)

Phuc Sơn (Ninh Bình)

Total (n=32) Individual & household

Co-workers/ people sharing the same residence IDI/FGD 2 2 4

Occupational

Community

Leader of Commune Health Center where the

company located

Collaborators at CPC (village leaders, women

union) where the company located

Leader of Commune Health Center where the

migrant’s residence located

Collaborators at CPC (village leaders, women

union) where the migrant’s residence located IDI/FGD

Leaders of Commune Health center in charge

of COVID-19 where the company located

Leaders of Commune Health center in charge of

COVID-19 where the migrant’s residence located

2.6 Data collection

2.6.1 Quantitative data collection

Migrant survey will be conducted to understand the migrant experiences in combating with COVID-19 The questionnaires is included the information following the conceptual framework, covered: 1) Individual information (demographic, socio-economic status, employment, health status, psychological condition and habit); 2) Environment (household): number of people living in the same house, health status, access to clean water, WC, internet; 3) Employment information (occupational hazard, working status, incomes); 4) Community engagement in combating with COVID-19: guidance on COVID-19 prevention, measures applied, supports for migrants, and KAP on COVID-19 The questionnaire is included in the Annex 1

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An online survey was conducted to understand the migrant experiences in combating with COVID-19 Migrant workers have received a REDCap link via Zalo or SMS text The link showed three parts: Part 1: study introduction, Part 2: Consent form, and Part 3: a questionnaire After viewing the study introduction part, the consent form appeared A participant selected “No” to stop the survey or select “yes” to agree to answer the questionnaire The REDCap tool was authorized to HUPH by Vanderbil University

2.6.2 Qualitative data collection

In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with key informants to understand situation and experiences of different stakeholders in combating with COVID-19 The experienced public health researchers conduct the IDIs or FGDs using the question guides structured around the components of the conceptual framework (Figure 1)

2.7 Data management and analysis

2.7.1 Quantitative analysis

A total of 634 migrant workers received information and accessed the REDCap link to answer the questionnaire on their smart devices such as mobile phones or computers 445 migrant workers had completed the survey with valid information Data was backed up and cleaned daily during collection time The data were entered using EPI DATA 3.1 and analyzed using SPSS version 20 Descriptive data analysis was applied We report the findings following the conceptual framework in Figure 1 Characteristics of participants related to impacts of COVID-19, knowledge, attitude, and practice on COVID-19 prevention of migrant workers were compared between between two companies using Chi-square or Fisher exact tests for statistical significance The report of findings following the conceptual framework of study

Table 2 Analysis of variables

E1 Select both options: Fever and dry cough

Correct knowledge on COVID-19 transmissions

E2

Select all bellowed answers:

1 Through coughing or sneezing

2 spread from person to person

3 spread from animal to human

4 Object contained with the virus

Correct knowledge on how to prevent COVID-19

E3

Select all bellowed answers:

1 Avoid contact with people from respiratory illness (cough, sneezing, flu)

2 Clean and disinfect objects and surfaces

3 Wash hand frequently with soft and water

4 Cover mouth and nose when cough/sneeze

5 Avoid touching eyes, nose, mouth with unwashed hands

7 Avoid crowded places

8 Wearing a mask in public places

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Select “Yes” for both answers –

1 Agree that COVID-19 will be successfully controlled

2 Confidence that government can handle the COVID-19

Select “Yes” for all 8 answers:

1 Avoid crowded places during COVID-19 pandemic

2 Have more frequently washed your hands

3 Wear face-mask in the public space

4 Keep a certain distance when talking

2.7.2 Qualitative analysis

The IDI and FGD transcripts were coded following the components of the conceptual framework shown in Figure 1, by experienced qualitative researchers The results were extracted and mapped based on the relevant codes Data were analyzed in Vietnamese and the codes and report were written in English Selective illustrative anonymized quotes from Vietnamese transcripts were translated verbatim into English for reporting

2.8 Ethical approval

The participants recruited in this study are inhabitants in an urban slum area that could

be considered as the vulnerable and open to exploitation No personal identifying data was collected from research participants All information collected through qualitative and quantitative survey were anonymized during transcription and before analysis, and participants were informed of this during the recruitment and consent process Participants were able to withdraw from the study at any time in data collection duration and informed of this before they consent and at any point during participation should the need arise All written information was provided in local language and if the participants are illiterate, all information sheets and consent forms will be read out and explained to participants And if they are unable to sign, they could provide a thumb impression on the consent form The Institutional Review Board

of Hanoi University of Public Health approved the study through decision No.281/2020/HDDD

2.9 Quality assurance

The questionnaires and guideline for IDI/FGD were piloted and revised to fit the local context (wording, structure, order etc) The data were coded with ID number and kept by the researchers to protect the confidentiality and privacy of participants

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III LITERATURE VIEW

3.1 Epidemiology of COVID-19

3.1.1 Global trend

Starting from Wuhan, China in October 2019, the novel coronavirus disease 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread resulting in a global pandemic [22] The pandemic is still increasing exponentially worldwide with a total number of confirmed cases exceeding 52 million cases with a nearly 500,000 new cases daily [23] This number, however, is under-estimated as only a fraction of infections has been diagnosed and reported Some studies suggest that real total number of cases could be 10-fold or more in Europe and US [24], [25] Infected cases have been found in all continents, except for Antarctica [23]

(COVID-SARS-CoV-2 spreads through the three main mode droplets, probable aerosols, and close contact to infected person(s) [26] The virus has a very high infectivity with a much higher fatality rate than that of seasonal influenza [27] Crude overall case fatality rate varied between 0.82% and 14.2% [28] The duration during which an infected individual could transmit to others is unclear [27] The infected cases can lead to long-term illness even in young and healthy people [27] Older patients are at the highest risks for severe illness from COVID-

19 In US, nearly a half of intensive care and more than three forths of deaths [29] The duration

of protective immunity and how frequently of re-infection is unknown The speed of transmission could be effectively mitigated through physical distancing, avoiding crowds, mask face, hand and respiratory hygiene [30] Other critical measures for controlling the COVID-19 spread are rapid testing, contact tracing, and isolation/quarantine [30]

3.1.2 Vietnam

In Vietnam, since the first case of the COVID-19 was reported in Viet Nam on 23 January 2020, the Government of Viet Nam was quite successful in control of pandemic in terms of containment of the spread of the virus and treatment for those infected The national committee on COVID-19 ccontrol and prevention was set up in January, 2020 [31] Several preventive measures were applied such as regulations restricting the mobility of people, closing schools and non-essential service facilities as well as implementing over time, a regime of social and physical distancing [32, 33]

As of this writing (Nov 12, 2020), Vietnam has avoided a major outbreak of

COVID-19 with about 1.252 confirmed cases and 35 deaths (crude case fatality rate: 2,85%) resulting

in 96% of recoveries [34] The average age of infected cases in Vietnam is about 40 Infected rate amongst men is higher than that in women (51.4 vs 48.6) [34] Most confirmed COVID-

19 patients in Vietnam have recovered The coutry has not recorded any new community transmission cases since September 2, 2020 [35] with all new confirmed cases are new arrivals

to the countries All of them were sent directly to quarantine and isolated for treatment [36] The Vietnamese government demonstrated one of the most successful responses to control COVID-19 in the world To date, the government keeps its regulation that wearing a face mask

is mandatory in public places [36] These places include hospitals, parking lots, public transportation, 4) shopping malls and markets [37]

