Author: Hong-Son, N.; Thanh, N. D.; Sam, L. T.
Moc Chau is the district of the Northwest province of Son La where UNICEF, ECD and Vietnam Women?s Union (VWU) have implemented several development projects. However, many communes have not participated in these projects such as Phieng Luong. Additionally, projects are lacking in remote areas with ethnic minority group, such as Suoi Giang in the Van Chan district. As a result, these two communes have been selected in the pilot phase of the Early Childhood Care Project (the Project) which will be implemented in the 2001-2005 period.
Purpose / Objective
In order to get baseline data and design the action plan for the Project, the field trips seek to:
- Identify the situation and status of health, nutrition and caring for children age 0 to 6
- Identify the childcare and parenting knowledge, and practices of the parents and childcare service providers
- Identify and analyze the problems related to the bilingual acquisition for children including opportunities for children to improve language abilities
- Assess the organization and mechanisms of primary health care for children in order to identify new opportunities for cooperation among related agencies
- Analyze the economic situation, which impacts the primary child health care at the household level
UNICEF invited the Research and Consultancy Division of the Rural Development Services Center to conduct a training course on Participatory Rural Assessment (PRA) and to facilitate the field trips. Results are given in two separate, independent sections: Phieng Luong and Suoi Giang.
For Phieng Luong, 4 villages were selected that had varying distances from the commune center and different ethnic population characteristics. 10% of the total number of households in each village were surveyed. Only households with children aged 0 to 10 were selected.
For Suoi Giang, 4 villages were selected that had varying distances from the commune center and different population characteristics. The total number of households with children aged 0 to 5 sampled was 25. Key players were interviewed in the villages, such as village heads and village health workers.
Key Findings and Conclusions
There are 5 adequate VHWs among 9 villages in the commune. The commune is lacking a medical doctor and health staff specializing in nutrition. The results of the survey show that the community believes the quality of the health service to be low. According to statistics from CHS, only 44% of a total of 18 pregnant women went to CHS for antenatal check-up last year. The remaining women went to the District Health Center. Poor skills of the local health staff and insufficient medical equipment are the major reasons for the mistrust of the community. Lack of opportunities to improve skills is the main reason for the poor quality of health staff.
There is a drug revolving fund named BAMACO, operating at the CHS. However, the CHS staff and the results from household interviews show that drugs are in short supply. Many people could not buy drugs at the CHS.
The commune has conducted many national health programs such as immunization, goiter, Vitamin A intake and polio. The percentage of children immunized is 100%. A nutrition program had been implemented and then it was transferred to a different committee in 1998. Since the transfer, nutrition actives have not been held. The major reasons are due to a shortage of operational funds. The results of the commune workshop revealed that the largest concern in health care activities is nutrition knowledge and practice. Despite this, 64.5% of parents reported that they believed their children's health had improved in the last three years.
Phieng Luong people have a high education level and the incidence of illiteracy is very low. The education system is complete from kindergarten to primary school. Most teachers have solid working experience: the least experienced teachers have been teaching for 6 years. Most communes have kindergartens and daycare centers. The number of teachers is sufficient; some teachers are from the local communities. Salaries and allowance of kindergarten and daycare center teachers are sufficient.
Most organizations and institutions from the commune to village levels participated in educational activities. However, these activities were poorly planned and organized. The survey results revealed that local people have adequate awareness about the role of education. In Phieng Tien and Muong villages, people contributed labor and money to construct kindergartens and daycare centers. Most families that have five-year-old children allow their children to go to kindergarten in order to have better preparation for primary school. The completion rate of primary school is 98%.
Poor infrastructure and equipment are considered the top priority issues. Many schools in Phieng Luong are in temporary places and are poorly equipped. There are no latrines or safe water systems in schools. The main reason was a limited budget. In addition, there is no master plan to improve the infrastructure. Most children have very limited Vietnamese skills when entering kindergarten. Meanwhile, most of the teachers are Vietnamese (Kinh) and have limited vocabulary in the ethnic minority language. Vietnamese is the worst subject of children in grades 1 and 2.
There are 352 households in the commune that have a latrine or 66%. The interviews show that 23.3% of households still raise their animals freely, next to houses. This is prevalent in Dao and Muong ethnic groups. Thai people often keep their animals in shelters far from houses.
There are 8 local VHWs of whom 5 have received 6 months training at DHC. The remaining only received one month training. The CHS is supplied with sufficient medical equipment and the quality and variety of drugs in the CHS are enough for the treatment of common diseases. However, drugs for VHWs are short. The main difficulties of health activities in Suoi Giang are transport, economies and awareness of the community about health care.
Knowledge on early childhood care, especially nutrition, of community people is very poor in general. Traditional taboos obstructed practices of early childhood care. Except for some health and family planning interventions of national programmes or other projects, there were almost no communication activities. There is a lack of ECD teachers and there is no special policy for ECD teachers in difficult areas.
Previous statistics show that the malnutrition rate is 22.7%. The discussion results at the commune workshop and interviews prove that many of the children were not included in that survey and the true figure is probably much higher.
Antenatal care and immunization against tetanus for pregnant women in villages are very rare. Th delivery of H'mong women is often done by husbands 52% or mothers-in-law 20%. Tools for delivery are not sterilized and are extremely simple. The interview results show that 84% of expecting women have a better diet than normal. 80% of women practice a special diet after giving birth that includes abstaining from buffalo meat, beef, fish, chilli, pumpkin leaves, cabbage and bamboo sprouts, which leads to an unbalanced diet. Long breastfeeding custom is an advantage. However, once additional foods are introduced at 6-9 months, the newborn's diet does not consist of vegetables and fruits, only meat or fish because of traditional beliefs.
There was no early childhood care for kids under three years of age. Each commune has only one or two kindergartens for 5 year olds, with very poor facilities. Salaries and wages of kindergarten teachers are very poor and there is a shortage of teachers, especially kindergarten teachers. Quantity and quality of classrooms are very poor. Children have to study in two shifts. There are no playgrounds, latrines or a safe water supply at the schools. Illiteracy is high. 64% of childcare givers are illiterate, 20% have completed literacy classes or quit primary school midway, and only 16% of parents have completed primary school.
The sanitation problem in the village is very serious. There is only one latrine in the whole commune, which was built in the CHS. All community members release 'hard waste' in the bushes so that dogs and pigs will reuse. Livestock roam freely, contributing to health problems. Households are surrounded by bushes and sewage ditches.
Vietnamese acquisition of children under six is very low. Most of the community members cannot communicate in Vietnamese. All residents of Suoi Giang are H'mong and they rarely have the chance for outside contact.
Poor economic situation also hampers ECC activities in Suoi Giang. The community considers economic difficulties its largest problem. The economy of the commune is mainly dependent on agriculture especially tea. The major reasons for poverty are lack of production knowledge and limited access to credit. According to the VBP, the total loans of Suoi Giang is VND 2 million, borrowed by two households to invest in production. Difficult transportation is also a problem.
According to the analysis of district leaders, poor management skills of commune leaders create big obstacles for the socio-economic development in general and child development in particular. Most of the key leaders in Suoi Giang have not completed secondary school. In addition, local leaders have very little chance to participate in training courses.
Many program recommendations were given to improve the clear lack of ECD. Of central concern is improved planning and managerial skills of local staff -- identification of goals and objectives; cooperation of government, organizations and institution; evaluation and follow up. Improvement in education is the highest priority for Suoi Giang. By improving literacy, further campaigns to increase health knowledge, husbandry skills, income-generating projects and credit schemes will also be augmented.
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ECD - Family & Community Practices
Vietnam Women's Union