what we do

Nutrition sensitive agriculture in Lao PDR and Vietnam

Background

Despite significant development progress in recent years, hunger remains a significant problem in Lao PDR, with 44% of children under 5 years old being malnourished placing their lives at risk and damaging their lifelong health. This issue is particularly severe in Nong District, one of the poorest areas in Lao PDR, and where the people can suffer food shortages for many months in the year. To tackle these problems MCNV takes a nutrition-sensitive approach to its agricultural and livelihoods work within some of poorest villages in the district.

MCNV’s responses

This approach seeks to maximize agricultures contribution to nutrition and recognizes the multiple benefits derived from enjoying a varied and nutritious diet, the social significance of food and the importance of agriculture in supporting rural livelihoods. Instead of focusing exclusively on crop production for the market, villagers use their land to cultivate a variety of commodities including fruits, vegetables, small livestock and fish. In Nong, MCNV has supported this approach by supporting the development of fish ponds, providing seeds and equipment for home gardens and strengthening village veterinary services to ensure healthy livestock. MCNV’s approach to agriculture also entails promoting gender equity, and providing nutrition education so that household resources are used to improve nutrition, especially that of women and young children. For example, the approach looks at the division of labour between men and women, to ensure mothers have enough time to breastfeed their infants. Finally, MCNV adopts a multi-sectoral approach to nutrition linking agriculture to sectors that address other causes of malnutrition, namely education, health and social protection.

Achievements

Through working in partnership with organisations ranging from village development committees to the Ministries of Agriculture, MCNV has improved agricultural production whilst preserving the soil, land and water that villagers depend upon, but most importantly it has helped to reduce hunger and malnutrition improving the health of children with lifelong benefits.

Future direction

In the coming years MCNV is working with the Food and Business Knowledge Platform and VU University in the Netherlands to conduct research into the impacts of nutrition-sensitive agriculture to ensure that it can be scaled-up so many more people in Lao PDR and elsewhere can benefit from this approach.

http://knowledge4food.net/research-project/scaling-up-nutrition-sensitive-agricultural-initiatives-in-vietman-and-laos/

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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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Women empowerment

Background

Women empowerment refers to the multi-dimensional development that supports and enable women to take control over their lives and control their future. MCNV focuses on the most disadvantaged groups; the poor rural women under the negative influence of climate change, isolated women in mountainous and remote areas, and women living with disability or HIV/AIDS. Among all projects MCNV supported in Vietnam, women empowerment became a cross-cutting theme to guide our work with particular attention to gender issues and women’s development specifically. In Ben Tre province, MCNV implements a specialized Women Empowerment program which focuses on comprehensive support on women, from economical inclusion through microfinance to improving the political participation by women through elections.

MCNV’s responses

Having a cow is a big asset for poor women. The cow helped her to gain more self-confidence and respect from others

Through microfinance projects, MCNV has made inclusive financial services available and accessible to more than 10 thousands women in Vietnam and contributed to positive changes in their lives. Women who live in rural and remote areas bear a double burden, taking care of their family and children while simultaniously generating an income with normal labor. Household burdens limit women when it comes to finding a wage job, this is due to the job locations being in the city, far from their homes and family duties. So self-employment opportunities created by household micro-entrepreneurs allow poor rural women to earn their own livings and at the same time, being able to complete their housework. The Women Empowerment microfinance project in Ben Tre has provided a wide range of inclusive financial services including credit, saving, health insurance, loans for production groups, loans for building water containers (for drought and salinity preparedness), together with financial literary and training for poor women. These services have helped more than one thousand impoverished women better the quality of their lives and increased their income and social status.

Achivements

Monthly credit group meetings is a good opportunity to learn and share among poor women

Monthly credit group meetings is a good opportunity to learn and share among poor women

Through the microfinance and livelihood development activities, women have more changes and solidarity to perform and contribute better in community work. Regular (monthly) meetings enable them to voice their matters; exchange life experience and production knowledge; and learn from each other. That self-learning process was created and maintained by MCNV projects and has become a sustainable mechanism to empower women. Through the years, many at MCNV have witnessed several examples of life improvements. Poor women became more self-confident and more skillful in production and doing business. The neighborhood and relationships were very much improved which enabled women and also men to care about and help each other.