3.2 Preventive measures for COVID-19

The spread of COVID-19 from the epicenter of Wuhan in China to worldwide is attributed to migration and mobility of people On the other hand, the medical professionals largely believe that the control of this infectious disease is possible through immobility and confinement like lockdown and social distancing In a globalized world, the lockdown is likely

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to bring unprecedented breakdown of our economic and social system Migrants are most vulnerable to urban disasters and epidemics [38]

Quarantine and workplace distancing should be first conducted over school closure at the early stage of the COVID-19 pandemic At higher asymptomatic proportions of cases in general population, intervention effectiveness might be substantially reduced requiring the need for effective case management and treatments, and preventive measures such as vaccines Lockdowns and other aggressive isolations, however, are hard to sustained for the long term [39]

Government of Singapore applied different measures to contain the pandemic, which included: (1) clear leadership and governance which adopted flexible plans appropriate to the situation; (2) timely, accurate and transparent communication from the government; (3) public health measures to reduce imported cases and detect as well as isolate cases early; (4) maintenance of health service delivery; (5) access to crisis financing; and (6) legal foundation

to complement policy measures Areas for improvement include understanding reasons for poor uptake of initiatives such as the mobile application for contact tracing and adopting a more inclusive response that protects all individuals, including at-risk populations The experience

in Singapore and lessons learnt will contribute to pandemic preparedness and mitigation in the future [40] Combined intervention is one of the most effective efforts with an estimated reduction rate of infections by 78,2%-99,3% in Singapore [41]

Countries have developed checklist to consider the infection situation, the healthcare system, and the surveillance system for performing [42] Two major approaches to decision making have been applied: (1) expert advice (not explicit and public criteria) to decide when and which restrictions to relax such as UK, Norway, Singapore and Spain; and (2) basis of epidemiological thresholds such as Japan, Germany, South Korea [39]

A strong commitment and rapid and aggressive response of the government of Vietnam with a focus on containment efforts and extensive public health measures at the early stage of COVID-19 pandemic is was shown effective in fully contain the outbreak [32, 33] The government, for example, has performed active surveillance and testing, contact tracing, and isolating those infected, case management with tracing all new arrivals and close contact up to three clusters [32] Vietnam is also one of the earliest countries in the world who performed suspension of flights to stop the influx of the virus from arriving travelers, shutting schools and all non-essential services [43, 44] Other essential methods to stop the outbreak are: procuring personal protective equipment to protect essential workers; and mobilizing the public to lockdown and socially distance so as to slow or break the chain of transmission [39] Vietnam has taken a targeted approach to testing, scaled up testing in areas with community transmission, and conducted three degrees of contact tracing for each positive case Testing is used as a tool for detection in contact tracing Contact tracing and quarantine are the key parts

of containment Vietnam’s contact tracing strategy stands out as uniquely comprehensive—it

is based on tracing degrees of contact from F0 (the infected person) through F1 (those who have had close contact with F0 or are suspected of being infected), F2 (close contact with F1), and all the way up to F5 Vietnam implemented mass quarantines in suspected hot spots based

on evolving epidemiological evidence over time Vietnam entered a nationwide lockdown on April 1 Initially, the lockdown was set for 15 days, but it was extended to 21 days in 28 out of

63 provinces

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3.3 Health risk communication

To ensure that public health information is communicated in timely, accessible and culturally appropriate ways to the most vulnerable, it is imperative to invest in risk communication and community engagement activities such as timely and accurate information

in appropriate forms and accessible languages, and community involvement in the design of readiness and response plans Lessons learned from past outbreaks in these contexts highlight that meaningful community engagement is a key element in ensuring that public health strategies are effective, including rapid uptake of vaccinations once available Urgently strengthening surveillance systems to detect initial cases early can greatly reduce the propensity for COVID-19 to spread, and appropriate case management can reduce mortality among people infected with the virus [45]

A number of guidelines have been published to help tackling to health risks while keeping essential healthcare services during outbreak of a pandemic Among them, the most notably regulations are the International Health Regulations [46] and Asia Pacific strategy for emerging diseases and public health emergencies - ASPED III - in 2017 [47] The new guidelines are especially highlighted the needs of risk communication for the public during a pandemic outbreak [48] A strategic Risk Communication and Community Engagement (RCCE) policy is considered as an essential public health effort to prevent and control the spread of the COVID-19 pandemic [49] The most updated recommendations for RCCE of WHO include: (1) Establishing a cohesive coordination for RCCE at all levels (global, regional and in-country); (2) Communicating evidence-based information and recommendations in a timely manner; (3) Accelerating priority research and innovation to support the implementation

of public health efforts and to ensure engagement of people and community at-risk; and (4) Enhancing country-level capacity to roll out effective and coordinated RCCE approaches However, given the current mobility restrictions, and some migrants’ limited access to technology, new and innovative strategies are needed for effective communications [50]

Vietnam government applied transparent communication sharing through most common and official channels including websites, television, radio, newspaper, social media, mobile phone messages, and so on [32, 33] For example, by distributing communication materials, community-based staff helped to spread the official information to all citizens down

to the village level [51] Hotlines (established by the Ministry of Health) also empowered the provision of information and psychology support

3.4 Migrant and COVID-19

3.4.1 Migrants in global centet

Migration is “a process in which individuals and groups of people leave their homes for various reasons” [52] People who do not live in the country in which they were born are called

as international migrations [52] while internal migrants are “migrants inside of their country of origin” [52] Globally, more people are migrants now than ever before [53] There have an estimated of more than a billion of migrant in the world (272 million international migrants and 763 million internal migrants) – that is, one every seven are migrant Migration could bring significant benefits for both host and origin communities [54] The three main categories through which they contribute are:

 Socio-cultural contribution (habits, traditions, and beliefs) such as food diversity, new

music trend, and sport achievements

 Civic-political contribution, that is, the extent to which migrants can participate in solving

problems in the community through volunteering, engaging with political processes or

government offices

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 Economic contribution is any activities involving trade, industry or money Migrants help

to stimulate economic growth, bring substantial financial sources to their home They brought about $442 billion to low- and middle-income countries in 2016 [55] They also contribute to promote trade and investment, and bring innovation to both host and origin countries [54] Migrant workers fulfill the labour shortages of the host countries, thereby

facilitate the productivity in different sectors

3.4.2 Migrants in Vietnam

It is estimated that about 80,000 Vietnamese become international labour migrants yearly [56] There are currently about 3 million Vietnamese live abroad with another 500,000 Vietnamese nationals as temporary workers presenting in over 40 countries and working in 30 different types of occupations [57] Since 2000, the number of Vietnamese workers sought for work overseas has increased significantly, mainly to China, South Korea, Japan, Malaysia, the Middle East, etc A smaller number of workers has been to Europe countries (Finland, France, Italy, United Kingdom, etc.)

