Vietnam is the first country in Asia to pioneer  the Community Health Club (CHC) Model of development to bring about hygiene behaviour change and improve sanitation coverage, adapting it to suit local cultures.  If sucessful,  Vietnam could lead the way as a powerful change agent for sound development in Asia ensuring that CHCs [...]]]> April, 2011

Vietnam is the first country in Asia to pioneer  the Community Health Club (CHC) Model of development to bring about hygiene behaviour change and improve sanitation coverage, adapting it to suit local cultures.  If sucessful,  Vietnam could lead the way as a powerful change agent for sound development in Asia ensuring that CHCs are as cost-effective as they have been in Africa for the past 15 years. Out of 48 CHCs established since 2009, six  were assessed in the three Provinces of Son La, Phu Tho and Ha Tinh over a 10 day period. In each district  a structured interview of provincial, district and commune MoH officials was conducted by the consultant to verify the CHC report for 2010. Existing MoH data from a pre and post intervention household inventory of all CHC members were used to measure knowledge and levels of behaviour change.  Standard monthly reported cases in each Commune Health Centre Changes were examined to see if there was a pattern of disease reduction.  The findings of this evaluation should provide lessons inform more effective replication and scaling up through the  National Target Programme, now entering its 3^rd phase.

Under the Hammer and Sicle Muong Bu Community Health Club is thriving

There is clear evidence that the training in the CHCs, in 24 sessions spread out over the past two years has improved knowledge of health issues and that peer pressure within the CHCs  is leading to very significent levels of behaviour change. For example there was a 42% increase in Ha Tinh and a 59% increase in Son La in good knowledge of how to make Sugar Salt Solution.  Changes in hygiene behaviour  are highly significant with a 58% increase in hand washing with soap in Ha Tinh . There has been a great effort at improving sanitation in the CHC areas, as demonstrated in Son La where 387 households  (70% of the CHC members) improved their sanitation facilites, without any subsidy, and the household inventory showed that only 4 families out of 1,036 were found to still practice open defecation. Phu Tho Health Centres in CHC communes have recorded a sharp decrease in diarrhoeal disease since the CHCs started, by 90%, 93% and 59%.  Although all communes in Thach Ha district (Ha Tinh Province) were targeted with the same IEC materials, diarrhoeal disease cases decreased by 35% in two CHC Communes but actually increased 18% and 31% in two non-CHC Communes. The CHC programme can be measured for cost per beneficiary at only US$1.30 for one year. This is remarkably cost–effective by any standards and compares well with similar projects in Africa.  As one MoH official from Ha Tinh remarked the CHC Model is ‘low cost- high impact’.

Achievements in all three provinces were made despite the fact that the CHCs were started without using membership cards, an incentive which has always been a draw card for joining CHC. With the training material complete, there is little doubt that the CHC Model will be replicated easily, scaling-up by using recommendations and lessons learnt. The Pilot Project has demonstrated that the CHC model can improve sanitation coverage and with very little subsidy, significantly reduced  diarrhoea within two years, simply by harnessing the power of peer pressure to ensure safe hygiene standards.  Within an emphasis on group consensus, the CHC Model resonates with cultural norms in Vietnam, whilst the training enables Village Health Workers  to run CHCs at very little extra cost within their duties.  This pilot project should provide the NTP3 with a sound methodology that can be predicted to achieve the Millennium Development Goals in CHC districts.

CHCs are spreading rapidly in Africa, but the question remains, ‘Can they appeal to more sophisticated rural communities in Asia?’   How can we adapt the CHC methodology to suit this very different scenario.

Since November 2009, when Ministry of Health (MoH) in Vietnam first decided to use the [...]]]> August 2010. J. Waterkeyn

CHCs are spreading rapidly in Africa, but the question remains, ‘Can they appeal to more sophisticated rural communities in Asia?’   How can we adapt the CHC methodology to suit this very different scenario.

Since November 2009, when Ministry of Health (MoH) in Vietnam first decided to use the CHC Approach,  they have, without any external support from Africa AHEAD, simply got on with the job of establishing a pilot project in four provinces: Son La, Ha Tinh, Phu Tho, and Ninh Tuan. One of the initial barriers to starting up CHCs is always the lengthy process of developing a Toolkit and Manual, and this has been done in the past six months by Africa AHEAD, supported by Danida for Vietnam MoH. However having decided to ‘do’ CHCs, there was no sitting around in Vietnam whilst waiting for the training materials to be developed.

Participants at the ToT workshop in Phu Tho, July 2010.

Dr Bang of the MoH e4njoys the sessions on Open defecation having contributed his own drawing

When I returned in July 2010 for the ‘start up workshop’ equipped  with the new manual and toolkit , we found we were lagging behind our participants, who said,  ‘Yes, interesting, we know all this, we already have CHCs!’  I was surprised to find that CHCs were not only formed up, but operating, and there are about 40 CHCs in total, 10 in each Province. Two provinces had already started the health sessions without assistence and had done 12 sessions, half of the course. They  had even developed a monitoring system based on the membership cards, having printed attendence books. Such is the power of an organised governmental system, where if the directive is given from above, the cadres below simply do it… no excuses, just get on with the job. From my experience in Africa where most external initiaitives, like a cow being driven to market on a long dusty road, need constant prodding by the driver, here I was runnng to keep up with the pace of the Asian buffalo, a symbol of hard work and fortitude in Vietnam mythology.

