Overview

Overview

 

Overview

Viet Nam has made impressive gains in economic growth and social development over the last 20 years, but these improvements vary widely between place, ethnicity and language group. High neonatal and maternal mortality, malnutrition, poor sanitation and hygiene, poor water quality, increased HIV transmission from mother to child, and child injuries are all continuing threats to child survival.

Though infant and child mortality rates have been cut by over 50 per cent since 1990, rates are much higher among ethnic minorities, the very poor, and those living in remote regions. Child illnesses like acute respiratory infection, diarrhoea, dengue fever and malnutrition are still far too common. Poor nutrition and infection are the main reason why one in three Vietnamese children are considered stunted. A relatively low national rate of exclusive breastfeeding of infants under six months (19.2 per cent)[1], which contributes to the high stunting level, is also a concern.

Access to drinking water and adequate sanitation has improved, but only 39 per cent of people in rural areas benefit from adequate sanitation[2]. Hygiene knowledge and behaviour remains poor in rural communities. These result in the spread of diarrhoeal diseases such as dysentery and cholera[3] and other infections such as parasites or trachoma.

Children are being hit by the emerging HIV epidemic as well, with girls and boys under 15 years making up almost two per cent of the total HIV-positive population in the country. The number of pregnant women with HIV was estimated to be about 4,100 in 2008,[4] and is expected to increase to 4,800 by 2012.[5] Without improved education and access to reliable information and services, this could amount to more than 2,000 newborns infected with HIV annually.

As an additional threat to the survival and development of children, in  2007, close to 7,900  children and young people under 19 died of largely preventable injuries caused by drowning, road traffic injury, poisoning, falling, burns and animal bites[6].

Total public finance for healthcare is still relatively low leaving ordinary Vietnamese people to cover about 70 per cent of total health expenditures from their own pockets[7]. This is one of the main barriers to access and cause of health service inequity. More funding is needed and increased coordination for healthcare at the national level between ministries and sectors will lead to better and more effectively responses to issues like malnutrition, child injury and HIV and AIDS, not to mention the persistent threat of Avian Influenza and the H1N1 influenza pandemic.

Action:

The Child Survival and Development programme has contributed successfully to the following results.

Policy advocacy and knowledge generation:

• The first National Assembly’s Decision on health (Decision 18) was issued in June 2008, which recommends increase of health budget in general with at least 30 per cent of total budget to be allocated for the preventive sector;
• The Government Decree 21 on Breast Feeding Code was approved, forming a legal base for promoting breast feeding practices as well as curbing illegal/inappropriate marketing of breast milk substitutes;
• A National Plan of Action for accelerating stunting reduction was formulated, feeding into the development of the next national nutrition programme covering 2011-2020;
• The Rural Water Supply and Sanitation (RWSS) National Target Programme (NTP) gave higher priority to the sanitation component, with an increase in budget for sanitation component corresponding to 35 per cent of the total budget;
• A National Arsenic Mitigation Plan, Guidelines on Arsenicosis Diagnosis and Initial Treatment, an Action Plan of Environmental Sanitation and Hygiene Behaviour Change Communication, National Standard Child-Friendly Water, Sanitation and Hygiene (WASH) designs and the national RWSS monitoring and evaluation system were developed and rolled out nation-wide;
• Establishment of safe communities and safe schools nationwide; the sectoral plan of action on injury prevention (2007-2010) and its 2008-2010 plan of action on childhood injury prevention were developed, accelerating progress on the reduction of injuries;
• Enforcement of the implementation of the National Policy on Accidents and Injury Prevention and advocacy for the issue of Child Injury Prevention with the lead and increasing engagement of the National Assembly;
• Government’s strong commitment to combat HIV/AIDS includes the roll out of Prevention of Mother-to-Child Transmission of HIV (PMTCT) National Programme of Action; UNICEF is one of the leading institutions assisting the Government to set up the systems as well as establishing environment for wider donor involvement in the area of women, children and HIV/AIDS;
• Increased knowledge and more positive attitudes and changed/healthier behaviours of household and community members around key issues affecting children’s and women’s well-being, including: major child injuries, maternal and child health, HIV/AIDS-PMTCT, sanitation, hygiene and Avian Influenza (AI).

Capacity Development and System Strengthening:

• An essential maternal and new born care package was developed by the Government and a range of capacity building interventions to implement the package at the sub-national level were undertaken;
• A Maternal Mortality Audit, which helps pinpoint the specific causes of women dying in childbirth, was jointly developed with the United Nations Population Fund (UNFPA) and World Health Organisation (WHO), under the leadership of the Government, and successfully piloted in three provinces resulting in development of revised tools for national application;
• The pilot phase of PMTCT 2006-2007 was successfully completed in five districts in five provinces from 2006 – 2008. The model was evaluated, and the lessons learned from the project fed into the technical guidelines to scale up PMTCT coverage nationally;
• Through the school WASH model, 118 new child-friendly school WASH facilities were built, benefiting around 23,000 school children in poor and disadvantaged areas;
• The comprehensive Childhood Injury Prevention model with its three components of child-safe home, child-safe school and child-safe community was implemented in selected communes in six provinces. In early 2009, four communes were assessed and designated as “International Safe Communities” by WHO. In addition, 18 more communes were designated as National Safe Communities based on national criteria;
• Innovative interventions such as the organization of swimming lessons for children in rural settings, and access to alternative appropriate childcare during summer holidays have been introduced in a number of communes.

Impact:

By targeting disadvantaged areas of the country and national policy measures, this programme will reduce inequality for disadvantaged children in access to health and nutrition services. Local authorities and families will have greater access to information related to child development and how to live in a healthy and safe environment.

Work on knowledge development creates new information on child survival to improve existing mechanisms and to develop new policy, programmes and laws. Already among other results, the programme has helped develop: Government Decree 21 on breastfeeding to provide a legal framework for breastfeeding and limit inappropriate marketing of milk substitutes; a national plan of action on stunting for the next national nutrition plan (2011-2020); the rural water supply and sanitation National Target Programme; Decision 18 issued in 2008 to increase the national health budget by 30 per cent; a prevention of mother to child transmission of HIV Programme of Action; and support to the revision of the 2007 mandatory helmet law.

Notes

[1] NIN (2010) Annual Nutrition Surveillance System 2009

[2] Central Population and Housing Census Steering Committee (2010)The 2009 Viet Nam Population and Housing Census Expanded Sample Results

[3] WHO Global Task Force on Cholera Control (2008) Cholera Country Profile: Vietnam[online]

[4] MOH, WHO and UNICEF (2009) 2009 Joint Global Report on Health Sector Response to HIV and AIDS

[5] MOH (2009) HIV/AIDS Estimates and Projection 2007-2012

[6] MOH (2008) Injury Mortality Statistics of 2007

[7] UNICEF Viet Nam (2008) Health Equity Situation Analysis

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