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Evaluation report

2011 Viet Nam: Evaluation of Child injury Prevention interventions in Viet Nam



Author: Jennifer Oxley, Cuong Pham V, Anne Jamaludin, Mark Stevenson

Executive summary

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Background:

Despite the international recognition that every child matters and has overall rights to live and function in a safe environment and to protection from injury and violence, child injuries remain a growing public health problem and injuries are now acknowledged as one of the leading contributors to the global burden of disease. While neonatal injuries are still the primary killer of infants, injuries contribute significant proportions of deaths for children aged between 5 and 14 years (27%) and adolescents/young adults aged 15-29 years (40%) (WHO, 2008). Each year, injury and violence kills up to 950,000 children under 16 years of age and millions more suffer long-term consequences of non-fatal injuries. Unintentional injuries (such as traffic-related injuries, drowning, poisonings, falls and burns) account for the majority of these cases (approximately 90%), with the remaining 10 percent due to intentional injuries (violence, abuse, etc). Both types of injuries are a major source of trauma and devastating events for individuals, families, the community, and the system which is attempting to resource them.
Moreover, the evidence suggests that the burden of injury on children is unequal, being heaviest amongst the poor and in developing and middle income countries, compared with more affluent communities and high income countries. These countries are where most of the world’s children live. In these countries children are exposed to high levels of risk from hazards in all environments, from unfenced ponds, to open fires, exposed poisons, unprotected stairways, unsafe work environments, to heavy traffic and a scarcity of safe places to play. For example, the rate of unintentional injuries amongst children 18 years and younger in high income countries worldwide in 2004 was estimated at 16.5 per 100,000 population, in contrast to 46.5 per 100,000 population in low and middle income countries. The rate in South East Asian countries (low and middle income) was 48.1 per 100,000 population (WHO, 2008). More importantly, many of these children die before reaching their fifth birthday.

Purpose/Objective:

The aims of the evaluation of the CIP program were to i) measure the effectiveness of the program in achieving its main aims and objectives, that is, to reduce the morbidity and mortality caused by injuries among children in Viet Nam, ii) understand the key facilitators and barriers in the process of implementation for each of the program phases (planning, implementation, delivery, capacity building, etc), and iii) provide recommendations for future programming of CIP interventions.

Methodology:

A two-staged evaluation was undertaken to assess the above aims and included i) a review of documents and publications outlining the implementation of the program and interviews with key partners and organisations, and ii) a comparative analysis of injury mortality and morbidity data, comparing injury data between the intervention and non-intervention communes pre- and post-intervention.

Findings and Conclusions:

Successful implementation of the CIP in some Provinces but not all Provinces.
Sustained declines in injury morbidity rates, however, not consistent across all Provinces in which the intervention was implemented.
Major achievements:
• program approach anchored within a human rights-based approach and incorporated key elements of this approach, i.e., realization of people’s rights, a holistic view of the environment, a participatory process that is transparent and accountable, empowering people to participate and sustainable outcomes,
• good partnerships established with stimulation and encouragement to commit to reducing child injuries,
• good planning and program guidelines,
• establishment of injury surveillance system,
• high community involvement/engagement, and
• activities in intervention communes resulted in higher awareness of child injuries and strategies to reduce injuries, improvement to hazardous environments and building capacity in Provinces.
An assessment of the cost-effectiveness was difficult to determine, however, assessment of selected Province and commune activities revealed appropriate utilisation of resources, reaching substantial numbers of parents/caregivers and children.
What is most apparent from this evaluation is that the overall dose or level of activity associated with the intervention was not sufficient to achieve an impact large enough to see significant reductions in child injury across all Provinces in which the interventions took place.

Recommendations:

The findings highlighted some important information related to the effectiveness of the CIP programs in Viet Nam, with encouraging declines in injury morbidity rates in 4 of the 6 Provinces. However, the declines may have been larger if greater effort was placed in activities that targeted reductions in injury.
Initiatives to scale up:
• Greater level of investment in implementing intervention programs and activities that directly relate to reducing high priority risks associated with child injury *.
• Increased engagement, commitment and collaboration from all agencies.
• Core and ongoing funding from key stakeholders for sustainability and success of CIP. More investment from the National Government to sustain long-term CIP activities *.
• Greater levels of investment in delivering ‘best-practice’ programs *.
• Provision of ongoing training for community members.
Initiatives to scale down:
• Guidelines and policies need not be developed further
• Focus on enhancing existing government data systems rather than investing in reporting systems specifically for the CIP program.

Lessons Learned (Optional):

The findings of the process and injury outcome evaluations highlight there are a number of benefits from the CIP program but the benefits were not uniform across the six Provinces; which was, in part, due to the fact that the types of interventions implemented were not uniform across the Provinces. Despite this, it appears communes that had local counterparts (or champions) and which targeted high priority injury causes delivered better outcomes in relation to reductions in injury morbidity.
What is most apparent from this evaluation is that the overall dose or level of activity associated with the intervention was not sufficient to achieve an impact large enough to see significant reductions in child injury across all Provinces in which the interventions took place.



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Report information

Year:
2011

Country:
Vietnam

Region:
EAPRO

Theme:
Health - Other

Type:
Evaluation

Language:
English

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