A Sing Song at the first CHC we met in Vietnam

A field trip was arranged to go to Da Du village in Phu Tho Province, three hours north of Hanoi. We drove up to the village Community House in the evening, where hundreds of scooters were parked, whilst people squeezed into the hall, waiting for our party of 10 outsiders to arrive. The hall was packed with around 60 men, women and children, as fascinated to see us as we were to see them.   One after another,  men and women provided  the entertainment,  without a shread of self consciousness singing gloriously into the microphone.

A traditional Vietnamese instrument provided fascinating wailing music

The Master of Ceremonies was a dedicated community organiser and  a war vet with one arm. He introduced the community members: women bravely warbling out their strong patriotic songs full of love for Vietnam,  a man who played  a  mean mouth organ, which must have survived from the war against the American GIs in the 70’s and a more traditional musician playing a one stringed  instrument, adding a surreal Chinese tinge to our spirits which soured as each speech became more and more fired up with energy for the universal cause of Health for All by 2015.

They told us that they gather every week like this for one hour of song and the second hour of health education, and using the PA system makes it all the move enthralling. Karioke in Vietnam, like most of urban Asia is very popular, and here the rural folk were having home grown plugged in performance.

Under the sagaceous gaze of Ho Chi Minh, the saviour and hero of Vietnam, the times were a-changing, but really were they?  I couldnt help feeling the CHC approach fits perfectly into a society used to  celluar socialist organisation. In Africa  we have largely dyfunctional rural communities as the brain drain to the towns leaves the less able and more conservative in the ‘rurals’,  eeking out  a basic subsistence whilst living largely on remittances from their folk in town.

Here in Vietnam, one of the last communist countries, the north still operates from the top down and the people are organised by the party, and unlike Africa they are not disorganised communities in the rural areas.

The rural areas of Vietnam  are highly regulated,  with ‘mass organisations’ like the Womens Union, that plays a key role in development in Vietnam. The people have survived  years of war and poverty and in their desperation are highly motivated to progress. It appears they only need a good reason to get together with an agenda to improve and they will achieve.

Community Health Clubs resonate with their needs. Unlike the Womens Union which are purely for women, CHCs provide a forum for men and women to get together and solve some of their health issues together.

Our Vietnamese counterparts said that they had been ‘nerveous’ as to whether the CHC would work, but having seen this CHC in the flesh, they were now ‘confident of success’ of the Methodology. I felt just the same, with a new generation primed for take off.

A child identifies key messages on the visual aids developed for the programme

In response to a strong request by the Ministry of Health, Danida agreed to sponsor the introduction of the Community Health Club (CHC) Approach, and the originator of the methodology, Dr. J. Waterkeyn (JW) was invited  to provide training and mentor local consultants so that  [...]]]> COMMUNITY HEALTH CLUBS TO BE STARTED IN VIETNAM

In response to a strong request by the Ministry of Health, Danida agreed to sponsor the introduction of the Community Health Club (CHC) Approach, and the originator of the methodology, Dr. J. Waterkeyn (JW) was invited  to provide training and mentor local consultants so that  a pilot project could beset up to test its effectiveness.  The consultant was engaged for a preliminary assignment to review progress to date and to assist in providing sound training material so that the approach could be scaled up.

The Provinces chosen for the Pilot Project were Son La, PhuTho, Ha Tinh and Ninh Thuan.  Twelve villages in each Province will start CHCs making a total of 48 CHCs if each facilitator runs one club, although it would be hoped that they could manage two or three clubs depending on the size of the area, distance between homes and availability of transport and incentives to participate.  It is expected that each facilitator will aim for a CHC of 100 members, and if this is multiplied by the number in the households who will benefit from improved hygiene, it can be estimated that the programme will serve a minimum of 2,400 people, or twice that if each facilitator runs two clubs.

The Pilot project will be integrated into existing structures such as the Women’s Union, although it should be appreciated that CHC’s embrace the whole community, not just women, as men are as important as women when it comes to disease transmission., and the CHC provides a forum for open debate on subjects that my otherwise be taboo or ignored.

The CHC will also try to mould the training so that it results in outputs that will enable families to be recognised as Cultural Families, and for CHC Villages to have the honour of Cultural Villages. Thus the graduation which will reward those who have completed 24 topics, may also include the Cultural Family awards. It is expected that local dignitaries and village leaders will avail themselves and support those who attain this level of hygiene and that the Graduation will become a day of celebration that can be an ongoing reminder to maintain good hygiene standards.

It is expected that the training will begin in December and be completed by July 2010. However before this time it would be ideal if a second Stage of the Training were planned to enable all the criteria for a Cultural Family to be met. The 1^st Stage focuses on water and sanitation, and home  hygiene, and aims to prevent common diseases such as diarrhoea, dysentery, cholera, helminthes, skin and eye disease, ARI’s as well as Swine flu, Avian Fly and Malaria. The 2^nd stage should ensure that nutrition, child care, immunisation, good parenting, substance abuse and other social issues are addressed in a complete Tool Kit which will build on the knowledge gained in Stage 1.