Overseas migrants play an important role for the economy growth of the country since their remittance has reached about US$2 billion recently [56] For in-country migrant workers,

an estimated 25 to 30 per cent of Viet Nam's largest cities consist of migrants [58] It is estimated that Vietnam’s informal economy accounts for up to 25% of its GDP and a majority

of employees (70%) is classified as informal employment [59]

Migrant workers, however, represent both greatest advantages and greatest challenges These are worker rights violated by employers, illegal recruitment, and human trafficking [57] For in-country migrants, they often have low incomes, poor benefits, unstable employment, and far from family support [58] Migrants are also difficult to access state support as they could not get permanent registration documents – a document to ensure the access to all government services such as basic health and education services for local people [58]

3.4.3 Migrant and their vulnerability during COVID-19

Migrant’s vulnerability is related to several factors, including personal characteristics, employment, environmental, political-economic and health system context

3.4.3.1 Vulnerability related to economic factor

Due to COVID-19 pandemic, many countries must apply severe constraints on mobility and business closures, quarantines and movement restrictions These measures drive stress and thus exacerbates the livelihood and health crisis for vulnerable people due to lockdown and containment activities, threats of job losses, food insecurity, loss of family income, school closings, and difficult access to healthcare The pandemic has dramatically altered societies and labor markets, and people suffered from two epidemics at one time, a health crisis and a livelihood loss epidemic, which has radically changed the world’s lives

It is estimated that nearly 1.6 billion workers, who mostly are migrant workers, in the global informal economy are suffering from a sharp decline in working hours, meaning an immediate danger of having their livelihoods destroyed [60] They find themselves bearing the brunt of this economic and livelihood crisis During the outbreak of COVID-19 pandemic, the lives of migrant workers are characterized by insecurity of work and income, and food, as well

as limited or no access to social security [61, 62]

Migrant workers are potentially in a more vulnerable to lose their job or drop in income due to their less stable employment conditions and lower seniority on the job [63] The negative

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impact on income is still increasing faster as migrant workers are strongly over-represented in most affected sectors by the COVID-19 [64] Consequently, this means that many migrant workers in supply chains will lose their jobs, or worse, lose their work permits and become not regularized Especially, migrant women are among those who experience the highest degree of socioeconomic marginalization, labor exploitation (unpaid domestic and care work) and sometimes, even gender-based violence and abuse within households [50] Moreover, migrants and refugees are particularly at risk of stigmatization and xenophobia and being subject to formal and informal discrimination as the socio-economic impact of the epidemic is increasingly felt across society [50]

Some Australian industries that have been large employers of temporary migrants in recent years, such as hospitality, have been impacted particularly heavily by the economic shutdown caused by COVID-19 A survey of temporary migrants by Unions New South Wales at an early stage of the shutdown found that around 50% had lost their jobs as a consequence [65] Many migrants lost their lives either due to hardship on the way, hunger, accident or comorbidity and some even committed suicide A telephon survey of more than

3000 migrants from north central India shows that majority of the workers were the daily wage earners and at the time of lockdown, 42% were left with no ration, one third was stuck at destinations city with no access to food, water and money, 94% don’t have worker’s identity card [38]

In Vietnam, it was estimated that by the end of 2020’s second quarter, the crisis could

affect the livelihoods of 4.6 to 10.3 million workers [66] In June, approximately 7.8 million workers in Viet Nam had lost their jobs or were furloughed, while 17.6 million people saw a decrease in salaries in recent months more severe than predicted The lives of migrant workers

in Vietnam are characterized by insecurity of work and income, and food, as well as limited or

no access to government services (health and education services) during COVID-19 outbreak

in Vietnam [61] Migrant workers’ usual sources of income are broken and many do not have any paid leave during lockdown time Others stranded in places away from their homes without proper shelter and supplies [67] This may lead to different negative coping mechanisms, such

as skipping or reducing meals, prioritizing children’s food or sales of productive assets [68]

3.4.3.2 Vulnerability due to higher risk of contracting COVID-19 related to employment

Migrants are more likely to work in informal employment sectors and low paid job and rely on daily or monthly wages for survival In some specific sectors, migrant workers also have to deal with difficult and unsafe working conditions, which associated with higher risk of acquiring and transmitting COVID-19 [69-71] such as petrol stations, grocery shops, fast food restaurants, taxi drivers, day laborers, small vendors, construction workers, industrial laborers These jobs are vulnerable, especially when migrants have little to no safety equipment, no social distancing and no additional support or pay, including the developed countries like United States of America and European countries [72] The situation was more severe for those

in the migrant camps [73], when higher potential outbreak of the virus in makeshift camps with thousands of migrants awaiting entry into the countries like US or European countries [72] These cause serious crisis for migrants to maintain their jobs and their earnings

Other migrant groups work in essential services with hazardous, crowded working conditions and have to continue to work while sick due to economic pressures or coercive work situations, all of which further promote transmission of SARS-CoV-2 and potential delays to seeking care Consequently, several outbreaks in factories, production plants and on farms staffed primarily by migrant workers have been reported [73]

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3.4.3.3 Vulnerability related to the housing/living conditions

Migrants are potentially at increased risk of contracting diseases, including COVID-19,

because they typically live in overcrowded conditions without access to basic sanitation [74]

The absence of basic amenities, such as clean running water and soap, insufficient medical personnel presence, and poor present a severe health risk to inhabitants and host populations [75] Further, migrant workers are also more likely to live in higher density buildings and neighborhoods, which makes them not able to respect social distancing [71], [73] For cultural and economic reasons, these populations may live in crowded multi-generational households, increasing the risk of transmission within households and making it impossible to social distance or isolate from family members who may be elderly or have underlying co-morbidities

In Vietnam, access to clean water is a serious challenge in many parts of Vietnam, especially in the Mekong Delta region due to severe drought and saltwater intrusion [76] More than 35% of commune health stations in Dien Bien, Gia Lai, Kon Tum, and Ninh Thuan provinces reported insufficient or unsafe drinking water [76] Migrant workers could not practice regular handwashing with soap and use of hand sanitizers during the outbreak pre- and post-social distancing period which led to outbreaks of other diseases, especially in these regions

3.4.3.4 Vulnerability due to limited knowledge and awareness towards COVID-19 prevention

Migrant often have limited access to adequate health information [74], as the results, they have limited awareness of recommended prevention measures [71], [77] A study in China highlights that international migrants in China have much lower level of knowledge about the COVID-19 than that of Chinese resident [78] The main sources of information on COVID-19 are from friends, social media and messaging tools (Facebook and Whatsapp), local news, and brochures [77] Their knowledge about the COVID-19 does not good even in the middle of the epidemic [78] The main reason leading to low knowledge of migrants is the shortage of assessing to accurate and timely information and language barriers to the local language [78] Previous studies showing that poor knowledge towards infectious diseases is associated with poorer adherence to prevention and control measures [79] Further, poor knowledge about COVID-19 could increase social stigma and can potentially drive people away from adhering

to screening, quarantine/isolation and other prevention measures [77]

3.4.3.5 Vulnerability due to poor health status and lack of access healthcare services

Health issues of the migrant workers could be complicated during COVID-19 outbreak due to several factors Poor conditions in origin and transit areas could enhance the risk of COVID‑19 comorbidities Moreover, one of the most vulnerable health issues of the migrant workers is the psychological ill-effects due to the loss of livelihood [80] The situation could

be worse as many migrant workers have to deal with adverse occupational scenarios [80] The migrant workers who have pre-existing physical health issues are now more likely facing with adverse psychosocial factors like absence of family support and caretaker during the crisis and their limitations to follow the rules and regulations of personal safety [80]

Migrant workers are less likely to go for a healthcare examination or to hospitals due

to several reasons, including poverty, cultural and linguistic barriers, racial discrimination, difficulties navigating the health care system, or lack of entitlement to health care or sectors within the health system They often have limited awareness of options or right to receive health care [81] The lack of language skills could also hamper access to information on COVID‑19

