Since the Government of Viet Nam approved the first National Strategy on Reproductive Health Care for 2001 to 2010, the country has made great strides in this area, expanding coverage significantly, improving the quality of services and integrating the response to HIV/AIDS. There are now national standards and guidelines on reproductive health (RH) and a unified Health Management and Information System (HMIS). Yet there are opportunities for improvement. RH policies need to shift their focus away from women-centred family planning to the broader areas of RH with attention to the differing needs of individual women, men and adolescents.
About half of Viet Nam’s population is under 25 and there are now high rates of unplanned pregnancies and abortion particularly among unmarried females in the city. Cutting across this issue is a steadily increasing HIV rate. Yet condom use remains low and young people still have misconceptions about transmission and prevention of HIV/AIDS. Addressing this requires a stronger response and one that increases access to contraception. The two key reproductive outputs from CP7 are:
- increased availability of high-quality, gender-sensitive reproductive health information and services, including family planning and sexual health
- increased demand for high-quality, gender-sensitive reproductive health information and services
UNFPA also supports the Ministry of Health in updating national standard guidelines on reproductive health to improve the quality of RH care services at all levels. These guidelines address five main services:
- safe motherhood and newborn care
- family planning
- reproductive tract infections (including sexually transmitted infections and HIV/AIDS)
- adolescent reproductive health
- safe abortion
1. Key Technical Areas
Maternal and Neonatal Health: Towards Millennium Development Goal #5
MDG #5 is to improve maternal health. It grows out of the 1987 Conference on Safe Motherhood in Nairobi, which produced a resolution to reduce maternal mortality and morbidity by 50% by the year 2000. Maternal health and safe motherhood are natural components of sexual and reproductive health and preclude the wellbeing of both mother and baby.
Leading causes of maternal mortality are haemorrhage, obstructed labour and infection, and maternal deaths are more frequent among women in Viet Nam’s Central Highlands and mountainous northern regions (from Achieving the MDGs: UNFPA’s Responses to the Needs of Safe Motherhood and Newborn Care in Viet Nam). There is adequate evidence that maternal deaths are both underreported and misreported.
Viet Nam successfully reported reduction the maternal mortality ratio (MMR) from 120 per 100,000 live births in 1990 to 85 per 100,000 live births in 2004, and currently more than 90% of pregnant women and women in delivery receive care from skilled health workers. Nevertheless, a national study by MOH in 2003 indicated that the MMR in Vietnam is still at 165 per 100,000 live births and in some remote areas, it reached over 400 per 100,000 live births. And there is still wide disparity among regions of the country. Areas of the northern and central highlands, home to many of Viet Nam’s ethnic minorities, have higher MMR and lower access to health care than delta and urban areas.
Maternal health is integrated into Viet Nam’s development planning with the National Reproductive Health Care Strategy 2001, formulated with UNFPA support. This produced the National Safe Motherhood Master Plan 2003-2010. Funded by the Government of the Netherlands, this is a collaborative effort by UNFPA, the Ministry of Health and other partners to reduce maternal mortality by 50%, reduce peri-natal mortality by 20% and reduce incidence of low birth weight by 25%.
With UNFPA support, MOH is implementing safe motherhood interventions as part of CP7 in seven target provinces based on needs assessments conducted in 2006. There were mid-term evaluations in 2008 and a final review is set for 2010.
Some activities include:
- midwifery competency-based training at colleges and secondary medical schools
- EMOC training for clinicians
- refresher trainings for health managers
- refresher trainings on national standards and guidelines for reproductive health services
- a pre-service training programme for secondary midwives
- an 18-month training programme for ethnic minority midwives
- specialised training in obstetrics and specialized training for general practitioners
- training on use of medical equipment
- community-based referral system for emergencies
- health education for safe delivery
(For more activities see Achieving Millennium Goals: UNFPA’s Responses to the Needs of Safe Motherhood and Newborn Care in Viet Nam.)
UN Joint Programme on Kon Tum
Viet Nam is yet to achieve universal access to vitally-needed reproductive health services and family planning, which is necessary if the country is to achieve the Millennium Development Goals and advance the status of women. Currently women rely heavily on IUDs for contraception, but UNFPA advocates a shift in emphasis away from ‘women-centred’ methods of family planning to include male methods, such as using condoms. Security of the supply of contraceptives, or “contraceptive commodity security’, has taken on new importance (for both family planning and prevention of HIV) and Vietnam is developing a national strategy for this with UNFPA support.
