Health Development

Improving nutrition for hundreds of Cham H’roi children

Located in the remote mountainous area of Phu Yen province, 100% of Phu Mo commune’s residents are of Cham H’roi ethnic group. 25% of the children in the community are malnourished. Being aware of this situation, MCNV has cooperated with local partners in Phu Yen to bring about better meals and better lives to the children.

Malnutrition obsession

On contrary to the name which means “rich and fertile”, Phu Mo is known as the highest, remotest and poorest commune in the southern central province of Phu Yen.

With a population of more than 3,000, 70% of the local residents are impoverished or living on the threshold of poverty.

Local people earn their living on shifting cultivation, earning for their livings mostly by planting cassava. Due to the instable price, this crop only can help them generate a limited and instable income. Rice, cassava leaves, wild vegetables and chili mixed with salt are what usually seen in their daily meal.

According to a survey conducted by MCNV and Hue University of Medicine and Pharmacy in March 2018, 76.7% of the households in Phu Mo and Xuan Quang 1 communes (Dong Xuan district) did not have sufficient food to eat each year. Besides low income, people in these localities face with another challenge in access to food, which is the shortage of supply, since most nearby groceries only sell dried food like instant noodles, porridge and snack for kids. Meanwhile, in kindergartens, neither lunch nor breakfast is provided due to the lack of funding.

In Phu Mo commune, out of 100 kids, 25 suffer from malnourishment, in the form of stunting or underweight. In some villages, this rate even exceeds 50%.

Mang Thi Su, 25 years old, is a mother of two children: one boy (6 years old) and one girl (3 years old). Both of them were pale and weak, due to malnutrition. Feeding the kids was a tough job for the young mommy, since regardless of how hard she tried, her children kept refusing to eat.

Mang Thi Su prepares a meal for her children

According to MCNV, the high rate of malnutrition in Phu Yen is caused by several factors. Apart from economic constraint and scarcity of quality food supply, parents’ lack of understanding and knowledges in childcare and nutrition is a critical factor which must be tackled.

Awareness change

In June 2018, the concerns of Su and other women in Phu Mo commune began to be relieved thanks to the project “Scaling up of malnutrition fighting initiatives based on agricultural solutions in the mountainous areas of Vietnam and Laos ”(referred to as Nutrition Sensitive Agriculture – NSA), implemented by MCNV.

Thanks to the project, for the first time, Su gained basic knowledge in nutrition, learn how to prepare suitable meals for her children with tasty, nutritious yet still affordable dishes.

The instruction of nutritionists and healthcare advisors has enabled Su to diversify the ingredients for the daily meals, and turn them into child-friendly dishes (pleasant to taste and easy to digest). The dishes Su cooks now looks more catchy, as they are added the colors of a variety of healthy ingredients. Some of them are very easy to find in her home garden, such as tomatoes, carrots, eggs, etc.

Nowadays, in Su’s family’s every meal, the pleasure has replaced the worry, and the excitement has filled the eyes of the children. Her home is now full of smile and laugher, instead of the sound of scolding and crying. “He (Su’s son) loves colorful dishes very much. He can eat one bowl or even one and a half bowl of rice with food. I am overwhelmed with joy, especially when he finishes eating, sits on a scale and asks me “Mom, how much do I weigh now?” In the young mom’s eyes, happiness sparkles.

The change in one individual step by step leads to the change of a group and later on spread to several groups. Every month or every week, members of each group gather for a meeting, at which they share about the health and nutrition situation of their children. They often exchange opinions and learn from healthy child-rearing examples and update cases that need to be monitored, practicing how to prepare nutritious and affordable dishes.

Joining hands to solve the malnutrition problem

Improving the community’s awareness about nutrition in childcare is one of the many activities conducted in the NSA project. A holistic approach has been implemented with the close coordination of four sectors: health, agriculture, education and private businesses.

Under the coordination of local health staff, district, commune and village workshops and trainings were implemented. Health workers, leaders of mother groups and pre-school teachers are trained in nutrition and environmental sanitation. Children get regular health checkups, and severely malnourished children receive treatment.