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of migrant workers in ethnic minority groups or immigrants from other countries Although many countries provide access to information on health care services and good practices, accessibility through multiple information channels or reaching to the most vulnerable groups remain challenging [82] Migrants, those live in underserved locations also tend to have less access to healthcare services due to lack of money or the fear of losing jobs, which raises the possibility of not seeking immediate health care and run the risk of spreading the infection [69], [71], [83] This call for changes of the healthcare systems in the delivery and payment for migrant workers and other vulnerable populations [71]

Migrant workers also often have a smaller support network to rely upon in case of a COVID‑19 infection, especially in humanitarian settings whereas suffered from shortages of medicines and lack of health-care facilities [74], [84] Even in the developed countries like USA, the undocumented migrants were excluded from the Patient Protection and Affordable Care Act, they were not entitled to primary care and sought care in crowded emergency rooms (increasing their risk or exposure to COVID) or stayed home until their disease was severe [73]

Migrant workers are younger on average than the local-born population, so theoretically less susceptible to develop serious However, migrant workers due to a range of vulnerabilities such as higher incidence of poverty, over-crowded housing conditions, and the reliance on public transportation are more likely to have bad health conditions and suffer more from chronic diseases, which can increase the risk of co-morbidity in the context of COVID‑19 [75]

As a result, migrant worker is at a much higher risk of COVID‑19 infection than the born [63, 85] Migrant workers in Europe have a higher incidence, prevalence and mortality rate for diabetes and higher risk of heart diseases than the local people [86] The COVID-related mortality rates for migrants could also be much higher than those of the local-born population [85]

native-Migrant workers in Vietnam were also discouraged to go to health center and hospitals from fear for infection This does notably happen to pregnant women and child healthcare The numbers of children under 5 years old visiting community health centers dropped by 48%, children immunized fell by 75% and pregnant women accessing antenatal care dropped by 20%

at commune level in April, 2020 when many cases confirmed in Bach Mai hospital [87] There are multiple underlying reasons for reduced health-seeking behavior, including not wanting to access health facilities (“social”), healthcare system stresses and reduced access to health facilities (‘’physical’’, due to limited public transportation and travel restrictions), or reduced household income (“financial”)

3.4.3.6 Vulnerability due to lack of access to other public basic services

Availability of food, hygiene items and medicines appear to be less than normal due to COVID-19 Migrants were more likely suffered in accessing markets due to movement restrictions and store closures or frighten of leaving the house and income loss [88] Further, migrant workers have to change their daily activities School closures and distance learning measures put children of migrant workers at many disadvantages Migrant workers tend to have fewer resources than local people to help their children in their homework Children of migrant workers are also less likely to have access to a computer and an internet connection at home or having a quiet place for study [89]

In Vietnam, workers in household businesses and without contracts in some service and manufacturing fields were most severely hit But not all vulnerable people could access the

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government’s social assistance package In a survey, over a quarter of interviewed rural households reported social assistance procedures were too complicated, with 19% waiting a prolonged period to receive assistance and 14% found the criteria too demanding to meet [90] These workers fall out of the government’s social assistance as they were involved in non-agriculture work in industrialized zone which are not specifically listed in the Government assistance package As a result, migrant workers could have the long-term impacts on poverty and vulnerabilities and increased inequities to other better-off groups Further, their children are more likely to have poorer nutrition when they are kept at home with reduced meals and lack of access to school lunches [76], [87]

As essential services such as education, health and childcare were disrupted for a considerable period, families struggled to ensure children’s well-being with only a small number of children able to access the social assistance package within the narrowly defined category of beneficiaries School closures could trigger school drop-outs and other problems regarding children care as household registration remains a potential administrative barrier, especially for migrant children to access the public education system in Vietnam Further, children live in poor household or remote areas have limited internet coverage and/or cannot afford devices required for online learning or do not have teachers confident to facilitate such learning [91]

3.5 Governmental supports for migrants during COVID-19

Governments of many countries provided supports for negative impacts on livelihood

of migrant workers Some governments provided screening and treatment regardless of legal

status of migrants, covered benefits for loss of income due to the government order to suspend employment in certain sectors, temporarily given all migrants and asylum seekers full citizenship rights (Thailand), granting them full access to the country's healthcare as the outbreak of the novel coronavirus escalates in the country (Portugal) [92] [93] Government of India also talked about the mental health of these migrant workers and issued guidelines, putting up mechanisms to enable the migrant workers reach to the family members through telephone, video calls etc and ensuring their physical safety [38]

Some countries applied different measures to prevent the spreading of COVID-19 for migrants such as banned cross-border travel between countries However, when governments tighten border controls and implement other measures in response to COVID-19, the impacts

on refugees and migrants on accessing safety, health-care services, and information should be considered [74] The government must make long-term plans for the security of those who go

to work in other countries and set out a comprehensive plan to protect them so that country can sustain its foreign reserve and address the economic shock in future Moreover, multilateral collaboration can be developed to support the UN’s SGD of promoting safe, orderly and regular migration [70]

World Bank suggested four main groups of efforts that could be effective to support to migrant workers who hit hard during COVID-19 outbreak [94]: 1) social safety nets to protect migrant workers during the outbreak including social security, income insurance and health impacts; 2) employment retention regulations to maintain jobs for migrant workers; 3) employment promotion policies to help displaced migrant workers get back to work; and 4) remittance policies to address the income loss These efforts can be targeted directly to migrants

or migrant-sensitive if targeting general population [94] Policies to support employment

retention and promotion will be particularly important as a complement to these safety nets for internal migrants and migrants returning from abroad

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To avoid the marginalization of migrants during COVID-19, government of Australia applied different policies to support the migrant status: remained social inclusion benefits of permanent migration and temporary migration; granted mobility between employers; ensure institutional protections of employment rights for migrant workers and skill shortages should

be independently verified through an assessment of existing supply and demand within the labor market and addressed by more coordinated education and immigration policies [65]

The Joint Global Initiative on Diversity, Inclusion and Social Cohesion (DISC) has developed a Resource Bank on COVID-19 to compile essential tools and practical guidance on some of the key issues and challenges related to the impacts of COVID-19 on migrants’ inclusion

in their communities This tool covers different thematic areas of COVID response which range from addressing stigmatization and discrimination, ensuring psychosocial and mental health wellbeing of migrants and access to social services in the context of this pandemic [50]

3.6 Effective intervention for COVID-19

The COVID-19 pandemic asks for collaborative efforts to develop and implement treatments and vaccines, as seen with the launch of the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) public–private partnership [95] Testing of interventions should go hand in hand with efforts to understand the pathology, disease mechanisms, clinical features, and clinical course of COVID-19 [95] Other focus should be good clinical practice, including the need to apply evidence-based practice such as lung-protective ventilation for acute respiratory distress syndrome (ARDS) and to prevent the use of unproven treatments [95] In low-income and middle-income countries where there are scarce of resources, best interventions should be training and education of health-care providers, application of the current guidance to best fit with the local context, and performing research in clinical settings [95]

The need for a proactive approach has been acknowledged with the publication of a research and development roadmap by WHO [96] The COVID-19 pandemic has triggered the response of both clinicians and researchers in providing critical care for a new disease and in rapidly establishing research programmers to explore the best interventions to stop its transmission [95] In 2020, research for COVID-19 accounts for nearly 45% of the total $954 million for coronavirus research during the first four months of 2020 [92] Developments in research and clinical practice will bring new challenges, but also opportunities for progress in meeting the needs of individual patients However, this is especially important as the resources

to tackle the COVID-19 pandemic has left little room for other infectious diseases [97] The resource allocation could severely worsen the major infectious diseases who are responsible for the most deaths worldwide each year for example, HIV, malaria, and tuberculosis [97]