Contraceptive commodity security means to ensure that all clients, regardless of age, sex, marital status, social status, income or living conditions can access, select and use quality contraceptives whenever they are in need, for family planning and prevention of STDs and HIV. UNFPA estimates that a deficit of about US$1 million (16 billion VND) for procurement of contraceptives would lead to an increase of 360,000 unwanted pregnancies, 800 maternal fatalities, 11,000 cases of under-5 mortality, and 150,000 abortions (from the Country Technical Support Team (CST), Bangkok. For more information, please see the UNFPA global website.
Securing sexual and reproductive health commodities including condoms for HIV prevention
The UNFPA approach to reproductive health commodity security can be summarized in a simple statement: the right quantities of the right products in the right condition in the right place at the right time for the right price. We take a lead role in this, coordinating the process, forecasting needs, mobilizing support and building logistical capacity at the country level. The strategy proposed for Vietnam (with UNFPA support) would ensure sufficient finances and supplies for contraceptives, improve capacity in coordination and management for assurance of contraceptive security, and develop and expand the contraceptive market so that individuals and the community can share part of the cost. A capacity building component in social marketing in the private and non-governmental sector, including DKT International, would encourage enterprises and local NGOs to conduct social marketing, while advocating development of this market through supportive policies, at the same time providing opportunities for partners to share experience with government counterparts.
Adolescent Sexual and Reproductive Health (ASRH)
Viet Nam is a challenging environment for adolescent sexual and reproductive health initiatives due to traditional opinions about talk of sex with youth. Yet UNFPA is working to change attitudes and policymakers now recognise the need to address the reproductive health needs of young people. For example, in CP7 UNFPA will train trainers at the central and provincial levels in implementation of the National Standards and Guidelines for RH Care Services specifically on adolescent sexual and reproductive health and rights. CP7 also includes support at the provincial level for increased availability of RH-friendly services and information for youth. This includes youth care, youth interactive theatre, counselling centre services, youth-friendly corners, and peer education. This includes training for health service providers in selected provinces on how to provide appropriate SRH services and information to youth as well as community-based activities to create a supportive environment for youth to access information.
Mothers no longer avoid the subject
Comprehensive educational sector response
The Joint UN Programme on HIV in Viet Nam addresses HIV education, seeking chiefly to strengthen institutional capacity, support RH and HIV prevention education in secondary schools and address the issue of stigma and discrimination in policy development and in prevention programmes. Under this initiative, UNICEF, UNFPA and UNESCO work together with the Ministry of Education and Training (MOET). Where previous efforts have been uncoordinated and fragmented, the initiative seeks in particular to systematize interventions against stigma and discrimination where the focus has typically been on prevention. For more information see our section on HIV.
3. Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs)
UNFPA has conducted in-depth review of 221 studies on RH and published its findings in a series of lessons learnt and best practices, entitled Research on Reproductive Health in Viet Nam: A review for the Period 2000 - 2005. Although data among studies was inconsistent, some revealed that a high proportion of women have reproductive tract infections. Researchers also discovered that knowledge among women is still poor, including among high-risk groups such as female sex workers.
4. Sexual and reproductive health for internal migrants
A lack of understanding of sexual and reproductive health among internal or “spontaneous” migrants, most commonly women, has led to increased risk of STIs and HIV transmission. Yet this population is uncomfortable exploring more formal sources of accurate sexual and reproductive health information and quality services. They instead seek help from public health services, which do not provide supportive, confidential and non-judgmental treatment. Thus, they are less likely or unable to change their risk-taking behaviours and to practice positive life skills.
UNFPA has partnered with MOH and the Community Health and Development Organisation (LIGHT), a Vietnamese civil society partner, as well as health services in the community, to pilot a project in HCMC and Hanoi. Based on a needs assessment conducted in 2006 the project will train service providers and offer technical assistance in migrant reproductive health and gender.
Reaching out to migrants at work and at home, the pilot will provide numerous activities, including:
- creation of a ‘Guidelines for Migrants’
- creation of brochures on SRH and HIV prevention
- creation of referral card with information on locations that provide information, consultantcy and services designed for migrants
- educators and communicators will be selected from CPFC and the network of mass organizations
- one course over three to five days for each site on communication skills, RH/SH and HIV/AIDS prevention
- contract with partners to provide counselling on RH, STIs and HIV as well as services for migrant groups
- promotion of a referral network for health services
Viet Nam’s HIV epidemic remains largely concentrated among key populations at higher risk, with high HIV prevalence among injection drug users, female sex workers and their partners, and men who have sex with men. Significant interaction between the risk behaviours of sharing injecting equipment and unprotected sex, particularly among young men, continues to drive the HIV epidemic. (For UNFPA’s HIV programming for youth, see the section on ASRH).
