April, 2011
Vietnam is the first country in Asia to pioneer the Community Health Club (CHC) Model of development to bring about hygiene behaviour change and improve sanitation coverage, adapting it to suit local cultures. If sucessful, Vietnam could lead the way as a powerful change agent for sound development in Asia ensuring that CHCs are as cost-effective as they have been in Africa for the past 15 years. Out of 48 CHCs established since 2009, six were assessed in the three Provinces of Son La, Phu Tho and Ha Tinh over a 10 day period. In each district a structured interview of provincial, district and commune MoH officials was conducted by the consultant to verify the CHC report for 2010. Existing MoH data from a pre and post intervention household inventory of all CHC members were used to measure knowledge and levels of behaviour change. Standard monthly reported cases in each Commune Health Centre Changes were examined to see if there was a pattern of disease reduction. The findings of this evaluation should provide lessons inform more effective replication and scaling up through the National Target Programme, now entering its 3rd phase.
There is clear evidence that the training in the CHCs, in 24 sessions spread out over the past two years has improved knowledge of health issues and that peer pressure within the CHCs is leading to very significent levels of behaviour change. For example there was a 42% increase in Ha Tinh and a 59% increase in Son La in good knowledge of how to make Sugar Salt Solution. Changes in hygiene behaviour are highly significant with a 58% increase in hand washing with soap in Ha Tinh . There has been a great effort at improving sanitation in the CHC areas, as demonstrated in Son La where 387 households (70% of the CHC members) improved their sanitation facilites, without any subsidy, and the household inventory showed that only 4 families out of 1,036 were found to still practice open defecation. Phu Tho Health Centres in CHC communes have recorded a sharp decrease in diarrhoeal disease since the CHCs started, by 90%, 93% and 59%. Although all communes in Thach Ha district (Ha Tinh Province) were targeted with the same IEC materials, diarrhoeal disease cases decreased by 35% in two CHC Communes but actually increased 18% and 31% in two non-CHC Communes. The CHC programme can be measured for cost per beneficiary at only US$1.30 for one year. This is remarkably cost–effective by any standards and compares well with similar projects in Africa. As one MoH official from Ha Tinh remarked the CHC Model is ‘low cost- high impact’.
Achievements in all three provinces were made despite the fact that the CHCs were started without using membership cards, an incentive which has always been a draw card for joining CHC. With the training material complete, there is little doubt that the CHC Model will be replicated easily, scaling-up by using recommendations and lessons learnt. The Pilot Project has demonstrated that the CHC model can improve sanitation coverage and with very little subsidy, significantly reduced diarrhoea within two years, simply by harnessing the power of peer pressure to ensure safe hygiene standards. Within an emphasis on group consensus, the CHC Model resonates with cultural norms in Vietnam, whilst the training enables Village Health Workers to run CHCs at very little extra cost within their duties. This pilot project should provide the NTP3 with a sound methodology that can be predicted to achieve the Millennium Development Goals in CHC districts.