Ben Tre women who joined MCNV capacity training for People Committee election's candidates

Ben Tre women who joined MCNV capacity training for People Committee election’s candidates

A great step forward for women empowerment is the improvement for their political participation. More female delegations in the local government could ensure the rights and voices of women to be heard and respected. Ben Tre province is the first province in Vietnam to have a project intended to improve the successful rate for women in People Council’s election. Online survey tools were also used to collection ideas and data from the field. The successful rate for women in 2016 election had increased to 28% of total People Council comparing to 22% in the last election in 2011.

Future direction

Enhancing the ongoing women empowerment efforts and sharing our experience widely to other provinces in Vietnam as well as to other countries is the target. We are now cooperating with the Center of Women and Development to start a media development project which could film the best practices and methods in this field and share the experiences widely throughout social network to advocate for women’s development.

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Support to people with disability

Background

Approximately 7.8% of Vietnamese people are living with a disability (PWD) and about 75% of them are living in rural areas. Vietnam has ratified the UN Convention on the Right of People with Disabilities (CRPD). Accordingly, the Government commits to protect the rights of PWD based on the principles of equal opportunity and inclusive development in a barrier – free society. To realize these rights, the Vietnam National Assembly has approved the Law on Disability. Based on this, the Government has in the last 10 years developed and brought into operation many policies to support the PWD, focusing on health care, education, social security and vocational training.

Problem

However, many PWD are still excluded from different aspects of complete life. About 35 % of disabled children at primary schooling age have never gone to school while this applies to only 3 % among those without disability. Still about 42% of the PWD who can and want to work could not find a job; in comparison to 4% among those without disability. PWD are faced with many challenges in socio-economic development and in their daily life when they could not access transportation vehicles or public buildings; could not participate fully in social activities due to limited access to information and communication; could not benefit from developments as they were not heard and not counted sometime and somewhere. This situation is caused by the limited capacity of public service providers in policy implementation and the weak capacity of PWD in demanding and raising their voices while stigma and discrimination against disability still exists.

MCNV’s response to the problem

MCNV has invested a lot of resources over a long time to implement activities that support the inclusion of PWD in Vietnam. The Disablity program started with Community Based Rehabilitation (CBR) as a part of Community Managed Health Development (CMHD) program in Quang Tri in the 1990s. Then it was expanded to Dak Lak (1998), Cao Bang (2001), Phu Yen (2002), Khanh Hoa (2005), and Dien Bien (2014). Today MCNV’s Disability Program consists of 4 main components:

  • Medical Rehabilitation
  • Inclusive Education
  • Income Generating Activities
  • Empowerment for PWD and Disabled People Organizations

In the implementation of the Disability Program MCNV collaborates with Governmental partners from the national to the commune level based on the existing structure of the public service system. MCNV also always involves the PWD and their families in the process. The program focuses on creating new services that are suitable to the local context of culture and resources to ensure sustainable changes in the quality of life of PWD. Much attention is given to the building of capacity for all stakeholders, including the PWD themselves, from the individual to institutional level. All support for PWD are based on their real needs and distributed with their full participation.

Achievements so far

More than 20,000 adults and children with disabilities and their families have benefited from different types of medical, educational and economical rehabilitation and social support. About 60% of PWD improved their independent functioning in daily life as a result of home based rehabilitation and referral services. 70% of poor PWD have escaped from poverty thanks to MCNV’s financial and technical support to their Income Generating Activities. 88% of CWD at school age now have access to appropriate education in the project areas. In total 47 Disabled People’s Organizations (DPO) were supported to amplify the voices of PWD in communication and dialogue on policies and services in their communities. These DPO play a fundamental role to facilitate the participation of 55% members of DPO in social and sport activities on the local and national level. The CBR model initiated by MCNV was successfully documented and integrated into the rehabilitation policy by the Ministry of Health and replicated in other provinces.