In 2005 prevalence was estimated at .53%, or 293,000 cases nationwide. The response from the government has included establishment of the National Monitoring and Evaluation Framework, expanded prevention interventions among most-at-risk populations (MARPs), support for civil society organisations working in HIV and a recent national funding increase of nearly 100%, from $5 million in 2006 to $9.4 million in 2007. (See note below, ‘Building civil society in the fight against HIV’, for more on HIV and civil society.)
International development aid makes up 60% of the funding for the national response to HIV (US$ 47.15 million in 2006). The major donors are the President’s Emergency Plan for AIDS Response (PEPFAR), the Global Fund to fight AIDS, TB and Malaria (GFATM); the UK Department for International Development (DFID), the Asian Development Bank (ADB) and the World Bank. Their contribution has assisted Viet Nam greatly in scaling up and improving prevention, treatment, care and support activities in the country. (From the Third Country Report on Following Up the Implementation to the Declaration of Commitment on HIV and AIDS .)
UNFPA supports Viet Nam’s national efforts against HIV/AIDS and has integrated the global response to the pandemic, including MDG #6, into its reproductive heath programmes in the country, participating fully in the Joint UN Programme on HIV/AIDS. Outreach includes community education to reduce stigma and discrimination against PLHIV, sexual and reproductive health for PLHIV and security of condom supply, greater involvement of PLHIV among others. For more information please visit the UNAIDS Viet Nam website (data from July 2007).
Building civil society in the fight against HIV: The UN in Viet Nam adopts a broad view of what constitutes 'civil society' when considering HIV activities, including PLHIV groups, local NGOs, mass organisations and religious organisations.
In Viet Nam, civil society organisations can promote greater government accountability and bolster government services at the central and local levels. They can encourage and support the participation of male and female PLHIV in programme development, planning, implementation and monitoring, thereby strengthening their voice in policymaking and implementation. Civil society is also well placed to deliver services which contribute to the national response to HIV, particularly in gaining access to marginalised and often hidden key populations whose behaviours place them at higher risk, and in building and utilising networks of community- and home-based treatment, care and support.
The Government of Viet Nam operates a series of treatment and education centres for injection drug users (IDUs) and female sex workers (FSWs), called “05” and “06” centres for the numbers given the decrees that created them. HIV prevalence is high among IDUs and FSWs, so naturally it is high in these centres, possibly 50%. Yet health services are provided not by the Ministry of Health, with whom UNFPA has partnered in capacity building, but by the Ministry of Labour, Invalids and Social Affairs (MOLISA), which can’t always provide high-quality care. This issue is particularly evident in Hoa Binh Province where the number of PLHIV residing in these centres may be 20% of the HIV-positive population province-wide. (See Fact Sheet Hoa Binh Province 2007 and Hoa Binh Briefing for more details). . But Hoa Binh is also a UNFPA focus province and UNFPA has worked to bridge the provincial Department of Labour, Invalids and Social Affairs (DOLISA) and Department of Health to ensure that the health staff in the centre receive the same SRH training as the service providers
Detailed HIV programme information:
1. Reducing stigma and discrimination toward people living with HIV, including through empathy clubs
In 2006 and 2007 UNFPA provided technical support to Hoa Binh and Tien Giang provinces to establish a series of “Empathy Clubs” designed to facilitate communication on HIV/AIDS prevention, reduction of stigma and reduction of discrimination against PLWHIV. These clubs are designed to make members feel safe and comfortable. Members are treated respectfully and with confidentiality by others, and the club promotes respect for their individual wishes. In this environment PLWHIV are better able to access care and treatment, including antiretroviral therapy (ART). This is just one example of a national strategy and is an opportunity for partnership with civil society.
2. UNFPA in the field with AGFUND
With support from the Arab Gulf Fund for United Nations Development Organisations (AGFUND), UNFPA carried out a program to raise awareness of HIV and reduce stigma and discrimination against people living with HIV in Tien Giang and Hoa Binh provinces. This was a community-based initiative emphasising a rights-based approach, and one key output was increased political support from community activists, religious leaders and policymakers. (See the project document.)