In addition, households are trained to increase production, improve nutrition from their own gardens, fields and yard, for example raising chicken to lay eggs, or intercropping with vegetables and fruits.

To increase the quality of children’s meals, the NSA project also gives funding to preschools to provide in-school lunches and breakfasts, as well as orienting the private sector (food and grocery stores) to sell nutritious products such as porridge, cakes, and cereal flour, and facilitating the household to access nutritional products.

The NSA project is implemented by MCNV in Dong Xuan district in the period of 2017-2020, in cooperation with different partners, including WOTRO, the Vrije University Amsterdam (Netherlands), Hue University of Agriculture and Forestry, and Hue University of Medicine and Pharmacy.

Not only does it solve the problem of malnutrition among Vietnamese children, the NSA project also supports Lao children in 10 villages of Nong district, Savannakhet province. Currently, the Lao side has completed the initial survey, knowledge sharing and quantitative research survey toolkit, trained on research methods, data analysis, development of intervention plans and organized some initial intervention activities.

MCNV’s nutrition project is an effort towards the UN’s Sustainable Development Goal No. 2 on hunger eradication, food security, nutritional improvement and agricultural development.

By Phi Yến (Vietnam Times)

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Learning through health research

Background

Research is vital for informing and underpinning MCNV’s interventions and ensuring that we can understand their impact. It also helps to ensure that knowledge is generated to inspire new ideas, catalyse innovations, and provide evidence to policy makers to inform their decision making and help ensure that policies are effectively implemented. The publication of research also helps to inform others of new processes, methods, techniques and ways of thinking that contributes to improved ways of working to reduce poverty and improve health.

MCNV’s responses

In Lao PDR, MCNV runs the LEARN (Lao Equity through policy Analysis and Research Networks) this a 5 year program that is funded by the EU Commission to enhance the capabilities of public health institutes in Laos. Working together with a range of partners the program aims to ensure that the Laos National Institute of Public Health becomes of centre of excellence for the provision of evidence-based and contextually adapted policy advice. This evidence is used to enhance decision making and improve the implementation of health policies both within Laos and the wider Greater Mekong Sub-region (GMS)

LEARN brings together a unique range of partners to achieve this goal. As well as the Laos National Institute of Public Health, LEARN also brings together the University of Health Sciences in Laos, the VU University in the Netherlands, the Hanoi School of Public in Vietnam and MCNV, an international NGO that has been working in the health sector in the GMS for many decades.

These partners come together to help ensure that:

  • Effective and convincing evidence is available to policy-makers who are better able to use it for policy making and programming
  • The National Institute of Public Health and its partners have increased access to finance, skilled human resources and information.
  • Researchers are able to produce high quality research and are able to convincingly present results and recommendations to a wide range of stakeholders.

Expected results

During its 5 year implementation the program will support a range of activities including;

  • International scholarships for Lao researchers to gain Phd’s
  • A joint Masters in Public Health Program between University of Health Sciences and Hanoi School of Public Health
  • Upgrade of IT facilities and introduction of public health e-learning resource centre
  • A research grant scheme to support the production of high quality research with Laos
  • Development of a long-term strategic plan for National Institute of Public Health
  • A wide range of workshops and trainings in areas ranging from ethics, transdisciplinary research practice, and production of policy briefs.

In addition to this major project, MCNV also conducts research in a wide range of areas including the impact of its agricultural interventions on nutrition and how these can be scaled-up, the use of IT in development, the control and prevention of malaria, the effectiveness of self-help groups in empowering people living with HIV and examining barriers to policy implementation in areas as diverse as the provision of mental health services and access to mother and child healthcare. Research is often conducted in partnerships with Dutch Universities such as VU University. The research is action-based and reflective and is designed to ensure that all people are involved in the process, for complex issues such as malnutrition, multiple stakeholders and engaged in the research and transdisciplinary approaches are used. MCNV’s works in research helps us to understand better the world around us and ensures we can support people within development processes to make the world a better place.

