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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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Support women living with and affected by HIV

Background

HIV/AIDS epidemic has become the most emerging public health problems in Vietnam since 1990s. By the end of year 2015 there was a total of 227,000 people living with HIV while more than 75,000 people have died from AIDS. In estimation about 14,000 new cases of HIV are founded every year.

During 12 years working in HIV/AIDS area, MCNV had a considerable contribution to Vietnam HIV/AIDS situation in establishing and providing support to a community – based organization of women who are living with HIV, called Sunflowers, in seven Northern provinces in Vietnam. The program has contributed to improving access to health care for women living with HIV because of the strengthened referral system.

MCNV’s responses and achievements

Beginning in 2004, a group of women living with HIV was established by MCNV’s support. The simple aims were to ensure that, if pregnant, women can access to information and medicine that would help to prevent the transmission of HIV from mother to child. This initial pilot was successful in achieving its goals, and with the generous support of the Royal Netherland Embassy, it was scaled-up to a further three provinces between 2006 – 2009. In its third phase these achievements were consolidated and the model adapted to suit the needs of people living in remote mountainous regions. Then the program covers seven provinces and the Sunflowers group supports over 1,500 women living with or affected by HIV/AIDS and their families.

The Sunflowers groups help to ensure that they can overcome the barriers and obstacles they face to live active and fulfilled lives. This support comes in many forms, it includes: counselling and care at home and in hospitals, support to secure stable livelihoods, assistance with children’s education, and engagement with the community to reduce stigma and discrimination. Over more than 12 years the program has demonstrated that when women living with HIV work together their confidence and self-esteem increases enabling them to become powerful advocates for change and developments.

From 2012, after handing over, the network of Sunflowers had worked more independence with its own steering board of national level, and leaders of each provincial group. The Sunflowers are maintaining supports in improving health care access, income generating, and social by monthly meeting, revolving fund, and many supportive events. From this period, overcoming difficulties, Sunflower maintains its groups and networks with many valuable activities. More than 1,100 women living with HIV frequent attend the monthly meeting. Living with poor health status, many leaders of Sunflowers cannot be able to have a longer contribute to their group. Sunflower have refreshed themselves by changing most of group leaders and Network leaders and its structure.

In addition, MCNV provides health care insurance to Sunflower members, therefore, 100% of women living with HIV are protected by health insurance. The program also organizes vivid trainings to cultivate skills and knowledge to Sunflowers and their family members. Specifically, parenting skills were provided to grandparents who are raising orphan children. The training, such as hepatitis C prevention, ARV therapy, pig raising skills have been delivered to members of the Sunflower groups.

Future plan

Currently and in a couple of year MCNV is providing technical and a little financial supports, which is enabling the Sunflowers to be strengthened, and capable to work more independently as a Community Based Organization of women living with HIV, to bring support to women living with HIV continuously.

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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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