3. Strengthening linkages between sexual and reproductive health and HIV
Typically, the majority of HIV infections are sexually transmitted, and UNFPA along with the international community strongly advocates for closer linkages between HIV/AIDS interventions and sexual and reproductive health care as a matter of better public health, economic efficiency and human rights. For more information please see the New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health and UNFPA’s policy on linking HIV/AIDS with sexual and reproductive health .
Working in conjunction with WHO, UNAIDS and the International Planned Parenthood Federation, UNFPA has also contributed to the Framework for Priority Linkages, designed to strengthen programmatic linkages between SRH and HIV/AIDS. The framework proposes a set of key policy and programme actions to strengthen links between SRH and HIV programmes.
4. “Desire of Life” - A radio soap opera for behaviour change on Voice of Viet Nam
On April 6, 2008, youth in Viet Nam began benefitting from a new resource that addresses their life concerns in their language, a twice-weekly radio drama that addresses communicating with parents, stopping domestic violence, living with HIV, and other pressing issues. Titled the Desire of Life, the programme will run for two years nationwide and will look at such issues as gender equality, HIV, and the need for parents to communicate more with young people.
The idea for the series is outlined in the publication, Soap Operas for Social Change to Prevent HIV/AIDS: a Training Guide for Journalists and Media Personnel , compiled by the Population Media Center. It follows the Sabido methodology for social change using entertainment-education format serial dramas broadcast over mass media channels, developed by Miguel Sabido. The principle of the Sabido method is that that the most important element of entertainment-education is entertainment. Productions may follow two sub-plots involving change of fortune and human drama, for example, and then should focus on social content and the role models for the desired behaviour.
Desire of Life is supported by UNFPA with funds from the Danish International Development Agency (DANIDA). Click here for a full press release in English or Vietnamese. To find out more about the series and download episodes, visit the VOV website http://www.vov.org.vn.
5. Comprehensive educational sector response
The Joint UN Programme on HIV in Viet Nam addresses HIV education, seeking chiefly to strengthen institutional capacity, support RH and HIV prevention education in secondary schools and address the issue of stigma and discrimination in policy development and in prevention programmes. Under this initiative, UNICEF, UNFPA and UNESCO work together with the Ministry of Education and Training (MOET). Where previous efforts have been uncoordinated and fragmented, the initiative seeks in particular to systematize interventions against stigma and discrimination where the focus has typically been on prevention.
Chief activities are:
Support MOET to establish a “coordination mechanism” for a comprehensive education sector response.
- Support MOET in the development of an education sector strategy on HIV.
- Provide support to prioritise HIV within secondary education (as part of the implementation for the Action Programme for RH and HIV Education for Secondary School Students.
Develop and disseminate core teaching and learning materials and teacher training programmes for RH and HIV for other education sub-sectors including vocational training and non-formal education.
Establish a monitoring and evaluation framework for adolescent sexual and reproductive health and HIV education, ensuring linkages with the National HIV Monitoring and Evaluation framework.
Develop and disseminate the guidelines to implement and monitor observation of the HIV Law in the education sector.
For more information, see Common UN support to the MOET for the Comprehensive Education Sector Response to HIV and AIDS 2008 - 2010.
6. UNFPA’s participation in the Joint Response to HIV in Viet Nam
The "Three Ones”
For more details visit: http://www.unaids.org/en/CountryResponses/MakingTheMoneyWork/ThreeOnes/
The UN Joint Programme on HIV is managed by the Joint UN Team on HIV. This group works chiefly to support national authorities and stakeholders, including civil society and PLHIV groups, in the national response to HIV, and to resolve barriers to implementation of the National Strategy on HIV/AIDS Prevention and Control. It is also an entry point for national stakeholders to access HIV technical assistance from the UN system, developing common communication strategies and coordinating financial and technical resources, among other vital roles. (For more information please see the section, UNFPA’s participation in the Joint Response to HIV in Viet Nam, in our HIV section.
The Joint UN Team on HIV will link, as appropriate, with other UN Country Team coordination mechanisms such as the UN Theme Group on Gender, the UN Theme Group on Youth, the UN Theme Group on Social Policy and the Communications Task Force.
UNAIDS plays a coordinating role and other UN agencies on the team provide technical expertise. UNFPA will be lead agency on provision of information and education, condom programming, prevention for young people outside schools and prevention efforts targeting vulnerable groups (except injection drug users, prison inmates and refugee populations). Chief outputs and activities will be to support the M&E framework for ASRH and see that HIV education is in place while ensuring linkages with the national HIV M&E framework.