3.7 Progress of Vietnam with vaccine development and clinical treatment

Vietnam’s government published swiftly the first guideline for diagnosis and clinical treatment for COVID-19 in Jan 16, 2020 (Decision 125/QĐ-BYT) [98] To date, the guideline has been revised with eight versions [98] As there has no current therapeutic agent to treat COVID-19, doctors in Vietnam apply oxygen therapy, ventilators, antibiotics and antiviral drugs depending on the severity of the case [99] In term of clinical treatment for COVID-19, some clinical trials are being tested under the approval of the Ministry of Health such as the VICO trial to test Chloroquine [100], the plasma transfusion trial in Bach Mai hospital [101]

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In Vietnam, producing vaccine has been started right when the pandemic occurred Currently, the four COVID-19 vaccines are being developed by Nanogen, Vabiotech, Polyvac and the Institute of Vaccines and Medical Biologicals (IVAC) [102] Some preliminary results with a fairly high immune response to the vaccine antigens have shown [102] Nanogen and Vabiotech vaccine are the most promising as they have been tested successfully in animal phase [102] Both Nanogen (Nanogen Pharmaceutical Biotechnology) and Vabiotech (National Institute of Hygiene and Epidemiology) are being considered for authorizing the phase 1 human trials in November, 2020 [103]

3.8 Community engagement

3.8.1 Concept of community engagement

Community engagement is “a process of developing relationships that enable

stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes” [104] It is used as a general notion with terms

like social mobilization, community participation, community action and empowerment [105] Community engagement refers to the process of involvement and participation of individuals, groups and structures within a community for “decision-making, planning, design, governance and delivery of services” [106] The process is often facilitated by local governments or community-based organizations Community engagement support to build trust and ensure the community representation structures [104] The concept of community engagement, however, varies amongst agencies depending on levels of engagement [107]

Community engagement is seen as critical to ensure tailored interventions to local context during outbreak [107] It has been successfully proved in interventions on communicable disease [105] such as Ebola epidemic in West Africa in 2014-2015 [106], and maternal and child health projects [108]

3.8.2 Application of community engagement approaches in solving local problem

Communities should take the central role in all responses for an outbreak The local context of the community such as the way of interaction and political-cultural and social structures should be considered in designing any intervention during a disease outbreak [109] For example, key lessons in risk communication during outbreaks point out the importance of local leaders’ engagement and a two-way communication practice [110] Local communities need to be involved as a player before and during emergency risk communication process [110] Social media could be a new avenue for communication but traditional communication channels (such as radio, speaker) should also be utilized [110]

Experiences from Ebola outbreak in Africa during 2014-2015 highlights several barriers, including low awareness/suspicious regarding the existence of the disease and poor motivation of the government [111] Community engagement measures, including building partnerships with local representative, involving local people in developing key behavior change messages, successfully helped to overcome these barriers to control the outbreak [111] During the fight against HIV/AIDS epidemic, community engagement was also crucial for all activities, including HIV testing and counselling, access to treatment and drug, and stigma mitigation [112]

In terms of the COVID-19 pandemic, community engagement is called to be applied worldwide for creating local and context-based responses [112] Using a ‘bottom-up approach’, local individuals and stakeholders could actively engage into decision-making processes for any efforts to fight against COVID-19 Local residents, including vulnerable and marginalized

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groups, can identify solutions for themselves as they know stigma and structural barriers and easy to work with each other to devise collective responses [112] All recommended measures

to prevent and control COVID-19, such as social distancing, case identification and contact tracing requires all members of society to work together [30]

In situations of COVID-19 outbreak, interventions not only rely on the health systems but also on the role of communities to prevent and manage the pandemic through nonpharmaceutical public health measures [53] Well-implemented community engagement strategies could support designing of interventions, building trust, risk communication, surveillance and contract tracing, and logistic support [113] The three priorities for community engagement for COVID-19 prevention and controlling are: (1) Strengthen/ Establish partnerships to further reach to wider community; (2) Strengthen governance structures to leverage existing mechanisms among national and local stakeholders; and (3) Optimize the role

of community healthcare workers Other suggestions should be considered in performing community engagement activities in health programs and interventions:

Identify and work with community representatives: The importance of identifying

community representatives, informal leaders and marginalized groups has been repeatly highlighted [104], [107] Voice of all groups within the community should be heard [104] Six main actors for community engagement were: local leaders, community and faith-based organizations, community groups, health facility committees, individuals and key stakeholders Vulnerable and marginalized groups are harder to identify, reach and engage [114] These groups need to be engaged in the design and feedback on the responses to COVID-19 as they have specific issues when measures such as isolation and quarantine are being implemented [107] Different digital tools could also support connect remotely with the communities such

as mobile phone, hotlines, text messages, social media or online software (Zoom) However, vulnerable and marginalized groups could have uneven reach or difficult using these tools [107]

Develop plan for emergency preparedness that includes the participation of all groups including vulnerable and marginalized groups: Using community engagement systems and

tools to develop mechanisms need to include representatives from all groups within the community, to ensure their capacities and needs are fully integrated and addressed Digital feedback and engagement mechanisms could be considered as an alternative for non-digital methods during COVID-19 outbreak

A clear and contextualized community engagement strategy and mechanism:

Mechanisms for community participation should be placed in all strategic plan and activities Skills and capacities as well as the support needs of all community groups should also be identified to facilitate their participation

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Que Vo – Bac Ninh

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Ninh Binh (47.8>24.2%; p<0.05); proportion of workers with ethnic origin in Bac Ninh is higher than those in Ninh Binh (38.5>11%, p<0.05); proportion of married worker in Bac Ninh

is higher than those in Ninh Binh (50.9>32.4%, p<0.05); proportion of workers with labor contract in Ninh Binh is higher than those in Bac Ninh (100>99.1%, p<0.05)

4.1.2 Migrant workers’ employment and working condition

Table 4 Occupational working environment

Variables

Phuc Son – Ninh Binh

Que Vo – Bac Ninh

p

Total

219 226 445

Migrant workers exposed to working hazard:

Exposed to heat/high temperature 4 (1.8%) 9 (4.0%) 0.18 13 (2.9%) Exposed to dust * 3 (1.4%) 19 (8.4%) <0.001 22 (4.9%) Exposed to noise * 37 (16.9%) 93 (41.2%) <0.001 130 (29.2%)

Exposed to chemical* 6 (2.7%) 18 (8.0%) 0.015 24 (5.4%)

The occupational working conditions is quite good Only few people reported the working hazards: 2.9% working in high temperature conditions; 4.9% dusty conditions However, noise is quite common problem, 29% reported working in noise conditions The expose to dust, noise and chemical in Que Vo, Bac Ninh province was significantly higher than Phuc Son, Ninh Binh (p<0.05)

Table 5 Employment, salary and economic responsibility

Variables

Phuc Son – Ninh Binh

Que Vo – Bac Ninh

Employed 196 (89.5%) 190 (84.1%) 386 (86.7%) Temporarily unemployed 14 (6.4%) 23 (10.2%) 37 (8.3%)

Employed 214 (97.7%) 215 (95.1%) 429 (96.4%) Temporarily unemployed 1 (0.5%) 7 (3.1%) 8 (1.8%)

Income (million VND)

Before COVID-19, mean (SD) 5.7 (1.8) 7.9 (4.4) <0.001 6.8 (3.6)

