Summer campaign
In the border region of Huong Hoa, there are 1900 teenagers with too little knowledge of sexual matters. Their parents also want to gain knowledge and self-confidence so that they are able to discuss delicate subjects.
Summer campaign
In the border region of Huong Hoa, there are 1900 teenagers with too little knowledge of sexual matters. Their parents also want to gain knowledge and self-confidence so that they are able to discuss delicate subjects.
Youth in Vietnam, especially ethnic minority youth in mountainous areas, increasingly face health and social problems as a result of lacking the knowledge and skills of sexual and reproductive health and rights (SRHR). Vietnam has the highest abortion rate in the world, 83.3 abortions/1,000 women. In 2012, Vietnam had the highest incidence of new HIV infections in mainland South East Asia, and more than one-third of people living with HIV are under the age of 30. The HIV epidemic is growing most rapidly where education is poor, particularly in ethnic minority areas. Many of these problems can be attributed to a lack of comprehensive SRHR/HIV education for young people, who are not provided with the knowledge and skills they need to confidently and effectively protect themselves and others from unwanted pregnancy and infection. Only half of adolescents surveyed were able to correctly identify ways of preventing the sexual transmission of HIV. Young people increasingly engage in pre-marital sex and early marriage and childbirth are common. Poverty and remoteness limit access to information about SRHR. The little SRHR/HIV education available does not incorporate life-skills approaches. The effectiveness of health education programs are compromised by not being linked to quality youth-friendly SRHR/HIV services.
To improve SRH in Vietnam, MCNV has strategies to support ethnic minority adolescents in improving accessibility of SRH education and services. We are now implementing a pilot project in Dien Bien called: “Open Door: improving access to sexual and reproductive health services for ethnic minority youths in Dien Bien high schools”. This three year project is implemented in two target schools, providing high quality life-skills-based SRHR/HIV education for ethnic minority adolescents, enabling them to make responsible choices and decisions regarding SRH and equipping them with the knowledge and skills to engage in safer sexual behaviors. This education is focused on ethnic minority youth in boarding schools and delivered through school-based youth clubs.
Technical guidance is provided by skilled SRHR health workers, teachers and women living with HIV. These clubs also aim to engage young people within the wider community outside the boarding schools, through a variety of innovative communication activities, such as drama, music and sports events. They also utilize social media channels to engage and communicate with young people. By doing this, the knowledge and skills of teachers are strengthened for better communication with young people about the sensitive topics of SRHR.
In the future, MCNV expects to expand the SRH project to other schools in Dien Bien provinces and other provinces in Vietnam. After finishing the pilot project, the technical guidance for teachers would be published and introduced to education networks, from the national level through to district level. The work will also be distributed regionally, in particular through the new Adolescent Health Platform launched in Laos in November 2016.
In the health system of Vietnam, village health workers (VHWs) are grassroot based that are closely connected with villagers and are often called the “extended arm of the health sector”.
VHWs are not employees of the government; they are local community volunteers who receive special training for their community health work. The network of VHW is an important component for providing health care at the village level. The VHWs link the commune health centres with the villagers. They live in the villages where they work and provide simple health care and counselling to people, most of whom they know. The services given by VHWs are very important not only for the villagers but also for the government health system, especially to reach the poor and those living in remote areas with limited access to quality medical care.
For many years MCNV has been helping to develop capacity and improve the quality of work of the VHWs in the three provinces of Cao Bang, Phu Yen and Quang Tri. In these provinces, the VHWs have established their own organizations called the Village Health Workers’ Association (VHWA) which function as local NGOs. Currently, these VHWAs are forming a network of approximately 3,000 members. The establishment of the VHWAs came in response to the expressed needs of VHWs in the provinces to foster learning and sharing for professional capacity improvement. In addition, they make it easier to voice the concerns of VHWs and villagers at higher health levels.
One of the most important tasks of VHWs is to give health educational communication at the grassroots level, as pointed out in Circular 07/2013/TT-BYT of the Vietnam’s Ministry of Health. To improve the quality of this kind of work, MCNV has helped the VHWAs learn and successfully apply many creative methods for behavior change communication (BCC). Some methods often used for BCC activities in the community include drama, shadow drama, folk composing and singing, participatory video, photo-voice and puppet shows. Although different in terms of techniques, these two-way methods of communication improve the interactions between VHWs and villagers and are applicable to almost any community health problem. The VHWAs now have good experience and skills in these methods, contributing to making people change their knowledge, attitudes and practices for better health in a more effective way. In the period of 2011 – 2015 the three VHWAs have used these methods to provide 807 communication events for different target groups and the communities, attracting the attention of over 26,500 people.
