what we do

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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Entrepreneurship

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SDG’s: connecting the local to the global

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Working on the individual level as well as on levels, engaging more sections of society

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Social organisation of marginalised groups

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