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Reproductive Health Project 8 years in Nghe An Province Vietnam Phase I : June 1997 – May 2000

Reproductive Health Project 8 years in Nghe An Province Vietnam Phase I : June 1997 – May 2000 Phase II: Sept. 2000 – Aug. 2005. Nghe An Province. 1 city, 1 town, 17 districts, 469 communes Pop. 3 million. Reproductive Health Project. Ｖｉｅｔｎａｍ　Ｒｅｐｒｏｄｕｃｔｉｖｅ　Ｈｅａｌｔｈ　Ｐｒｏｊｅｃｔ.

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Reproductive Health Project 8 years in Nghe An Province Vietnam Phase I : June 1997 – May 2000

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  1. Reproductive Health Project 8 years in Nghe An ProvinceVietnam Phase I : June 1997 – May 2000 Phase II: Sept. 2000 – Aug. 2005

  2. Nghe An Province 1 city, 1 town, 17 districts, 469 communes Pop. 3 million

  3. Reproductive Health Project Ｖｉｅｔｎａｍ　Ｒｅｐｒｏｄｕｃｔｉｖｅ　Ｈｅａｌｔｈ　Ｐｒｏｊｅｃｔ Working with Womenfor a Better Future Aiming for better client-friendly services for the reproductive health of women

  4. Reproductive Health Project Overall goal: To improve reproductive health of women of reproductive age in Nghe An Province Project Purpose: To improve reproductive health service in Nghe An Province

  5. Project Area: Nghe An • Administration (1 city, 1 town, 17 districts and 469 communes) • Area: 2nd largest in Vietnam • Geographical diversity (2/3 of area covered with mountains, 1/3 of area is plain or coastal area) • There are many rivers and boat is one of the transportation means in some mountainous area.

  6. Nghe An Province • Population : 3 mil- 4th largest in Vietnam • Ethnic Minority (consist of 16% of total population) • Low economic condition (43rd among 61 provinces of Vietnam in 1997) (Since 2004, 59 provinces + 5 special cities) • Literacy rate: 90%

  7. Vietnam Birth rate：19.9‰ Death rate：5.6‰ TFR：2.33 IMR：36.70‰ TT：85% Delivery attended by health workers：78% No. of health staff：1 health staff/ 403 pop. Secondary midwife：1 per 7,757pop. Nghe An Province Birth rate ：21.01‰ Death rate ：6.72‰ TFR ：2.73 IMR ：30.65‰ TT ：90% Delivery at health facility: 90% (plain area only) Delivery attended by health workers: about 70% No. of health staff ：1 health staff /426pop Secondary midwife ：1 per 13,419pop. Health statistics 1999 MOH 1999

  8. Vietnam Birth rate： 17.5 ‰　 Death rate：5.8‰　 TFR： 2.1　 IMR：21.0 ‰　 TT：91%　 Delivery attended by health workers：96% No. of health staff：1 health staff/ 399pop. Secondary midwife：1 per 6,383pop. Health statistics 2003 Nghe An Province • Birth rate： 17・7‰ • Death rate：6.5‰ • TFR： 2.4 • IMR： 24.0‰ • TT：97% • Delivery at health facility: over 98% (plain area only) • Delivery attended by health workers：85% • No. of health staff：1 health staff/ 466 pop. • Secondary midwife：1 per 8,491 pop. Health Statistics Year book 2003 Report by MCH/FP Center & PCPFC

  9. Project Site Phase I • 8 districts 266 communes • Pop. 1.55 million Phase II • Whole Province1 city 1 town 17 districts, 469 communes • Pop. 3 million ●Vinh City

  10. JICARH Project aims at: Phase I1997.6～2000.5 Realization of hygienic and safe delivery at the commune health center (CHC) Pre-natal care Improve facilities Midwifery care Postnatal care Phase II2000.9～2005.8 Improvement of Quality RH Services in Nghe An Province Family Planning RTI Reduction of Abortion HMIS

  11. Challenges for Phase II ～From Phase I to Phase II～ • Improvement of quality of RH services • Gap between mountainous area and non-mountainous area in RH services • Improvement of health information system • Strengthening management capacity of Vietnamese Counterparts (MCH/FP Center, DHC, Women’s Union） • Male involvement and further awareness creation

