A/HRC/17/34/Add.1 80. The principle of availability requires that benefits and services should be sufficient in quality and quantity to meet the needs of the community in question. Thus, while States should bear in mind the need to expand the coverage of existing social protection schemes, the benefits must be high enough to enable people to enjoy an adequate standard of living and to realize at least the minimum core content of their economic, social and cultural rights. 81. From a human rights perspective, facilities, goods and services, and programmes must not only be available but must also be of good quality. In the Vietnamese context the provision of public health care is of particular concern in this regard. While public spending on health has increased considerably, the system is still under-resourced in several areas such as capacity and training of local staff, adolescent reproductive health, and sanitation and hygiene. In addition, the current disparities in coverage of health care between regions, between urban and rural areas and between ethnic groups also raise concerns regarding compliance with the principles of equality and non-discrimination. 82. Quality also requires that public service providers have the relevant skills and avoid prejudice against and stigmatization of those living in poverty. In this regard, the independent expert is concerned about reports of the low skill level of health care providers and negative attitudes of health staff towards patients benefiting from HCFP, which reportedly discourages many potential beneficiaries from seeking the care they need.72 She welcomes the adoption of the Law on Medical Examination and Treatment, which entered into force in January 2011, requiring health care providers to meet certain criteria to obtain a licence, and encourages the Government to ensure that the licensing and monitoring provisions of the law are fully implemented. She also recommends revising the system whereby hospitals are reimbursed less for patients with a free health care card, as anecdotal evidence suggests that this can result in treatment of a lower standard for those with a free health care card. 4. Accessibility 83. Accessibility requires that benefits and services must be allocated and provided to all without discrimination of any kind. This implies both physical and economic access, and access to relevant information regarding these services. The geography of rural Viet Nam presents several challenges to the physical accessibility of social services for some parts of the population. The great disparities in accessing public services between regions, between rural and urban areas, and between ethnic groups raise human rights concerns that should be remedied. 84. Accessibility also requires the State to remove administrative barriers that prevent vulnerable groups from accessing social protection benefits on an equal basis with the rest of the population. Of particular concern is the permanent residential permit that limits access to social services by internal migrants. 85. Benefits and services must be economically affordable to those living in extreme poverty, who must not be disproportionately burdened by direct and indirect costs and expenses. In this regard, despite the increased investment in these sectors, the independent expert is concerned by the current trend towards user fees in health and education, and the existence of considerable indirect costs even for “free” services, which are 72 See, for example, World Bank, Viet Nam Development Report 2008: Social Protection, pp. 88-89. 19