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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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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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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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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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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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Sexual and reproductive health and rights-education in Huong Hoa

Summer campaign

In the border region of Huong Hoa, there are 1900 teenagers with too little knowledge of sexual matters. Their parents also want to gain knowledge and self-confidence so that they are able to discuss delicate subjects.

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Local Authorities – Vietnam

The official partner in MCNV’s CMHLD program in Khanh Vinh district, Khanh Hoa province, is the District People’s Committee.

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Local NGOs and CBOs – Vietnam

In Vietnam, MCNV also actively cooperates with local non-governmental organisations (NGOs) and community-based organisations (CBOs).

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Women’s Union – Lao

The Lao Women’s Union is a close partner of MCNV, helping to promote gender equality throughout the whole district.

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Women’s Union – Vietnam

The Vietnam Women’s Union is one of the most important partners in MCNV development programs in Vietnam, at all levels.

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