  12. Meeting the challenges in Phase II ~ Quality of RH Services ~ September 2000 ~ August 2005 1) Promotion of client friendly services 2) Strategy development for RTI prevention 3) Improvement of Health Management Information System (HMIS) 4) Health promotion by the community based organizations (eg. Japanese model: activities by women volunteers) 5) Improvement of post-abortion counseling and FP services for reduction of abortion 6) Collaboration with various organizations through Women’s Union and encouraging men to participate in RH promotion activities

  13. Characteristic of the Project June 1997 ~ May 2000/ September 2000 – August 2005 • Focus on commune level • GO-NGO collaboration • Establishment of Steering Committee • RH Model Formulation • Plus α・・・

  14. 1. Focus on commune level • Commune level is given priority Phase II: Estimated Inputs Sept. 2000 ~ May 2005 Total：about US$2,210,000 • Total amount not included the cost for experts and counterpart training • Support by Grant Assistance for Grass-root projects included R

  15. 2.GO-NGO collaboration • Grass-root approach through collaboration of JICA and NGO (JOICFP) which has rich experiences in working with community people • Community involvement in project promotion in collaboration with Women’s Union • Project supporting unit established at JOICFP

  16. 2. GO-NGO collaboration Network with International organizations Network of Japanese experts Tokyo Hanoi Project Supporting Unit Network of Human Resources in Developing Countries JICA RH Project Office

  17. Birth of RH ProjectFrom NGO to ODA Project • 1988～:JOICFP “Integration Project（IP)” Environmental sanitation, parasite control, MCH/FP Pilot project in 9 communes in 3 provinces (Nghe Tinh, Hue,Long An) Implemented in collaboration among 4 parties: Vietnam MOH, UNFPA, UNICEF, and JOICFP laterexpanded to 70 communes • 1997～: “JICA RH Project” 244 communes 469 Communes

  18. 3． Project Steering Committees • Established at provincial, district and commune level • Representatives of • People’s Committee • Health Center • Women’s Union • Population-Family-Children Committee • Responsible for the project management (nearly 2,000 members)

  19. Advisor Observer Rreproductive Health Dept. リプロダクティブヘルス局 Project Management Structure MOH 保健省 Japanese Embassy Nghe An Provicial People’s Committee Health Service, MCH/FP Center,Women’s Union Population, Family, and Children Committee JICA Experts, JICA Vietnam Office Joint Commitee ＪＩＣＡ Project Team Provincial Steering Committee MCH/FP Center District Steering C. District Health Center Committee for Population Family and Children District People’s Committee District Women’s Union Commune Steering C. Commune Health Center Committee for Population Family and Children Commune Women’s Union Commune People’s Committee Hamlet Health Worker Support and report Hamlet Women’s Union FP Collaborator Services Community People R

  20. 4. RH Model Formulation • Present a model for practical implementation of the Vietnamese Government’s RH related guidelines, policies, and strategies • Major role player of the Project is existing system and personnel • Share experiences and make recommendations to the national policy and strategies（dissemination model） ★The experience of the Project has been reflected in the National 10 year RH strategy for 2001 – 2010 。 R

  21. Characteristic of the Project ~Plus α~ • Collaboration with the other ODA scheme (eg.Cooperation with JOCV) • Conducting survey and research to benefit the project implementation • Collaboration and cooperation with other agencies such as Population Council, UNFPA, WHO, the World Bank and GTZ

  22. Activities • Package approach for CHC ＊Training ＊Equipment supply ＊Renovation of facilities • Human Resource Development • Research and study

  23. Retraining of CHC midwives Supply of medical equipment Renovation of CHC facilities Activities1. Package Approachfor CHC One month course 26 coursesnearly 600 participants (1998 ~ 2005) Delivery room, toilet, shower room, and well Medical equipment for Pregnancy care and delivery care In selecting the equipment, the consideration is given to the condition of the area and the other donor’s inputs.

  24. Activities:2. Human Resource Development • Improvement and maintenance of RH services at CHC • Strengthening management capacity of Vietnamese Counterpart • Promoting health education for the community people • Learning form the Japanese experiences

  25. Various training, seminars, workshopsat Provincial, district and commune levels • Orientation and workshops for project steering committees/collaboration strengthening workshop/ advocacy seminar for leaders/ media seminar • CHC midwifery staff re-training/ refresher courses • Workshop on monitoring methods • Participatory planning by PCMworkshop • IECworkshop for RH knowledge dissemination • Technical training (midwifery, ultrasound, post-abortion counseling, RTI examination and diagnosis, HMIS、IEC material utilization, formulation of health plan, community based health promotion, etc.) • Training on hospital management (management of MCH/FP project, utiliation of home based maternal record: HBMR, HMIS, 5 “S” promotion, infection control, practice of client friendly services) • Study visit to Thailand and south of Vietnam ★accumulated no. of participants is over 20,000