1 Jan to 23rd July, mean (SD) 5.3 (1.7) 7.9 (4.4) <0.001 6.6 (3.6) 23rd July to 11 Oct., mean

Economic responsibility

Yourself living-cost 128 (58.4%) 187 (82.7%) <0.001 315 (70.8%) Family living cost 158 (72.1%) 157 (69.5%) 0.53 315 (70.8%)

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Before COVID-19, most workers were having the full employment (90.1%) However, during COVID (January – July), the proportion of having full employment was reduced to 86.7% From August up to October, the situation was improving, the full employment was increased to 96.4% The proportion of people having unemployment or temporary employment was significantly higher in Bac Ninh than in those in Ninh Binh province (p<0.05) However, there were no significant differences between two provinces (p>0.05)

The average income of migrant worker was ranged from 5.3 to 8.5 million Vietnam dong (Vietnamese currency), which equivalent to 320 USD to 350 USD per month The incomes of migrant workers in Bac Ninh was significantly higher than those in Ninh Binh (p < 0,05)

Most migrant workers had to pay for the expenses themselves and their families (70%) The proportion of migrants are paying themselves in Bac Ninh is significantly higher than those

in Ninh Binh province (82.7>58.4%; p<0.05)

4.1.3 Living condition

Table 6 Living condition of migrant workers

Variables

Phuc Son - Ninh Binh

More than one third of migrant workers living in house with area of 25-36 m2 (31.9%), the next was >36 m2 (23.8%); 12-24 m2 (28.1%); and <12 m2 (16.2%) The prorortion of those living in small areas <24 m2 was significantly higher in Bac Ninh than those in Ninh Binh province (p<0.05)

In Ninh Binh, most migrants are living with families (94,1%) and significantly higher than those in Bac Ninh province (94.1>67.3%, p<0.05) The proportion of migrant living with

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friends in Bac Ninh is significantly higher than those in Ninh Binh province (27>14.6%, p<0.05) The proportion of more than 5 people living in the same house was significantly higher

in Ninh Binh than those in Bac Ninh province (12.6>12.4%, p<0.05)

The majority of migrant workers are having access to clean water, WC& sanitation and internet and health insurance (>94%) However, the proportion of those having access to clean water, access to internet in Ninh Binh was significantly higher than those in Bac Ninh province, respectively (100>97.8%; 98.2>91.6%; p<0.05)

Table 7 Health status of people living in the same house

Variables

Phuc Son - Ninh Binh

higher than those in Ninh Binh province (71.9>62.5%, p < 0.05)

4.1.4 Migrant workers’ health status, Access to health Services during COVID-19

Table 8 Migrant worker’s health status in two industrial zones

Variables

Phuc Son – Ninh Binh

Health risk behavior

Play online games 33 (15.1%) 70 (31.0%) <0.001 103 (23.1%)

Regarding migrant worker’s health status, three fourths (78.5% and 74.3%) of workers

in Ninh Binh and Bac Ninh self-reported good health condition, respectively There were differences in the proportion of migrant workers having health problems between provinces such as having chronic diseases, acute diseases, mobility problem and self-care problem However, these differences were insignificant (p>0.05)

Regarding the health risk behavior: the proportion of smoking is about 10%; drinking

is 25%; and play online game is 23.1% However, there are significant differences between

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provinces The proportion of migrants having self-reported smoking, drinking and playing online games in Bac Ninh was significantly higher than those in Ninh Binh province, respectively (16.8 > 3.7%%; 40.3>10.5%; 31>15.1%; p<0.05)

Table 9 Mental symptoms and health risk behavior of migrant workers

Variables

Phuc Son – Ninh Binh

Table 10 Relationship between having mental symptoms and health risk behavior

OR (95%CI)

No

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Table 11 Health care support during COVID-19

Variables

Phuc Son – Ninh Binh

Que Vo – Bac Ninh

Having health insurance 218 (99.5%) 225 (99.6%) 443 (99.6%)

About two thirds (62.5%) reported that they could receive support from the hospital, 58.8% from the company health agency and 41.4% from the local commune health center Most of workers reported that they could seek/receive support at all day (87.2%) However, the proportion of migrant workers, who could find support from hospital, community health center

in Bac Ninh was higher than Ninh Binh and while the proportion reported in company health agency was higher in Ninh Binh, with statistically significant (p < 0.05)

The proportion of workers could receive care at all the time was higher in Ninh Binh, while the proportion could receive care during working time in Bac Ninh was higher (p<0.05)

4.1.5 Supports to migrant workers during COVID-19

Table 12 Information received on COVID-19

Variables

Phuc Son - Ninh Binh

Que Vo - Bac Ninh

p

Total

Updated information on COVID-19

Number of COVID-19 new

Yes Number of dealth due to

Yes COVID-19 preventive

Sources of information were mainly from internet (91.7%), television (88.3%), text messages via mobile phone (89.2%), radio (44%), and few received via leaflets (18.2%) Proportion of people receiving information from TV, radio, internet and leaflets in Ninh Binh was significantly higher than those in Bac Ninh province (p<0.05)

Table 13 Sources of guidelines received on COVID-19 prevention

Variables

Phuc Son - Ninh Binh

Social distancing

Landlords 23 (10.5%) 93 (41.2%) <0.001 116 (26.1%) Community agencies 123 (56.2%) 186 (82.3%) <0.001 309 (69.4%) Healthcare facilities 125 (57.1%) 165 (73.0%) <0.001 290 (65.2%) Family/Friends 101 (46.1%) 138 (61.1%) 0.002 239 (53.7%)

Nearly 100% workers got the guidelines and instruction on social distancing and prevention COVID-19 from their company About 70% migrant workers received this information from other agencies in the local community such as community agencies, health care facilities and family/friends The landlords were the least provided information (26%) The proportion was higher in Bac Ninh than those in Ninh Binh province (p<0.05), except for companies

Table 14 Supports received during COVID-19

Variables

Phuc Son - Ninh Binh

House ownership 208 (95.0%) 194 (85.8%) 0.001 402 (90.3%) Organization in community 172 (78.5%) 162 (71.7%) 0.095 334 (75.1%) Healthcare facilities 55 (25.1%) 79 (35.0%) 0.024 134 (30.1%)

Housing support from

House ownership 20 (9.1%) 53 (23.5%) <0.001 73 (16.4%) Organization in community 38 (17.4%) 54 (23.9%) 0.088 92 (20.7%) Healthcare facilities 35 (16.0%) 38 (16.8%) 0.81 73 (16.4%)

Migrant workers received the main support from their company with personal protective equipment, food and housing with 54.2%, 41.8% and 37.3%, respectively The supports for workers in Bac Ninh, were significantly higher than Ninh Binh province (p <0.05) The other supports from organization near their living place and healthcare centres Landlords has lowest support to the workers Only 1 in 10 migrant workers received the supports from landlords

4.1.6 Migrant workers’ knowledge, attitudes and practice on COVID-19 prevention

Table 15 Migrant workers’ knowledge on COVID-19 symptoms

Variables

Phuc Son – Ninh Binh

Que Vo – Bac Ninh

Running nose 197 (90.0%) 150 (66.4%) <0.001 347 (78.0%)

Migrant workers' knowledge about COVID-19 symptoms was quite good The most likely self-reported symptoms were fever (97.3%), fatigue (86.1%), dry cough (88.3%), and other symptoms such as: myalgia, shortness of breath, sore throat, headache, running nose The knowledge in Ninh Binh was significantly higher than those in Bac Ninh provinces in all aspects (p<0.05)

