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Nhanhs_familyDong Thap, February 2010 - Thirty-six-year-old Ms Nhanh moved to Lung Hung A Commune 10 years ago after marrying her husband, who comes from the area. Now with two children, 10 and two-years-old, Nhanh is just one of the many mothers in the area that have benefited from the commune’s maternal health community outreach education initiative, part of UNICEF’s Provincial Child-friendly Programme (PCFP) being implemented in 6 provinces across Vietnam.

Co-organised by the commune’s 14 health workers and village motivators following UNICEF training and capacity building, each session sees the participation of between 20 and 30 women and addresses a wide range of maternal and infant health issues such as pregnant and postnatal care, disease prevention, nutrition and hygiene.

“We received a lot of good information to take care of our children’s health during the village communication meetings,” Nhanh said. “I learnt that I have to take iron tablets during the pregnancy up to the delivery date. Half-an-hour after the delivery I have to start breastfeeding and continue for the first six months. I also have to get my children  immunized and weigh them every month so I can enter their weight on their growth charts.”

One copy of the charts is kept by the parents and one by the health centre in order to monitor child nutrition in the commune, which is one of the most serious health threats for children in the area.

Innovative approach
The community education outreach initiative employs pioneering approaches to get its many messages across and, together with other aspects of the PCFP, has been credited with significant improvements in the health of the people.

The sessions primarily focus on reproductive issues, women’s health concerns, childcare and nutrition, thereby helping to tackle some of the most challenging health threats to the local community.

talknig_book_goodOne such approach is the use of the UNICEF electronic ‘talking’ health booklets – small, cheap and easily transportable flip page booklets containing illustrated key health messages. An electronic speaker at the back of the booklets reads out the messages on
each page to help facilitators conduct the educational sessions.

Developed in association with the Ministry of Health, the UNICEF talking booklets ensure  consistent message is taught at each session and help village motivators and the audiences to overcome any embarrassment they may have talking about sensitive issues in such a public forum. Many of the trainers are low-educated women from the local area and are not used to talking to large groups of people.

The talking booklets therefore provide an attention-grabbing tool that releases some of the pressure of ‘performing’ in front of crowds. Recorded in the local southern accent rather than the standard Hanoi accent normally used in TV and other state-sponsored educational outreach activities, the booklets also provide a message tailored to local conditions in language that locals can understand and relate to. In other PCFP-targeted provinces the booklets are made in local ethnic minority languages to ensure the localisation of the message.

“The equipment is very useful to get people’s attention,” said Mr Ngoan, head of the Binh Thanh Trung Commune Health Centre. “In the past we used to use normal booklets to  communicate messages but now we use the talking booklets in health outreach activities with the community and people really like this approach. Communities are actually requesting sessions with the talking booklets and are eager to attend.”

Local solutions
Under the PCFP, UNICEF trainers have introduced a new locally-based approach to health planning in the area.

“In the past, we had top-down training; now we have bottom-up participatory training based on the real problems facing particular areas,” said head of the Long Hung A Commune Health Centre Ms Lieu.

This is important as health threats vary significantly across the province and, if statistics are anything to go by, the approach is certainly paying off.

“There has been no major outbreak of diseases such as dengue fever or cholera in the area since the training and other more common water-bourne diseases have also been decreased,” said Ngoan. “By this time last year we had 25 cases of dengue fever, but this year there has been only 3.

Cooperation the key
A key factor contributing to the success of the health initiative has been the close cooperation between UNICEF, local authorities, the community and health workers. Indeed, today the Binh Thanh Trung Commune Health Centre is located in a brand new building with a range of new training, education and medical equipment thanks to an effective partnership between UNICEF, provincial and district authorities and the local People’s Committee.

Fresh_watersmallAnother example of the PCFP’s success can be seen in the 320-metre deep freshwater tubewell installed in Long Hung A Commune through an innovative cooperative approach between UNICEF, local authorities and residents. The well was built on land donated by a local farmer, with technical assistance and funding coming from UNICEF and the WATSAN (Water and Sanitation) National Targeted Programme.

Not a rich man by any means, 48-year-old Mr Tang donated the land for the pumping station to be built because he saw a pressing need for clean water in his community. With a large family of six children (five girls, one boy), he has a real personal interest in improving the health of the local people.

“We live in a very remote area that was heavily affected by the war and people have very poor living conditions here,” he said. “Conditions are very difficult. During the six months of the rainy season, water levels increase a lot, bringing a lot of dirty water to the area.”

“In the past we had to get dirty water from the river and treat it for 8-10 hours with allum in a jar before we could use it. During the dry season when the river level was very low, the water was very polluted and it often made people sick. Now with the new water system, it’s very convenient. When we want water, we just turn the tap and it flows.”

More time and money
Prior to the completion of the pumping station, water collection and treatment took at least two-to-three hours every day and women used to wash themselves regularly in the river, which led to a wide range of women’s health issues.

Using dirty water on a daily basis was also cashdraining on local families. Besides the monthly cost of the chemical allum, the cost of curing water-related diseases such as diarrhoea and skin diseases could eat into the household incomes significantly.

“Water supply has always been very difficult here and I wanted to help,” Tang said. “We
received international assistance from UNICEF and all I had to provide from my side was some land to get water for the community.”

Nhanh’s family is also one of the 100 households in the area to benefit from the UNICEF-sponsored well. Despite living literally next to a river, collecting and treating the river water used to consume a great deal of her time, and still provided no absolute guarantee of safe water for her family.

“Since we have the clean water supply system, my family is much healthier, we don’t get sick so often and don’t have to spend so much money on medicine,” she explained. “There are less women’s diseases among my friends and I don’t have to spend a lot of time collecting and cleaning the river water so I have more time to look after my children.”

Fourth generation local farmer Mr Hao was one of the early families to be linked up to the pipeline network and his house now sports a sparkling new flushing toilet and shower. With four kids aged 13-26, Hao has a clear understanding of the impact of the clean water system.

“My family has been living here as farmers for generations and I know how much pollution gets released into the rivers from the rice fields in the form of fertilizers and other chemicals,” he said.

“Our children used to get sick quite often, particularly from raw vegetables washed in the river water. I believe the new water supply system is very important for reducing diseases in the area.”

The well has a capacity of 400 households and each month new families are added to the water system through a slow expansion of the pipe network. It normally takes four years for a well to reach capacity but already its impact has been significant.

“Skin diseases, women’s diseases, dengue fever and water-borne diseases have all decreased since the clean water pump has been operational,” said head of the Long Hung A Commune Health Centre Ms Lieu.

With continued support, more parents like Hao, Nhanh and Tang will enjoy the peace of mind that comes with knowing the water their children are using is safe, clean and cheap.

Together with the community health outreach activities and other UNICEF initiatives in the area implemented under the PCFP, these families can look forward to a healthier, better informed and cleaner community for their future generations.

- Photos and text by Eddy McCall

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