Nghiên cứu rất quan trọng trong việc thông tin và củng cố những can thiệp của MCNV và đảm bảo rằng chúng tôi hiểu được những tác động của các can thiệp.
Nghiên cứu rất quan trọng trong việc thông tin và củng cố những can thiệp của MCNV và đảm bảo rằng chúng tôi hiểu được những tác động của các can thiệp.
ເຖິງແມ່ນວ່າ ການພັດທະນາໄດ້ມີຄວາມກ້າວໜ້າທີ່ພົ້ນເດັ່ນ ໃນຊຸມປີຜ່ານມາ ໄພອຶດຫີວຍັງເປັນບັນຫາໃຫຍ່ອັນໜຶ່ງ ໃນ ສປປ ລາວ, ສ່ວນຮ້ອຍຂອງເດັກນ້ອຍໃນເກນອາຍຸຕ່ຳກ່ວາ ປີ ຍັງຂາດສານອາຫານ ເຊິ່ງເຮັດໃຫ້ຊີວິດຂອງເຂົາເຈົ້າຕົກຢູ່ໃນຄວາມສ່ຽງ ແລະ ມັນເປັນຜົນຮ້າຍຕໍ່ສຸຂະພາບຂອງເຂົາເຈົ້າໃນໄລຍະຍາວ.
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.
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.
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.
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.
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.
Children who are born underweight or do not receive sufficient nutritious food during their first years of life have a much higher chance to die in childhood. If children are able to survive their malnutrition childhood results in a lifelong disadvantage in health as well as the capacity to develop intellectually. While the malnutrition rates for whole countries such as Vietnam and Lao PDR have steadily improved over the last decades, this masks the fact that it remains unacceptably high among ethnic minorities and other marginalized groups. Due to the developmental disadvantages that malnourished children face, they also encounter difficulties when it comes to progressing financially. These obstacles leave them at a young age to grow up as the next generation’s marginalized youth.
Malnutrition in children is strongly correlated with the poverty of their parents and the education level of their mothers. It is a complex problem comprising not only of the access to safe and nutritious food but also awareness and knowledge, food beliefs and taboos, as well as the deteriorating quality of natural resources and global developments in food systems. For many previously self-subsistent ethnic minorities economic development (growing cash crops instead of their own food) and a more ‘modern way of life’ (money to buy junk foods at the market) have made things worse rather than better.
The government of Vietnam has invested big efforts over many years but among ethnic minorities in remote areas the improvement is very slow, if any at all. Therefore NGO’s like MCNV work side by side with government agencies to try out better approaches that fit better to the local contexts.
Over the past ten years, MCNV has paid special attention to child malnutrition among ethnic minorities, specifically in the provinces Khanh Hoa and Phu Yen in Vietnam, as well as Savannakhet in Lao PDR. In Phu Yen the focus was on awareness raising and self-help activities in mother groups at the village level. In Khanh Hoa a nutritious cereal powder was developed that was locally produced and distributed by the health system to all families with malnourished children in the district. In Lao PDR the emphasis is on agricultural changes, such as home gardens, fish ponds and small livestock rearing. Positive effects have been demonstrated in several of these pilots but now it becomes urgent to combine the best approaches to find the most effective way to increase the scale in order to reach vast locations.
In the coming years MCNV will focus its work on malnutrition in Lao PDR where the problem is most severe. This will be done by systematic learning, taking the experiences in Vietnam and Lao PDR and seeing how the best interventions can be applied using the local context of Lao PDR. Together with the local population, the health, agriculture and education services will need to work together. MCNV will collaborate with researchers from the Free University of Amsterdam and the important national institutes in Vietnam and Lao PDR to produce evidence about effectiveness and sustainability of interventions. This evidence will then be widely disseminated to convince government authorities and policy makers to increase their efforts to increase the number of children who can start their life with more hope for a healthy future.
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.
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 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:
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.
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.
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.
In the health system of Vietnam, village health workers (VHWs) are grassroot based that are closely connected with villagers and are often called the “extended arm of the health sector”.
VHWs are not employees of the government; they are local community volunteers who receive special training for their community health work. The network of VHW is an important component for providing health care at the village level. The VHWs link the commune health centres with the villagers. They live in the villages where they work and provide simple health care and counselling to people, most of whom they know. The services given by VHWs are very important not only for the villagers but also for the government health system, especially to reach the poor and those living in remote areas with limited access to quality medical care.
For many years MCNV has been helping to develop capacity and improve the quality of work of the VHWs in the three provinces of Cao Bang, Phu Yen and Quang Tri. In these provinces, the VHWs have established their own organizations called the Village Health Workers’ Association (VHWA) which function as local NGOs. Currently, these VHWAs are forming a network of approximately 3,000 members. The establishment of the VHWAs came in response to the expressed needs of VHWs in the provinces to foster learning and sharing for professional capacity improvement. In addition, they make it easier to voice the concerns of VHWs and villagers at higher health levels.
