What we do

Background

Research is vital for informing and underpinning MCNV’s interventions and ensuring that we can understand their impact. It also helps to ensure that knowledge is generated to inspire new ideas, catalyse innovations, and provide evidence to policy makers to inform their decision making and help ensure that policies are effectively implemented. The publication of research also helps to inform others of new processes, methods, techniques and ways of thinking that contributes to improved ways of working to reduce poverty and improve health.

MCNV’s responses

In Lao PDR, MCNV runs the LEARN (Lao Equity through policy Analysis and Research Networks) this a 5 year program that is funded by the EU Commission to enhance the capabilities of public health institutes in Laos. Working together with a range of partners the program aims to ensure that the Laos National Institute of Public Health becomes of centre of excellence for the provision of evidence-based and contextually adapted policy advice. This evidence is used to enhance decision making and improve the implementation of health policies both within Laos and the wider Greater Mekong Sub-region (GMS)

LEARN brings together a unique range of partners to achieve this goal. As well as the Laos National Institute of Public Health, LEARN also brings together the University of Health Sciences in Laos, the VU University in the Netherlands, the Hanoi School of Public in Vietnam and MCNV, an international NGO that has been working in the health sector in the GMS for many decades.

These partners come together to help ensure that:

• Effective and convincing evidence is available to policy-makers who are better able to use it for policy making and programming
• The National Institute of Public Health and its partners have increased access to finance, skilled human resources and information.
• Researchers are able to produce high quality research and are able to convincingly present results and recommendations to a wide range of stakeholders.

Expected results

During its 5 year implementation the program will support a range of activities including;

• International scholarships for Lao researchers to gain Phd’s
• A joint Masters in Public Health Program between University of Health Sciences and Hanoi School of Public Health
• Upgrade of IT facilities and introduction of public health e-learning resource centre
• A research grant scheme to support the production of high quality research with Laos
• Development of a long-term strategic plan for National Institute of Public Health
• A wide range of workshops and trainings in areas ranging from ethics, transdisciplinary research practice, and production of policy briefs.

In addition to this major project, MCNV also conducts research in a wide range of areas including the impact of its agricultural interventions on nutrition and how these can be scaled-up, the use of IT in development, the control and prevention of malaria, the effectiveness of self-help groups in empowering people living with HIV and examining barriers to policy implementation in areas as diverse as the provision of mental health services and access to mother and child healthcare. Research is often conducted in partnerships with Dutch Universities such as VU University. The research is action-based and reflective and is designed to ensure that all people are involved in the process, for complex issues such as malnutrition, multiple stakeholders and engaged in the research and transdisciplinary approaches are used. MCNV’s works in research helps us to understand better the world around us and ensures we can support people within development processes to make the world a better place.

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.

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.