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.
Mental Health
Development of occupational therapy in Vietnam
Background
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.
MCNV’s responses
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 develop a group of capable OT trainers in HMTU and UMP HCMC.
- To develop a 4-year competency-based OT curriculum at a regional level.
- To pilot an OT Bachelor training course in HMTU and UMP HCMC
- To set up two OT units for practicing during training procedure.
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.
Achievements so far
After almost one year conducting the project, the following results have been achieved:
- Sending a group of 4 or more trainers from HMTU and UMP HCMC to one-month orientation course on OT in SOAHS – MU.
- Sending a group of 5 Physical Therapists to an English course and Bachelor of OT course (BOT) in SOAHS – MU.
- Sending a group of 6 key persons from MoH, HMTU, UMP HCMC and MCNV to the study tour on OT in SOAHS – MU.
- Develop the BOT program outlines for full-time and part-time training courses
- Develop the Syllabus of part-time BOT program which will be piloting at HMTU and UMP HCMC in year 2017.
In the coming years, MCNV will continue to run the program as planned to reach all objectives.
Microcredit and income insurance
Microfinance – A sustainable engine for development
Background
At the heart of the Sustainable Development Goals (SDGs) is a commitment “to eradicate poverty everywhere, in all its forms and dimensions by 2030”. Inspired from this goal, all MCNV programs in Vietnam are committed to contribute to poverty alleviation efforts by integrating microfinance tools to support marginalized groups who are normally the poorest in their community. Over the past 10 years, MCNV has disbursed micro finance services including loans for production and water retention, savings, and health insurance, to more than 7000 households with the total value of more than 650,000Euro in programs in Vietnam.
Microfinance has proved to be one of the most powerful engines in the global effort to end the crushing poverty that deprives hundreds of millions of the world’s people of sustenance and hope. Microfinance gives poor people the opportunity to establish an existence and to create a future with prospects.
Micro loans, saving and other financial services in combination with financial literacy trainings could greatly help the poor start-up their micro-businesses to generate income . This would provide the clients and their families with greater qua
ntities and more nutritious foods, education for their children and to the opportunity to improve their houses. Consequently, microfinance has an impact on the future generations.
Microfinance has a positive impact far beyond the individual household. Jobs are created, knowledge is shared, civic participation increases, and women are recognized as valuable members of their families and communities. Microfinance could also improve the community solidarity and connection between people.
An equally important part of microfinance is the revolving mechanism in using funds from donors so if microfinance is managed well, it could allow a certain amount of funding to serve more and more poor families. These funds would be more beneficial longer term so the impacts will be multiplied in comparison with other kind of development grants.
Micro-entrepreneurship is the key for the poor’s self-empowerment. It turns the poor from a passive and weak role in the development process to active agents of change. The personal talents and community support are fully mobilized for business development and this process is the best capacity building for those who are poor. Microfinance directly impacts and benefits women’s empowerment since microfinance particularly focus on women and gradually consolidates the role and capacity of women in family and in the community.
Future plan
In recent decades, the microfinance crises have showed that microfinance could harm the development if being used in an extreme way. So MCNV is making its effort to balance the social and financial performance of microfinance projects by using Social Performance Management (SPM) system. Applying the SPM permits microfinance assist the poor to escape poverty while ensuring the whole microfinance system runs as healthy as a double bottom-line financial institute.
MCNV also wants to share and expand the best practice in microfinance and social performance management to other organizations and communities. We look forward to like-minded partners and donors to promote the real microfinance with focus on social performance and sustainability.
Embracing Practices of Inclusion
A new publication by MCNV, Global Initiative on Psychiatry, and World Granny is available:
Download Embracing Practices of Inclusion
Stories of how people in Georgia, Lao PDR, Sri Lanka, Tajikistan and Vietnam made inclusive development happen in their societies.
MCNV and a.s.r. win Partnership Award 2016
On Thursday afternoon, May 12th, in the Hague, the Best New Partnership Award 2016 is awarded to the team of MCNV and a.s.r., for the best social project in a developing country.
Health Office – Lao
The main role of the Health office is to oversee the health care of all the communities in the district Nong.