  26. Improvement and maintenance of RH services at CHC • CHC staff re-training

  27. Improvement and maintenance of RH services at CHC Monitoring and follow-up of CHC activities • Supportive working environment for CHC Midwives after re-training • Strengthening of management capacity of Commune Steering Committee • On-the-job training on monitoring for district and provincial health staffs Discussion on issues identified during the monitoring activities among monitoring team, CSC members, and CHC staffs.

  28. Strengthening management capacity of Vietnamese Counterpart • Training on effective monitoring methods • Center Management-Client Friendly Service • Ownership development of Nghe An MCH/FP Center • Expanding opportunity for co-medical staffs • Taking initiative in planning, implementation and evaluation

  29. Promoting health education for the community people Training on IEC skill for members of Women’s Union • Utilization of IEC materials • Effective communication towards behavior change • Design IEC Activity Activities by community-based organization: Aiiku-han model

  30. Health management Information SystemTowards reduction of burden in recording and reporting + improvement of data quality Steady training along with the field situation and progress • Computer operation and maintenance • Software utilization • Network management • Quality control of data • etc….

  31. Health management Information SystemTowards reduction of burden in recording and reporting + improvement of data quality • Support Vietnam Government in promotion of HMIS/software developed and approved by MOH through its actual application in the project sites in Nghe An, providing feedback, recommendations, as well as advices for improvement. • Developed recording/ reporting software for RH data and utilized in Nghe An. RH Department of MOH is planning to apply this software nation widely.

  32. Activities:3. Research and study • RH situation and needs assessment n Nghe An Province (1997-1998) • Study on mass organizations (1998-1999) • Abortion situation study at the MCH/FP Center and the selected district health centers (1999) • Staff activity at commune health center in Nghe An Province (1999-2000) • The folk childbirth customs of the Kinh in Nghe An Province in Vietnam (2001 • The traditional beliefs, customs and practices surrounding pregnancy care and delivery among ethnic women in Nghe An Province (2002) • RTI prevalence among pregnant women in Nghe An Province (2003)

  33. Learning from the Japanese experiences • Dispatch Japanese experts Long-term experts: 4~5 persons Short-term experts: around 10 per year • Counterpart training in Japan

  34. Technical assistance based on the learning and experiences in Japan Similar situation in Japan for 40-50 years ago and current situation in Vietnam ・High rate of MMR（130.6）, IMR（30.7）, malnutrition, high rate of home delivery,high abortion ratio（66.2） ・High literacy rate, value of Confucianism, eager to learn, strong community tie, network of community people, etc. ⇒Japan: a rare case of developed country that has the experiences as the developing country. R

  35. Role of JICA long-term experts • Long-term experts stationed in Nghe An • Provide technical support • Work closely with Vietnamese in Nghe An • Communicate through regular and daily meetings and contacts • Involve in the whole process of project implementation with the counterparts

  36. Role of JICA experts • Long-term stay in the project area makes it possible to: • Appreciate the daily efforts and progress made by the counterparts • Understand the difficulties that Vietnamese counterparts encounter and the reasons why not • Wait until the timing to be matured to act • Be flexible to meet the changing condition and needs • Establish mutual confidence and trust by revealing the informal side of experts

  37. Assessment • Baseline survey (May – June 2001) all 19 districts 137 facilities were covered to find the situation of the RH services • Mid-term assessment (April 2003) 4 selected districts　（Anh Son, Dien Chau, Nhia Dan, Tan Ky) • Final assessment (March 2005) all 19 districts 77 facilities covered to compare the situation back in 2001

  38. Lessons learnt • The existing system and human resources should be strengthened in order to enhance the regular functions and roles for sustainable development (without introducing foreign elements) • Training and post-training support (supportive monitoring/ follow-up) are inseparable • Training need to be realistic, repeated and steady (aim high but start with basic as necessary)

  39. Lessons learnt • Powerful grass-root network need to be fully utilized • Conducive environment to promote RH can be created by involving leaders of various agencies • Development of infrastructure in social sector for the better access is necessary

  40. Obstetrics complications in Nghe An Province1999 – 2004

  41. Abortion ratio per 100 live births

  42. Thank you for your attention.

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