Table 16 Migrant workers’ knowledge on COVID-19 transmission ways

Variables

Phuc Son - Ninh Binh

From person to person 213 (97.3%) 190 (84.1%) <0.001 403 (90.6%) From animal to human 166 (75.8%) 121 (53.5%) <0.001 287 (64.5%) Object contained with the virus 182 (83.1%) 127 (56.2%) <0.001 309 (69.4%) Eating not properly cooked wild

The knowledge on transmission was good Two main transmission: (1) through coughing or sneezing (96.6%), (2) from person to person (90%) were mostly self-reported by the migrant workers The proportion of correct knowledge was higher in Ninh Binh than in the Bac Ninh provinces in all knowledge variables (p<0.05)

Table 17 Migrant workers’ knowledge on COVID-19 prevention

Variables

Phuc Son - Ninh Binh

and water 216 (98.6%) 217 (96.0%) 0.089 433 (97.3%) Cover mouth and nose when

Avoid touching eyes, nose, mouth 204 (93.2%) 200 (88.5%) 0.090 404 (90.8%) Well-cooked 183 (83.6%) 129 (57.1%) <0.001 312 (70.1%) Avoid crowded places 213 (97.3%) 214 (94.7%) 0.17 427 (96.0%) Wearing a face mask 216 (98.6%) 214 (94.7%) 0.021 430 (96.6%)

Table 17 presents migrant workers’ knowledge on prevention of COVID-19 The most frequently prevention methods were: (1) frequently washing hand (97.3%); (2) avoiding crowed places (96%); (3) wearing face mask (96.6%); (4) cover mouth and nose when coughing (94.4%); (5) avoiding contact to people with respiratory illness (cough, sneezing, and flu (93.9%); (6) avoid touching eyes, nose and mouth (90.8%) However, about 30% of migrant workers think they do not need have well cooked meal to prevent COVID-19 The proportion

of correct knowledge in Ninh Binh was significantly higher than those in Bac Ninh provinces

in all aspects, respectively (p<0.05)

Table 18 Migrant workers’ correct knowledge on COVID-19 prevention: symptoms, transmission, prevention methods

prevention 153 (69.9%) 72 (31.9%) <0.001 225 (50.6%)

The correct knowledge of COVID-19 was synthesized by combined all knowledge on symptoms, transmission ways and prevention of COVID-19 The proportion of corrected

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knowledge of migrant workers in Ninh Binh was significantly higher than those in Bac Ninh province (69.9>31.9%; p<0.05)

Table 19 Migrant workers’ correct attitude on COVID-19 prevention

Table 19 shows the attitude on COVID-19 prevention of migrant workers The majority

of workers have strong beliefs that COVID-19 will be controlled (98.9%) and government can handle situation from (99.8%) The proportion of synthesized correct attitudes on COVID-19 prevention in Bac Ninh was higher than those in Ninh Binh province (100>97.3%; p<0.05)

Table 20 Migrant workers’ correct practice on COVID-19 prevention

Avoided contact to people with

Report to health center when

having symptoms (fever, cough) 206 (94.1%) 192 (85.0%) 0.002 398 (89.4%) Keep minimum 2 m when talking 208 (95.0%) 211 (93.4%) 0.47 419 (94.2%) Setup Blue zone & reporting

Table 21 Relationship between migrant workers’ knowledge on COVID-19 and demographic and health risk behavior

Location:

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Married & Divorced (Ref: Single) 1.76* [1.09,2.85]

Live with family:

Live with friends

Smoking

Drinking

Play online games

Table 22 Relationship between correct knowledge and practice on COVID-19-prevention

Correct knowledge Correct practice

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knowledge was 3.63 times more likely to have correct practice (OR = 3.63; p<0.01)

Table 23 Relationship between KAP and sources of information

2.86** [1.44,5.69] Radio

No

[1.08,2.57]

0.38 [0.05,2.71]

3.51*** [1.78,6.92] Internet

No

[1.75,11.16]

0.83 [0.06,11.68]

1.53 [0.75,3.12] Leaflets,

No

[0.48,1.37]

1.00 [1.00,1.00]

1.20 [0.53,2.76]

* p < 0.05, ** p < 0.01, *** p < 0.001

In-depth analysis was shown the significant relationship between knowledge and source of information (TV, radio and mobile phone); between attitudes and internet access; between practice and source of information (TV and radio) Migrant workers, who were having access

to information from the above-mentioned sources were more likely to have correct

knowledge, attitudes and practice than those are not (OR varied between 2 to 16; p<0.05)

4.2 Community engagement in tackling COVID-19 in Vietnam

4.2.1 Committee on COVID-19 control and prevention

4.2.1.1 Central level

The national taskforce committee for COVID-19 control and prevention was set up on January 30 The committee consisted of 24 members from 23 ministries, committees, the press, and radio and television representatives, to direct and coordinate among the ministries, ministerial-level agencies, government-attached agencies, concerned agencies and localities,

in the prevention and control of COVID-19 The committee is under leadership of Vice Prime Minister Vu Duc Dam [16] Committee is responsible for all activities, including the technical

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guidance, communication, coordination of action from different stakeholders, mobilization of resources for implementation of public health and curative care [16]

The Communist Party issued the instruction on the consolidated efforts on COVID-19 control and prevention and required for preparation of plans for different scenarios with COVID-19 and impose the leader’s responsibility for control and prevention of each institution and agency [115] Following this instruction, all sectors have to prepare the resources for combating with COVID-19 at the highest level

The Government issued different directives on level of control and prevention of COVID-19 depending on the situation [116], [117] Among these stakeholders, the Ministry

of Health is responsible for issuing guideline on: 1) public health action: detection of cases, isolation, tracing cases, and the surveillance of suspected cases and close contact groups; 2) Clinical guideline on diagnostic and treatment [118]

The media sector provided updated and reliable information on COVID-19 status (new cases, death cases, outbreak areas) and reinforce preventive measures (face masks, handwashing, social distancing) through different channels: official newspapers, government’s website, MOH’s website, Zalo, FB, SMS etc The regulation on sanction of people who violated the preventive measures in public places (not wearing face mask; did not disclose the health status, dit nod apply social distancing etc); and those share the false, untruthful, distorted,

or slanderous information related to COVID-19 in the social media were also issued and applied at nationwide level [119-121]

Other stakeholders also play important roles in this process Ministry of public security

is working closely with local authorities in tracing cases and contacts Ministry of Finance is responsible for development of instruction to provide support to those affected by COVID-19 Ministry of Defense is providing space for local isolation of infected cases or people returning from overseas Ministry of Foreign Affairs and Transportation have the responsibility to close borders with neighboring countries Ministry of Education has the tasks to close schools and provide online teaching

According to the key informants, all the instruction and guidance from the central government were highly appreciated and followed by local leaders, stakeholders, industrial zone leaders and migrant workers They have strong beliefs on government action on COVID-

19 control and prevention, and they are very actively involved in all activities that instructed

by the government and local authorities

“People in community were aslo afraid of COVID-19 pandemic The situation of COVID-19 prevention and control in Vietnam seemed to be good and under control People in community complied and supported with the guidelines from government, the government took the leading roles and health sector gave the advices, guidelines and supported for the government Of course, there was someone not to comply or follow with the instruction, it was difficult to avoid it However, the community was also very supportive for the activities of COVID-19 prevention in general” - (IDI-1-PHD manager-Male-55 years old)