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Sexual and reproductive health and rights in Dien Bien province

Background

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.

MCNV’s responses

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.

Future plan

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.

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Network of village health workers

Background

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.

MCNV’s responses

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.

Achievements

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.

VHWs facilitated puppet making as a life-skills development activity for disabled youths

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.

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Nutrition improvement for children

Background

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.

Good nutrition is a Child’s Right

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.

MCNV’s response

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.

Future plan

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.

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Sexual & reproductive health for teenager in Huong Hoa

Background

Huong Hoa is a remote district of Quang Tri province, located in the border area Vietnam – Lao PDR. The district has a total population of nearly 80,000 in which above 50% are people from ethnic groups of Pacoh and Bru Van Kieu. In the villages along the border area where MCNV works, out of total population of 12,353 people, there are 1,999 poor households (16.2%) and 9,835 ethnic minority people (79.6%).

The Pacoh and Bru Van Kieu have no written language and have limited access to educational information and quality health services. They mainly live on growing banana, cassava, corn, and some rice, and practice shifting cultivation on the poor highlands. They work hard but obtain insufficient income to afford health and educational services. Similar to other ethnic minority groups in Vietnam, as a consequence of poverty and low awareness, they lag behind in all aspects of the development process.

Problem

As a cultural custom, teenagers of Pacoh and Bru Van Kieu ethnic groups are allowed by their parents to date quite freely, and they are allowed to get married, too, when they are still very young. Having sex is almost unavoidable among teenagers. The problem is that so many of them do not have enough basic knowledge in SRH, putting themselves always at risk of bearing unexpected pregnancy and sexually transmitted diseases (STDs). While SRH is not taught at schools, teenagers in this remote area also have limited access to educational messages about SRH through other channels of information. And even if they are aware of problems related to SRH, they avoid talking about it as it is too much “sensitive” or “private” to talk about.

A baseline survey done with teenagers in this area in 2013 has given shocking data – 56% of teenagers under 16 already experienced having sex, 78% didn’t know how to protect themselves from STDs, 14% of teen-girls got unexpected pregnancy, and 97% didn’t prove that they had enough basic knowledge in contraception.

MCNV’s responses

Since mid-2015, MCNV has launched a project to help tackle this problem. We started with co-creation workshops with some groups of active teenagers and village health workers (VHWs) selected from two piloted communes of A Tuc and A Xing. Co-creation workshops enabled the teenagers to get basic understandings about SRH, analyse their real problems, identify practical solutions and come up with an action plan. A story-based approach was applied so that the teenagers could share true stories that happened as a consequence of unsafe sex practices in their community and, with technical support from MCNV staff and the VHWs, re-formulate the stories in the form of shadow drama and puppet shows. The teenagers then presented the shows in combination with community events and interacted with the audiences about SRH aspects related to the stories. The community events were organized every month by the teenagers with the participation of peer/interest groups – youth football clubs, and RAP and hip-hop groups.

In parallel with this way of behavior change communication, some teenagers also volunteered to sell condoms at home, which was more easily approachable to the young people. In contrast, condoms could be easily found at the commune health stations, but the teenagers would never come there to ask for.

Another solution was to use the photo-story telling technique to tell the stories in the form of animations and shared them on the social media to reach and interact more with the online community. We also used a mass instant messaging service to deliver educational messages about SRH for teenagers in this remote area in a weekly basis.

Achievements

One of the most significant change, as revealed from 40 in-depth interviews and 4 focus group discussions recently with the teenagers directly involved in the project, is that they have changed their mindsets, attitudes and behaviours about SRH at teenage and actively communicated with their friends, families and neighbours to raise their awareness about this topic, which they never dared to speak out before.

Four small groups of teenagers, about 10 members each, have produced 4 shadow plays and 4 puppet shows and used them for behavior change communication events and for online communication.

An added value of the project was the increase in the teenagers’ power and motivation to make contribution to the community development, which they thought before to be the adults’ affairs. They have become more united for it, as well. There used to be tensions and conflicts among different groups of teenagers, making them not dare to go from one commune to another for fear of being beaten. Now they have become friends, instead.