Future plan

MCNV will apply the lessons learned in supporting PWD in new areas including the Northeast and the Mekong Delta. The program will focus on facilitating cooperation among stakeholders to ensure disability issues are integrated in the mainstream of society’s development. Specific projects will be designed for PWD and their organisations to improve their capacity in lobby and advocacy for the rights of PWD. MCNV also will strengthen its cooperation with Ministries and Institutions in development of disability – related human resources as well as in seeking evidence of cost – effectiveness that can be used for policies and decision making.

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Civil Society Development

Background

Civil Society embraces the general public at large, representing the social domain that is not part of the State or the market. Civil Society is a sphere where people combine their collective interests to engage in activities with public consequence. The increasingly accepted understanding of the term Civil Society Organisations (CSOs) is that of non-state, not for-profit, voluntary organizations formed by people within the social sphere of civil society. These organisations draw from community, neighbourhood, work, social and other connections.

The Disabled People’s Organisation (DPO) encouraged disabled people to share their dreams, to develop personal plans, and to help them to make those dreams and plans come true. As an organisation we grew our capabilities to support the holistic development of individuals, families and groups of people with disabilities (written by a disabled person from a village in Quang Tri Province during a reflection session in 2015).

MCNV’s response

MCNV has increasingly strengthened and cooperated with CSOs over the years. CSOs have become an increasingly common channel through which we assist elderly, women with HIV/AIDS, ethnic minorities, youth and People with a Disability (PWD) to exercise citizenship and contribute to social and economic change. The involvement of Community Based Organisations that are organised by the marginalised people themselves, ensures their full participation in our programs.

Besides working with a myriad of Community Based Organisations in Lao PDR and Vietnam, MCNV also collaborates with civil society organisations at provincial and national level. For example, MCNV has established and cooperates with provincial ‘Village Health Workers Associations’(VWHAs).

In the health system we are so close to villagers that people call us the “long arm” of the health sector. Our Village Health Workers Association was founded in 2006, and now has 1,115 members based in 138 communes in nine districts and towns of the province. On basis of our experiences in Quang Tri, two other Village Health Workers’ Associations have been established in Cao Bang and Phu Yen provinces, in 2010 and 2011. We for example support the Disabled People’s Organisations (DPO) and Old People’s Organisations (OPA) in fundraising activities. We also assist the Community Based Organisations to prepare dramas or to make video clips to lobby and advocate for better health practices and policies (Interview with Board Member of Village health Workers Association, 2015).

Achievements

To date, MCNV has strengthened and collaborated with over a hundred CSOs and CS movements in Lao PDR and Vietnam. In addition to that, MCNV has provided Technical Advice to Civil Society Partners in Sri Lanka, Tajikistan and Georgia, on the strengthening of Civil Society Organisations in their country.

Through CBOs and their clubs, peer-to peer support is channelled and improvements in policy implementation and policy development are lobbied for. For example, Old People’s Organisations in Quang Tri successfully lobbied for an increase of the district budget for health of the elderly.

Due to the flexible characteristics of CSO organisations and due to their profound local knowledge on the culture and values of communities in remote areas of Lao PDR and Vietnam, they are in an excellent position to collaborate with other societal groups in experimenting new approaches in health and sustainable livelihood. For example in Lao PDR, the CBOs at village level named ‘Village Development Committees’ (VDC) have been partners of the district department of agriculture in experimenting new rice varieties, cattle raising and fish ponds.

Trust relationships between villagers and district partners has improved. The VDCs are able to articulate the needs of the ethnic minority groups in the villages and this has led to more communication and achievements of program interventions in the villages. (Interview with consultant evaluating the program in Lao PDR, 2014).

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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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Climate change adaptive agriculture & livelihoods

Background

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.

MCNV’s responses

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.

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Climate Change Adaptation for the Poor Coastal Community in Ben Tre

Background

Serious drought in Ben Tre 2016

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.

 

A family lacks fresh water

A family lacks fresh water

 

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’s responses

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.

A mushroom production workshop

A mushroom production workshop

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.

Future plan

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.

First members of dried fish women cooperative

First members of dried fish women cooperative

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.

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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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