4.2.1.2 Local level

The committee for COVID-19 prevention is organized in all local level, from provincial, district to commune and at every institution and community The members

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consisted of different stakeholders including local authority, health representatives, policeman, mass organization such as women union, youth union, fatherland front, veterans etc These are responsible for all preventive and curative activities of COVID-19 at the local level

Following the instruction and guideline from the central government, the local committee implemented and enforced COVID-19 preventive measures (face mask, hand-washing liquid, social distancing, temperature measurement etc); mobilized the resources from different sources such as personal protective equipment (PPE), face masks, hand-washing, testing materials, disinfection materials and other essential materials for the works of preventive activities

At commune level, the Commune committee on COVID-19 control and prevention was set up and responsible for all preventive activities The main tasks are included coordination, communication, tracing cases, enforcement of regulation and mobilization of resources for preventive activities Different scenarios for combating with pandemic in the community also were developed (no cases, less than 20 cases, more than 1000 cases)

Coordination

The committee on COVID-19 control and prevention has the roles to coordinate all relevant stakeholders to implement activities on COVID-19 prevention The local committee set up the additional structure as the rapid response group (including policemen, people from justice field, representatives of women union and youth union) to control the situation when people did not cooperate and comply with the preventive measures Policeman play critical roles in this process The home visits were always accompanied with policeman They ensured the safety of health workers during the visits and the compliance of local residents when they are under surveillance (home isolation, sending for quarantine or hospitalization)

“The committee of COVID-19 control and prevention in commune level including village-health-workers who also understand the basics of medical and healthcare knowledge, also coordinated with the head of villager, chairman of people’s community and mass organizations in community such women union, youth union in all activities

at commune level” - (IDI-2-CPC representative-Male-46 years old)

The committee set up the community supervision mechanism to control the situation in case of emergency The representatives of mass organization in the community was involved

in the committee such as Youth Union, Women Union, Fatherland Front etc They are responsible for detection and notification of at-risk cases in the local community During the outbreaks of Bach Mai (March 2020) and Dang Nang city (July 2020), all people coming from these areas were detected for testing, isolation, quarantine or hospitalization The information was provided in official communication channels such local radio or announcement posted in each community corner People appreciated the values of information for COVID-19 prevention

“It was a difficult problem in large area where people could not spread information quickly, then the participation of community was in need and very important For example, people in community knew that the household had children, husband or wife who came from somewhere else, might be from the outbreak area Then, we had to access immediately and direct the rapid response team to meet the household to get information of their historical travels such as where did they come from, where did they pass by…So that we could update information If they came from the outbreak areas,

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we requested them go to medical isolation according to the government guidelines” - (IDI-2-CPC representative-Male-46 years old)

“The report on update information of those who came from the outbreak areas was requested For example, in the phrase I when pandemic started in China, we had to report all the cases who traveled or came from China Recently, the outbreak in Bach Mai hospital, we had to manage and update information of all people who went to the hospital During the time, we organized to isolate 2 cases of F1 who had closed contact with infectious patients” - (IDI-1-CHC manager-Male-47 years old)

Communication

The committees provide updated and reliable information on COVID-19 prevention in different local channels (local radio or meetings) The content of messages was followed the government instruction, included hand washing, face mask wearing, social distancing, temperature measurement, isolation, quarantine, social distancing, no meeting, banquets and party if not necessary; limits below 20 of participants in special events such as the wedding or funeral, all people must wear face masks and wash their hands before entering the public place

“Every morning at 6.30 am – 7am, a health staff in factory read the information of COVID-19 prevention, usually she read 1-2 news, then she reminded to all workers in factory and she continued to read again the news 3-4 times” - (FGD-1-Migrant Workers-Female-26 years old_01)

“In my opinion, it was quite effective and very good role Regarding health education and communication, at first, we need to give information to people who were not aware

of COVID-19 prevention Giving them information day by day and gradually it could bring the changes of their knowledge, attitude and practice As I could see that, I just turned on the phone to get a medical report via Blue zone app and I could read the title

or updated information in short Even people who did not pay attention, they still could find it It was very effective” - (IDI-1-CHC manager-Male-47 years old)

The local people were very creatively using Zalo to share the information within group members of local committee on COVID-19 control and prevention All updated information

on new high-risk cases, symptoms, and plan for testing, isolation, quarantine or hospitalization

in the locality was shared in the Zalo group With this approach, people were always updated with information and necessary action All members of local committee on COVID-19 were requested to turn on telephone/smart phone 24/7 during pandemic

“We also directed the connection of all member in the COVID-19 prevention committee

on the Zalo group We set up the group on Zalo app from the steering committee to all members We joined the group called “COVID-19 prevention” on Zalo app In this group, all media reports and guidelines are updated Therefore, all information from community and members is always up to date immediately” - (IDI-1-CHC manager- Male-47 years old)

“During the COVID-19 pandemic, to avoid close contact, we mainly updated information via Zalo or Facebook for all the members of committee on COVID-19 prevention For example, if we know that there are 1-2 new comers in this company,

we will call and announce the names of the workers When the committee on

COVID-19 come to find out information and guide people in the quarantine process, write the

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name and make a record, sign the commitment After finishing, there is regular contact and supervision all the people via Zalo or Facebook” - (IDI-2-CPC representative- Male-46 years old)

Tracing at-risk people

In order to tracing at-risk people, home visits were organized with health workers and accompanied by local policeman to person’s house at-risk (those are coming from outbreak region or abroad) The health workers are responsible for decision for home isolation, quarantine or hospitalization During the pandemic, very few cases were under quarantine in the region (2 cases), but many were under home isolation Those under home isolation were put under surveillance (report daily temperature, health status) Their houses were under disinfection

“In emergency situation or any updated information was reported, the chairman or vice-chairman of steering committee for COVID-19 prevention in community must be present at health commune center, requested the rapid response team and all the members of steering committee for COVID-19 prevention (i.e health staffs, polices…)

to access and get information from the household, guide for household to isolate at home Then transferred drugs, sprayed disinfectants in that area surrounding the household” - (IDI-2-CPC representative-Male-46 years old)

Enforcement to comply with government regulation on COVID-19 prevention

At the certain public place such as entry of market, school, the committee on

COVID-19 assigned people to supervise the compliance with the regulation by reminding all people to wear face masks; wash hands by handwashing antiseptic liquid etc However, there are some barriers on compliance related to local context such as it is very difficult to keep distance of 2 meters in market or meeting places or dormitory

“Actually, the enforcement of all organizations and agencies were very strict In the community, the practice of face-mask wearing was very good, but the practice of social distancing of 2m was difficult, especially in the market, it was impossible to do that Even though, people in community complied with the government guidelines quite well, they did not gather or eat together The workers in factory consciously observed with good practice” - (IDI-1-WU representative-Female-45 years old)

The committee on COVID-19 control and prevention at local level were allowed to fine the people who violated the regulation (fines of 10 USD for not wearing mask in public places

or attending group meeting taken in public places) and announce the names in the local radio for violation

“We did allow to fine the people according to the Directive No.16 of Government, in which a fine of 100,000-300,000 VND, we fined 103 people at a rate of 200,000 VND because they did not follow or comply with the government instruction of COVID-19 prevention After that, we reported on the radio in both of education and detergent purposes Moreover, we set up the checkpoints at the entrance of public places such as the entrance of market or entrance of village…” - (IDI-1-CHC manager-Male-47 years old)

During the COVID-19, many people use social medial to share the fake news, which make community having unpredictable activities, and could be promote the local people to

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