Further evaluation will be done in the coming time to see changes in SRH knowledge, attitudes and practices among more than 600 teenagers and older young people in these two communes.

Future plan

We expect to maintain this project in these two communes and upscale it in other three neighboring communes of Huong Hoa district in 2017 and 2018, directly benefiting to about 1,300 teenagers and older young people. In this new phase, we will promote the role of local leaders, parent groups and schools (both high schools and secondary schools) in changing SRH practices among teenagers. In addition, we will collaborate with the district and commune health centres and the Association of VHWs in applying e-health initiatives in SRH communication.

Good practices and lessons learnt from this project will be documented and shared with relevant organisations and networks, such as UNFPA, Barefoot Guide Alliance, ARROW, ADF, WGNRR, and the Vietnam’s health sector and policy makers.

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Mental Health

Mental Health (MH) disorders significantly contribute to the worldwide burden of diseases. The health services and policies in Vietnam pay only limited attention to MH.

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Development of occupational therapy in Vietnam

Background

Rehabilitation has been developed in Vietnam for more than 40 years; it is still a big gap of Occupational Therapy (OT) development. The main rehabilitation practice in Vietnam is Physical Therapy (PT), yet there are currently no qualified occupational therapists in Vietnam. OT services are provided by physiotherapists with minimal clinical training in OT, or by occupational therapists from other countries who come for short periods. It is only available in a few large hospitals. Specific OT services were unavailable for mental rehabilitation, elder care, home-based care, school-based services for children with special needs, etc. The faculty (PT and Rehabilitation doctors) may not be well-equipped to teach OT in depth, due to lack of experience, equipment, and resources, limited information from books, especially those written in English. In addition to the lack of qualified OT doctors, those qualified with Masters to teach OT are not available in Vietnam. The participants of OT training survey were of the unanimous opinion that OT education needs to be commenced in Vietnam.

Being aware of the fact that OT is essential to provide comprehensive rehabilitation services, the Ministry of Health (MOH)’s orientation of rehabilitation development up to year 2020 stated that OT is one of specialized fields in rehabilitation. It is obligatory to establish Occupational Therapy Departments in Rehabilitation Hospitals as well as Provincial General Hospitals.

MCNV’s responses

In October 2015, MCNV received a fund from USAID to run a 5 – year project of OT training development in Vietnam. The project’s goal is to create the foundation and necessary conditions in order to develop the training system of professional OT in Vietnam, including the provision of OT trainers, competency-based training curriculum and OT-related policies. Specific objective of this project as follows:

  • To develop a group of capable OT trainers in HMTU and UMP HCMC.
  • To develop a 4-year competency-based OT curriculum at a regional level.
  • To pilot an OT Bachelor training course in HMTU and UMP HCMC
  • To set up two OT units for practicing during training procedure.

To implement this project in the context of having no OT experts and trainers, MCNV already approached School of Allied Health Sciences, Manipal University (SOAHS – MU), India to ask for technical support during the project implementation. Two universities in Vietnam were involved in this project including Hai Duong Medical Technical University (HMTU) and University of Medicine and Pharmacy, Ho Chi Minh City (UMP HCMC). The project has also received strong supports from Administration of Medical Service and Administration of Science Technology and Training, MoH.

Achievements so far

After almost one year conducting the project, the following results have been achieved:

  • Sending a group of 4 or more trainers from HMTU and UMP HCMC to one-month orientation course on OT in SOAHS – MU.
  • Sending a group of 5 Physical Therapists to an English course and Bachelor of OT course (BOT) in SOAHS – MU.
  • Sending a group of 6 key persons from MoH, HMTU, UMP HCMC and MCNV to the study tour on OT in SOAHS – MU.
  • Develop the BOT program outlines for full-time and part-time training courses
  • Develop the Syllabus of part-time BOT program which will be piloting at HMTU and UMP HCMC in year 2017.

In the coming years, MCNV will continue to run the program as planned to reach all objectives.

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