One of the most important tasks of VHWs is to give health educational communication at the grassroots level, as pointed out in Circular 07/2013/TT-BYT of the Vietnam’s Ministry of Health. To improve the quality of this kind of work, MCNV has helped the VHWAs learn and successfully apply many creative methods for behavior change communication (BCC). Some methods often used for BCC activities in the community include drama, shadow drama, folk composing and singing, participatory video, photo-voice and puppet shows. Although different in terms of techniques, these two-way methods of communication improve the interactions between VHWs and villagers and are applicable to almost any community health problem. The VHWAs now have good experience and skills in these methods, contributing to making people change their knowledge, attitudes and practices for better health in a more effective way. In the period of 2011 – 2015 the three VHWAs have used these methods to provide 807 communication events for different target groups and the communities, attracting the attention of over 26,500 people.
The VHWAs are highly appreciated by local authorities and other organisations. For the past years the three VHWAs have cooperated with different organisations in the health sector, such as food safety departments, centres for HIV/AIDS prevention and district health centres, in community BCC actions. In Quang Tri, for example, the VHWA has trained groups of people living with HIV so that they can organize social events to communicate with villagers about HIV topics. The VHWAs also have good experience in working with ethnic minority groups in the border areas. One of the VHWA’s remarkable interventions is about using creative methods of BCC to communicate with groups of ethnic minority teenagers in some communes along the Vietnam – Lao PDR border, aiming at tackle the problems of unsafe sex practices and unexpected pregnancy.
The VHWAs also often train and collaborate with community based organisations, especially disabled people’s organisations, in using creative methods as a tool for expressions and life-skills development. In Quang Tri, the VHWA has been invited by other INGOs, including World Vision International and Handicap International, to provide trainings on creative methods of BCC for their partner organisations. In 2013, the VHWA joined in a consultancy mission together with MCNV to provide similar trainings to the UNFPA’s partners in Ben Tre and Hai Duong provinces. Earlier, the VHWA used to give such trainings for health workers and volunteers in Noong district, Lao PDR. In short, the VHWAs are now capable of providing technical support in creative BCC for health development projects/actions.
The working model of the VHWAs in Cao Bang, Phu Yen and Quang Tri has been reported to and appreciated by the Ministry of Health. These three VHWAs could play an important role in upscaling the model to other provinces in Vietnam in future.
Youth in Vietnam, especially ethnic minority youth in mountainous areas, increasingly face health and social problems as a result of lacking the knowledge and skills of sexual and reproductive health and rights (SRHR). Vietnam has the highest abortion rate in the world, 83.3 abortions/1,000 women. In 2012, Vietnam had the highest incidence of new HIV infections in mainland South East Asia, and more than one-third of people living with HIV are under the age of 30. The HIV epidemic is growing most rapidly where education is poor, particularly in ethnic minority areas. Many of these problems can be attributed to a lack of comprehensive SRHR/HIV education for young people, who are not provided with the knowledge and skills they need to confidently and effectively protect themselves and others from unwanted pregnancy and infection. Only half of adolescents surveyed were able to correctly identify ways of preventing the sexual transmission of HIV. Young people increasingly engage in pre-marital sex and early marriage and childbirth are common. Poverty and remoteness limit access to information about SRHR. The little SRHR/HIV education available does not incorporate life-skills approaches. The effectiveness of health education programs are compromised by not being linked to quality youth-friendly SRHR/HIV services.
To improve SRH in Vietnam, MCNV has strategies to support ethnic minority adolescents in improving accessibility of SRH education and services. We are now implementing a pilot project in Dien Bien called: “Open Door: improving access to sexual and reproductive health services for ethnic minority youths in Dien Bien high schools”. This three year project is implemented in two target schools, providing high quality life-skills-based SRHR/HIV education for ethnic minority adolescents, enabling them to make responsible choices and decisions regarding SRH and equipping them with the knowledge and skills to engage in safer sexual behaviors. This education is focused on ethnic minority youth in boarding schools and delivered through school-based youth clubs.
Technical guidance is provided by skilled SRHR health workers, teachers and women living with HIV. These clubs also aim to engage young people within the wider community outside the boarding schools, through a variety of innovative communication activities, such as drama, music and sports events. They also utilize social media channels to engage and communicate with young people. By doing this, the knowledge and skills of teachers are strengthened for better communication with young people about the sensitive topics of SRHR.
In the future, MCNV expects to expand the SRH project to other schools in Dien Bien provinces and other provinces in Vietnam. After finishing the pilot project, the technical guidance for teachers would be published and introduced to education networks, from the national level through to district level. The work will also be distributed regionally, in particular through the new Adolescent Health Platform launched in Laos in November 2016.
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.
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 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.
After almost one year conducting the project, the following results have been achieved:
In the coming years, MCNV will continue to run the program as planned to reach all objectives.