Child Survival

Overview

 

Overview

Overview

Viet Nam has made impressive economic growth and social development gains during the past 20 years, which have translated into better outcomes for children’s health, nutrition and access to water and sanitation. Infant and child mortality rates have halved since 1990. However, improvements are unequal and inequities are driven by ethnicity, household income, disadvantages of living in rural and mountainous areas and maternal education. The main causes of deaths in children less than five years old are neonatal causes, pneumonia, diarrhoea and undernutrition.

Ethnic minorities: Ethnic minority child mortality rates have actually increased during the last five years and an ethnic minority child is three times more likely to die in the first five years of life than a Kinh/Hoa majority child. 

High neonatal mortality: In Viet Nam more than half of children dying before their fifth birthday die in the first 28 days of life and most within the first seven days of life [1][2]. Low access to i) quality antenatal care and maternal nutrition, ii) safe delivery practices and iii) care of the newborn are the main drivers of deaths of newborns. Moreover, there is widespread under reporting of neonatal and stillborn deaths, especially in mountainous rural areas.  

Stunting and anaemia: One-third of Vietnamese children less than five years old are stunted and one-third are anaemic, from poorly balanced diets, low exclusive breastfeeding rates, poor complementary feeding [4], worms and infections. 

Low early and exclusive breastfeeding rates:  Only around 20 per cent of mothers breastfeed their babies early and exclusively for six months – the lowest rate in South East Asia. The rates, in Viet Nam, are lowest in middle class and urban settings [3]. Breastfeeding not only decreases incidences of stunting and obesity, but also decreases rates of various infections and can increase maternal bonding.

Sanitation and water/hygiene: Although there have been improvements at a national level, only 39 per cent of people in rural areas benefit from adequate sanitation [5], with 50 per cent of children less than five years old not able to access improved sanitation and 20 per cent of under fives not able to access improved water supplies. Hygiene knowledge and behaviour remain poor in rural communities and result in increased diarrhoeal diseases, other infections, worms and anemia [6].

HIV andAIDS: Children less than 15 years old make up almost 2 per cent of HIV-positive population in Viet Nam. The number of pregnant women with HIV was estimated to be about 4,100 in 2008 [7], and was expected to increase to 4,800 by 2012 [8]. Without improved education and access to reliable information and PMTCT services, this could amount to more than 2,000 newborns infected with HIV, as estimated annually.

Injuries: Almost 8,000 young people under 19 years die every year from preventable injuries caused by drowning, road traffic injury and accidents, poisoning, falling, burns and animal bites [9]. The death rates are two times higher for boys. These rates may rise with increasing use of motor vehicles.

Financing: Public healthcare financing is increasing, but ordinary Vietnamese people still have to pay around 70 per cent of total health expenditure from their own pockets [10], disproportionately affecting the poor and rural populations. Financial barriers to accessing routine healthcare services, covering the costs of long-term childhood illnesses and catastrophic expenditure such as a cesarean section or surgery after an accident can bankrupt whole families, increasing inequities between rich and poor. More funding is needed along with the more efficient and effective use of both human and financial resources already available for multi-sector approaches to address the root causes of inequities. 

Action:

UNICEF’s Child Survival and Development Programme in the period of 2006-2011has contributed to the following results: 

Policy Advocacy and Knowledge Generation: 