The VHWAs are highly appreciated by local authorities and other organisations. For the past years the three VHWAs have cooperated with different organisations in the health sector, such as food safety departments, centres for HIV/AIDS prevention and district health centres, in community BCC actions. In Quang Tri, for example, the VHWA has trained groups of people living with HIV so that they can organize social events to communicate with villagers about HIV topics. The VHWAs also have good experience in working with ethnic minority groups in the border areas. One of the VHWA’s remarkable interventions is about using creative methods of BCC to communicate with groups of ethnic minority teenagers in some communes along the Vietnam – Lao PDR border, aiming at tackle the problems of unsafe sex practices and unexpected pregnancy.
The VHWAs also often train and collaborate with community based organisations, especially disabled people’s organisations, in using creative methods as a tool for expressions and life-skills development. In Quang Tri, the VHWA has been invited by other INGOs, including World Vision International and Handicap International, to provide trainings on creative methods of BCC for their partner organisations. In 2013, the VHWA joined in a consultancy mission together with MCNV to provide similar trainings to the UNFPA’s partners in Ben Tre and Hai Duong provinces. Earlier, the VHWA used to give such trainings for health workers and volunteers in Noong district, Lao PDR. In short, the VHWAs are now capable of providing technical support in creative BCC for health development projects/actions.
The working model of the VHWAs in Cao Bang, Phu Yen and Quang Tri has been reported to and appreciated by the Ministry of Health. These three VHWAs could play an important role in upscaling the model to other provinces in Vietnam in future.
Children who are born underweight or do not receive sufficient nutritious food during their first years of life have a much higher chance to die in childhood. If children are able to survive their malnutrition childhood results in a lifelong disadvantage in health as well as the capacity to develop intellectually. While the malnutrition rates for whole countries such as Vietnam and Lao PDR have steadily improved over the last decades, this masks the fact that it remains unacceptably high among ethnic minorities and other marginalized groups. Due to the developmental disadvantages that malnourished children face, they also encounter difficulties when it comes to progressing financially. These obstacles leave them at a young age to grow up as the next generation’s marginalized youth.
Malnutrition in children is strongly correlated with the poverty of their parents and the education level of their mothers. It is a complex problem comprising not only of the access to safe and nutritious food but also awareness and knowledge, food beliefs and taboos, as well as the deteriorating quality of natural resources and global developments in food systems. For many previously self-subsistent ethnic minorities economic development (growing cash crops instead of their own food) and a more ‘modern way of life’ (money to buy junk foods at the market) have made things worse rather than better.
The government of Vietnam has invested big efforts over many years but among ethnic minorities in remote areas the improvement is very slow, if any at all. Therefore NGO’s like MCNV work side by side with government agencies to try out better approaches that fit better to the local contexts.
Over the past ten years, MCNV has paid special attention to child malnutrition among ethnic minorities, specifically in the provinces Khanh Hoa and Phu Yen in Vietnam, as well as Savannakhet in Lao PDR. In Phu Yen the focus was on awareness raising and self-help activities in mother groups at the village level. In Khanh Hoa a nutritious cereal powder was developed that was locally produced and distributed by the health system to all families with malnourished children in the district. In Lao PDR the emphasis is on agricultural changes, such as home gardens, fish ponds and small livestock rearing. Positive effects have been demonstrated in several of these pilots but now it becomes urgent to combine the best approaches to find the most effective way to increase the scale in order to reach vast locations.
In the coming years MCNV will focus its work on malnutrition in Lao PDR where the problem is most severe. This will be done by systematic learning, taking the experiences in Vietnam and Lao PDR and seeing how the best interventions can be applied using the local context of Lao PDR. Together with the local population, the health, agriculture and education services will need to work together. MCNV will collaborate with researchers from the Free University of Amsterdam and the important national institutes in Vietnam and Lao PDR to produce evidence about effectiveness and sustainability of interventions. This evidence will then be widely disseminated to convince government authorities and policy makers to increase their efforts to increase the number of children who can start their life with more hope for a healthy future.
Southeast Asia is one of the regions that will soon be severely affected by climate change. All throughout the region farmers are complaining that the rainy seasons have become more unpredictable and often bring too little rain too late, leading to misharvests.
The combined effect of less freshwater runoff from the Mekong river, due to upstream dams, and rising sea water levels is already leading to increased salinization. In Ben Tre province where MCNV has been working for many years this has become an acute problem for many as the famous Pomelo trees have started to wither away.
Climate change will eventually affect all, but the poor and marginalized are hit hardest and soonest. Therefore MCNV pays special attention to help pilot and promote more climate change resilient forms of agriculture in the areas where we work. Sustainable approaches that stop and revert the deterioration of soil fertility and conserve the use of fresh water are among the most important directions. As long as these methods do not require heavy investments which would per definition ‘exclude’ the poor people to benefit from. At the same time, to stabilise the lives of the poor who are seriously affected by drought and salinity, MCNV offers technical trainings and credit for poor women to start up on alternative income generation activities such as on husbandry and handy craft work. Establishment of new cooperative models for poor women based on their traditional professional strengths and market experience is a new approach that MCNV pilots in Ben Tre province. The cooperatives promises to create more opportunities for the poor because it reduce production cost and more effective in labour utilisation.
