Health and Nutrition

FAST FACT

  • Theme: Health and Nutrition
  • Portfolio: 2,994,263 USD (from 2015 - 2021)
  • Key donors: Bill and Melinda Gates foundation, Atlantic Philanthropies Foundation, GSK Company, Takeda, Wrigley Company Foundation, Botnar, and Japan Social Development Fund
  • Local Partners: Ministry of Health, Department of Health at all levels, National Institute of Nutrition, Medical Universities, Traffic Safety Committees at national and provincial levels.
  • Locations: Hai Phong, Ha Noi, Yen Bai, Son La, Dak Lak, Tien Giang
  • Key beneficiaries: Newborns, children under 5, pregnant mothers and households with children under 5

Vietnam has recorded remarkable progress in economic development in the last twenty years, lifting dozens of millions of people out of poverty. However, growth and its benefits have not been evenly distributed. The gap between the rich and the poor is increasingly widening. Especially, ethnic minority groups living in the rural and mountainous areas have not benefited from economic growth.

According to the National Institute of Nutrition (NIN), malnutrition rates of children under five reduced in the last five year; the rate of underweight reduced from 17.5 % in 2010 to 14.1% in 2015, and stunting rate declined from 29.3% in 2010 to 24.3% in 2016. On the other hand, in provinces where many ethnic minority children are living, the situation of malnutrition is still a huge burden. Between 32% and 37% of children under five in those regions are stunted, while the national stunting rate is around 24.3% (NIN, 2016).

The disparity in the health status and mortality rates is also significant as well. In the 63 poorest districts, where most minority ethnic women live, maternal mortality rates are three times as high as the national average - 157 deaths per 100,000 live births [1]. Under-five mortality among minority ethnic populations was 53 deaths per 1,000 live births in 2014,[2]  more than 2.5 times higher than the national rate. The leading cause of newborn mortality in all geographical areas (mountainous, plains and urban regions) was preterm/underweight birth. In mountainous and remote low-lying areas like the target area for this project, this was followed by suffocation and then infection, which is the results of birth delivery at home and without skilled birth attendance.

In addition, delivering birth at home without skilled birth attendants is still popular in the communities of ethnic minority groups. This is due to a combination of various factors. Awareness and knowledge of maternal and newborn care is limited among mothers.[3] There are a number of complex traditional rituals surrounding births (such as worship led by a local sorcerer before and after delivery or the burial of the placenta) which are more easily performed when babies are delivered at home,[4] and many minority ethnic people feel that the overall environment of local health centres is unfriendly towards them.[5] Behaviours and practices such as using unsterilized scissors or knives to cut the umbilical cord also put minority ethnic women and their newborns at risk. In more remote areas, long distances and poor roads create physical barriers to reaching health facilities, coupled with poor quality health infrastructure, low staff capacity, and unaffordable costs.[6] 

OBJECTIVES

The theme’s strategic objectives are all designed to achieve our Survival Breakthrough: No child dies from preventable causes before their fifth birthday, as well as contributing to improve children’s access to quality health and nutrition services. More specifically, its strategic objective are as follows:

  • Provide access to quality health and nutrition services for ethnic minority people and pregnant mothers
  • Reduce child deaths and injuries from preventable causes (e.g. road crashes, drowning)
  • Reduce child mortality and stunting rates among ethnic minority children.

STRATEGIC APPROACHES

An integrated strategic approach is applied by the theme as follows:

  • Policy development. It focuses on formulating policy and a methodology to address malnutrition using traditional and affordable methods that could be replicated at a certain scale. It also enhances the engagement of school leaders, parents and communities to improve policy and support for school health and nutrition area.
  • Awareness raising. Its designed interventions focus on raising community awareness on healthy maternal and newborn practices; promoting nutritional intake based on locally available food and ingredients, strengthening community-based nutrition care, and exclusive breastfeeding promotion for infants under 6 months of age, improving knowledge, attitudes and skills related to health and nutrition in school environments.
  • Capacity Building. The theme has interventions to improve capacity for local health staff as well as ability to provide health care services of local health stations. Through this, it access to these services for ethnic minority community can be increased and demand for these available services will be increased.

DELIVERABLES

  • On January 18, 2012, Vietnam’s National Assembly made a landmark decision to extend paid maternity leave from 4 to 6 months in support of exclusive breastfeeding. Three days later, the National Assembly expanded the ban on advertising of breast milk substitutes marketed for children under 24 months, which was adapted in Decree 100/CP dated December 5, 2014. The theme made great advocacy contribution to this.
  • The Ministry of Health approved the national IYCF training manuals, one for health staff at health facilities and the other for community based workers. Those manuals have been disseminated in all 63 provinces across Vietnam.
  • A SHN manual was developed and rolled out across 60 schools. Information, Education and Communications (IEC) materials were developed to distribute widely among students. Extra curriculum classes were organized among students to help them change KAP on SHN.
  • Food and nutrition training has been rolled out with focus on farmers in intervention areas.
  • Training of Trainers (TOT) trainings for 16 provincial and district health stations and roll-out trainings for their village health workers, commune women union’s representatives and skilled birth attendants on maternal and newborn health were organized.

[1] Millennium Development Goals Full Report 2013, Vietnam

[2] Viet Nam 2014 Multiple Indicator Cluster Survey (MICS5), Viet Nam General Statistics Office and UNICEF

[3] Save the Children, SNL II project baseline survey, 2007

[4] UNFPA, Childbirth in Ethnic Minority Communities – A Qualitative Study in Binh Dinh province, Vietnam, 2008.

[5] Global Public Health, Deconstructing ‘barriers’ to access: Minority ethnic women and medicalised maternal health services in Vietnam, 2012.

[6] Save the Children, ‘Household to Hospital Continuum of Care (HHCC)’ project baseline survey, 2014