  • The National Assembly decision on health (Decision 18) issued in June 2008, recommended health budget increases of at least 30 per cent of the total state healthcare budget to be allocated for the preventive medicine.
  • The Government’s Decree 21 on the Breastfeeding Code was approved in 2012, forming a legal basis for promoting breastfeeding practices as well as curbing illegal/inappropriate marketing of breast milk substitutes
  • A National Plan of Action for accelerating a reduction in stunting was formulated, feeding into the development of the next national nutrition programme for 2011-2020 
  • The Rural Water Supply and Sanitation (RWSS) National Target Programme (NTP) in the period of 2011-2015 gave higher priority to the sanitation component, with a budget increase for the sanitation component corresponding to 24.6 per cent of the 15,401 billion VND.
  • A National Arsenic Mitigation Plan, Guidelines on Arsenicosis Diagnosis and Initial Treatment, a National Water Quality Management Programme for Rural Areas, an Action Plan of Environmental Sanitation and Hygiene Behaviour Change Communication, National Standard Child-Friendly Water, Sanitation and Hygiene (WASH) designs for all children and children with disabilities, Community Approaches to Total Sanitation (Community-Led Total Sanitation, School-Led Total Sanitation and Sanitation Marketing) and the national RWSS monitoring and evaluation system were developed and rolled out nationwide
  • The establishment of safe communities and safe schools nationwide, the sectoral plan of action on injury prevention (2007-2010) and its 2008-2010 action plan on childhood injury prevention were developed, accelerating progress in the reduction of injuries
  • Enforcement of the implementation of the National Policy on Accidents and Injury Prevention and increased child injury prevention advocacy were witnessed with the greater National Assembly engagement 
  • The Government’s strong commitment to combat HIV and AIDS included 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 and establish an environment for wider donor involvement in the area of women, children with HIV/AIDS
  • Household and community members have displayed an increased knowledge, a more positive attitude and changed/healthier behaviour towards key issues affecting children’s and women’s well-being, including major child injuries, maternal and child health, HIV and AIDS including PMTCT, sanitation, hygiene and Avian Influenza 
  • A health-related MDG report 2012 was developed through extensive discussions and workshops to review MDG targets reached and identify issues and solutions that need to be addressed to reach all MDG targets by 2015. The post-2015 agenda for Viet Nam and measures to improve health equity in Viet Nam were also discussed. 

Capacity Development and System Strengthening: 

  • An Integrated Reproductive maternal newborn and child health care service package for women and children’s health including nutrition and water and sanitation   by the Government and a range of capacity building interventions to implement the package at the sub-national level have been being  undertaken
  • A Maternal Mortality Audit, which helps pinpoint the specific causes of women dying during childbirth, was jointly developed with the United Nations Population Fund (UNFPA) and World Health Organisation (WHO), under Ministry of Health of Viet Nam leadership and successfully piloted in three provinces resulting in the development of revised tools for its application nationwide
  • The pilot phase of PMTCT 2006-2007 was successfully completed in five districts in five provinces during 2006-2008. The model was evaluated and the lessons learnt from the project fed into the technical guidelines to scale-up PMTCT coverage nationally
  • Together with other international agencies (World Bank, WHO) a report on the evaluation of health insurance implementation in Viet Nam was produced, which will be used in documents and as evidence for recommendations to revise the Health Insurance Law during 2013-2014
  • 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 in 2009-2011 
  • The Community Approaches to Total Sanitation project was implemented in 250 villages of five provinces, of which 52 villages and 15,000 people are open defecation free. 
  • The comprehensive Childhood Injury Prevention model with its child-safe home, child-safe school and child-safe community components was implemented in selected communes in six provinces from 2007. In early 2009, four communes were assessed and designated as “International Safe Communities” by the WHO. In addition, 18 more communes were designated as National Safe Communities based on national criteria 
  • Innovative interventions such as the organisation of swimming lessons for children in rural settings and access to alternative appropriate childcare during summer holidays were introduced in a number of communes from 2007. 

Impact:

By targeting disadvantaged populations (children and their caregivers living in rural or urban poverty, ethnic minorities, those living with disabilities or affected by natural disasters), the Child Survival and Development Programme aims to sustainably reduce inequalities for disadvantaged children. These include addressing financial, supply and demand barriers to accessing maternal, newborn and child healthcare, nutrition, water and sanitation 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. 

By strengthening the links between provincial monitoring and policy work, UNICEF can provide evidence to national policy-makers and help adjust national priorities and resource allocation on an ongoing basis. 

Notes:

[1] MOH (2012), MDG report 2012

[2] MOH (2011) MCH Department report 2011

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

[4] NIN (2011) Nutrition report 2011

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

[6] WHO Global Task Force on Cholera Control (2008) Cholera Country Profile: Viet Nam[online]

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

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

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

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

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