CONFERENCE: 2011. Water and Health Conference. University of North Carolina
AUTHORS: Waterkeyn, J and Nga, NH.
TITLE: Low cost-high Impact: Hygiene Behaviour Change in Vietnam in Community Health Clubs.
FULL PAPER: 2011.9.Vietnam_Waterkeyn__Nga
ABSTRACT: Vietnam is the first country in Asia to use the Community Health Club (CHC) Model of development in a pilot project by Ministry of Health in 3 Northern provinces in Son La, Phu Tho and Ha Tinh districts. The CHC Model was originally developed in Africa (Waterkeyn, 2010) to bring about hygiene behaviour change and improve sanitation coverage, using health promotion as an entry point into sustainable development.
In Northern Vietnam, between 2009 and 2010, a total of 48 CHCs were started having 2,929 members, with an average of 63 members per club amounting to an estimated 12,784 beneficiaries. A household survey before and after the intervention shows that knowledge of health issues has increased in Ha Tinh by 42%, and in Son La by 59%, as measured by improved levels of good knowledge of how to treat diarrhoea. Hygiene behaviour has also changed in all three provinces.
Results from one district, Ha Tinh are used, comparing a survey of 7,126 respondents before the intervention in 2009, with post intervention survey of 1,200 CHC members. The results are all highly significant, with a mean increase of 36% in 16 observable proxy indicators (p>0.001). Handwashing facilities have increased from 14% to 59%, (45% improvement), and whereas soap was only in use in 6% of households it is now used in 63%, an uptake of 57%. Safe water storage has increased from 35% to 89%, a 54% improvement. Overall there is a 55% improvement in kitchen hygiene from 21% to 76%, and 60% more homes have clean floors. Whereas solid waste was conspicuous in 64% of the homes, it is now being controlled in 97% of the homes (a 59% positive change). The survey shows 30% more people (increased from 30% to 60%) now use a fly swot, and that 38% more people now practice some form of rat control (from 23% to 61%). In Ha Tinh, there was a 20% increase reaching the same level of sanitation as Phu Tho, with 57% coverage.
In Son La district, 387 households (70% of the CHC members) improved their sanitation facilities, without any subsidy during a one year period (Ministry of Health, 2010). Diarrhoea, dysentery and food poisoning, have all shown a steep reduction of reported cases: an average of 61 saved cases per commune with total number of reported cases dropping from 134 to 17 cases in one year per commune, as opposed to non CHC communes, which reduced on average 24 cases per commune (from 99 cases to 75).
At an estimated cost of only US$1.30 per beneficiary for six months of weekly health promotion sessions, the CHC model is considered by Ministry of Health as ‘low cost – high impact’. Within an emphasis on group consensus, the CHC Model resonates with cultural norms in Vietnam and has demonstrated that sanitation coverage can be improved with no subsidy, and communicable diseases have been significantly reduced, simply by harnessing the power of positive peer pressure to ensure safe hygiene standards. Vietnam is leading the way as an advocate for holistic and sustainable development in Asia demonstrating that CHCs are as effective in changing hygiene behaviour and reducing preventable disease as they have been in Africa for the past 15 years.