MCNV has responded quickly and effectively with an initiative to support the poor women to build big water container to retain rain water for their cooking needs in dry season right after the drought and salinity happened in early 2016. Up to September 2016, the revolving loans for water container building has been helping 160 household to build 296 containers which could retain total of 829m3 rain water for live needs in drought seasons. The number of poor households which could build containers will increase in coming year as the loans revolves.
The theme of sustainable agriculture is deeply intertwined with the increasing need of producing safe and nutritious food for growing populations. The massively increasing concern about food safety among the more affluent people in urban areas in Vietnam in fact offers new livelihood chances for poor ethnic minority farmers in organic farming. Their land and soils, if kept healthy and unpolluted, may in future become one of their most valuable assets. Luckily there are signs that the agriculture policy makers might turn away from the customary equation of high technology and large scale solutions with ‘development’, where these are still strongly promoted by global agribusiness and agro-chemical corporations.
MCNV is most strongly developing the theme of ‘Nutrition-Sensitive Agriculture’ among some of the most remote and poor ethnic minority farmers in Laos. These areas are too far from urbanized areas and markets and the emphasis must be on sustainable self-subsistence and improving/ restoring the access to nutritious foods, especially for infants and pregnant women, in a context of deteriorating natural resources /forests.
The serious drought and salinity in Ben Tre other Mekong river delta provinces of Vietnam in the beginning of 2016 was declared as a natural disaster by the government. The shortage of fresh water for human consumption and agricultural production is especially affecting poor people living near the coastal areas.
Global Climate change is increasingly making direct impacts on the living situation of huge numbers of people in developing countries whose livelihoods depend strongly on natural conditions. People who earn their living from agriculture, fisheries and aquaculture are the most vulnerable. Natural events such as typhoons, floods, droughts and saline intrusion are happening more often and more intensely in recent years, eroding people’s assets and investments and pushing many back into poverty. The salinity in the main rivers (4‰ isohaline) had intruded about 45-65km from river mounths and the whole of Ben Tre province was covered by water with a salinity of 1‰. More than 20,000ha of rice in Spring-Summer crop had been lost. About 8,500 ha of fruit trees were partly damaged by the drought and salinity. More than 98,000 households (about 400,000 people) lack fresh water because they do not have enough containers to store rain water.
MCNV quickly responded to the climate change issues in Ben Tre for the poorest people who are suffering most from the drought and salinity. The aim of MCNV is to create a sustainable mechanism which could help the poor maintain and step by step adapt their livelihoods to the more difficult natural conditions.
From May 2016, MCNV provided loans to help families to build big water containers to retain more rain water for human consumption during dry season. Loans from MCNV microfinance project in Binh Dai district allow poor family to build high capacity water container of about 3m3 each. Loans should be paid back monthly over 12 to 24 months so that it is convenient also for the poor. Up to August 2016, 150 households have borrowed from the MCNV project to build 286 big water containers with total capacity of 858m3. The loans for water containers will be available throughout this year and in coming years to create access for the poor to store more fresh water. Many more people can be supported by loans than with one time grant support.
With financial support from Jumpstart Foundation, MCNV collaborates with the Ben Tre provincial Women’s Union to establish women cooperatives, which provide stable jobs and income for poor women. These jobs help poor families to adapt to climate change by reducing their dependency on farming. Five women cooperatives will be established in Binh Dai and Ba Tri district for the production of mushrooms and dried fish, that will create jobs for at least 100 poor women. These cooperations will be the first test for more productive models for poor women in the future.
MCNV would like to establish a livelihood adaptation knowledge website to share our field experience to help poor communities to improve their livelihoods by adapting to climate change. We believe this could be very helpful for other places and people who are facing the same problems.
At the same time, MCNV also looks for Corporate Social Responsibility programs to supply water containers to kindergartens, commune health centers and friendship houses for extreme poor people in Ben Tre. Creative trainings on adapted livelihoods should be provided widely to raise awareness for everyone to better prepare them for unavoidable climate change.
Climate change impacts on livelihoods are very complex and many more poor communities will need comprehensive support to adapt to new situations. MCNV expects to find additional development partners to do practical field research and bring innovative methods that could help poor communities to stablise their lives and overcome the additional challenges from climate change.
This intervention records the first foot print of MCNV into the Climate Change sector. MCNV commits to support poor communities to adapt their livelihoods with best effective and innovative approaches to make this effort sustainable and helpful to poor people.