A/HRC/17/34/Add.1 disproportionately affecting the poorest and may contribute to a growing gap in access between rich and poor households.73 86. In the case of education, for example, the independent expert recognizes the progress achieved. According to available data, in 2006 more than 90 per cent of children from the poorest households in primary school were either fully or partially exempt from direct fees, as well as more than 45 per cent of children in lower secondary school.74 However, the additional costs are still beyond the capacity of households living in extreme poverty. The most common reason for ethnic minority children dropping out of school is lack of money for informal charges and indirect fees, which Government educational subsidies do not cover.75 In her visits to families living in poverty, the independent expert was told that indirect costs were an important obstacle to their children’s schooling. 87. The right to education requires that the provision of primary education shall be universal, compulsory and free (from direct and indirect costs). The independent expert therefore also recommends revising the use of fees and contributions as well as waiver schemes in the Vietnamese public schooling system. 88. State policies must take into account and remove additional barriers that those living in poverty face in accessing public services. In regard to health care, reports suggests that HCFP has done little to reduce out-of-pocket expenses for poor households, who must still pay for travel expenses and “non-essentials” such as blankets and dressings, and often even medicine.76 The independent expert confirmed in her interaction with communities living in extreme poverty that the majority had health insurance cards, yet many reported being unable to afford out-of-pocket and opportunity costs, therefore abandoning or postponing important health care treatment. Financial security and health status are thus intimately linked. 5. Acceptability and cultural adaptability 89. Cultural adaptability requires that benefits and services must be adapted to the needs of communities or individuals in different social and cultural settings, including the cultural needs of vulnerable and disadvantaged groups. It requires, for example, that States remove administrative, linguistic or any other cultural barriers that prevent or discourage people from accessing benefits or services. 90. Cultural adaptability is particularly important in ensuring that ethnic minorities are reached and benefited by public policies. Policymakers should strengthen their efforts to understand cultural norms and to incorporate them better into policy formulations. Minorities tend to benefit less than Kinh from Government poverty reduction programmes due to difficulties in accessing information regarding them,77 and therefore specific policies should be adopted to overcome linguistic barriers that have a significant impact in the perpetuation of their poverty. Outreach must also take into account and overcome literacy barriers that may impair access by some groups of the population. 73 74 75 76 77 20 H. Hansen., Le Dang Trung “Better than its Reputation? The Incidence of Social Transfers and Education Fee Exemptions in Vietnam” DEPOCEN Working Paper Series No. 2007/09. World Bank, “Viet Nam: Strengthening the social safety net to address poverty and vulnerability” (draft), 2010, p. 17. World Bank, Country Social Analysis: Ethnicity and Development in Viet Nam: Summary Report (2009), p. 25. World Bank, Viet Nam Development Report 2008: Social Protection, pp. 88-89. World Bank, Country Social Analysis: Ethnicity and Development in Viet Nam: Summary Report (2009), p. 19.