The Birth Control Trust of The Galton Institute

This is the third and final report to the Galton Institute on its three-year grant to address the unmet need for family planning (FP) and reproductive health (RH) care in three provinces in Vietnam. The overall aim of the project was to increase the utilisation of affordable, quality FP and RH services through three static centres and associated outreach services in the target areas.

Vietnam is the second most populous nation in South East Asia with a population of 79 million 32 million of which are under the age of eighteen. These young people are soon to enter reproductive age increasing the pressure on an already overburdened health system. If the population continues to grow at its current rates it will reach 110 million by the year 2025. The government of Vietnam lacks the resources to meet this increased demand for services and in l995 invited Marie Stopes International Vietnam (MSIVN) to extend its programme and establish three new centres in poorly represented areas. With support from the European Community (EC) and the Galton Institute MSIVN was able to embark on a project to provide essential services in the areas of Ha Tinh, Nam Dinh and Thai Binh, areas identified as having a greater than average proportion of young people and a lack of health services.

The project was implemented by MSIVN who have been working in Vietnam since 1990. The overall purpose was to increase access to and utilisation of, affordable, high quality, FP and RH services in three areas of Ha Tinh, Nam Dinh and Thai Binh. The Project comprised two principal objectives:

During the period of the Project three main centres were established within the target areas which together saw 31,257 clients during the three years. An increase in contraception prevalence rates (CPR) and decrease in fertility rates have also been noted within these areas indicating an achievement in the project’s objectives.

During the final year of the project the total number of clients seen and the number of services offered increased by 144 percent and eight percent respectively. The vast increase in clients seen can be attributed to many factors. Economic access to the centres was improved via a system whereby coupons for free gynaecological examinations were distributed among women's groups to encourage visits to the centres. Furthermore one-week periods of free service, widely advertised beforehand were offered at both the Nam Dinh and Thai Binh centres. This both increased access to the centres and acted as a promotional activity to increase awareness of the centres and the services offered. Successful outreach and IEC campaigns also contributed greatly to the increase in client numbers.

Community Outreach consists of trained health workers travelling out into the community and hard-to-reach areas with FP supplies, basic health provisions and information and is especially important in countries such as Vietnam where public transport is unreliable and beyond the reach of low-income clients.

The outreach services focussed primarily on voluntary surgical contraception (VSC) and teams comprising a doctor, nurse, driver and counsellor travelled into the wider communities offering these services. In the final year of the project 518 mini laparotomies and 27 vasectomies were performed, in addition to this, essential services such as gynaecological examination, IUD insertions and condom distribution were provided.

A comprehensive range of informative materials was produced by MSIVN with strong input from local Vietnamese to ensure cultural sensitivity. Promotional leaflets advertising the three centres, opening times and services offered were distributed to private practitioners and pharmacists within the catchment areas. A referral system was established whereby these pharmacies and health facilities received a 10 percent referral fee. A comprehensive advertising and promotional campaign was also embarked upon. This comprised a course of TV advertisements which proved to be a great success and responsible for approximately 35 percent of new clients in the final year. Over 190,000 leaflets and posters were used as a means of disseminating information on topics such as FP options, VSC and STIs including HIV/AIDS.

The principal problems faced by MSIVN during the project period stemmed from government bureaucracy. Vietnam lacks a comprehensive legal framework for international NGOs, especially for those involved in the establishment and running of service provision facilities. In Vietnam there are only two types of service practitioners, government and private. These categories exclude MSIVN, which operates as an NGO. As only government practitioners are allowed to perform services in public the legality of the outreach service component was questioned and it was advised that these activities cease. This posed a major threat as outreach provision forms the backbone of referrals and awareness raising. Not to be deterred MSIVN commenced advocacy talks with the Ministry of Health and gradually gained their support on the subject and were thus able to sign contracts enabling the continuation of these outreach services.

The grants from the EC and The Galton Institute provided MSIVN with the funds required to establish three highly successful centres within three underserved areas of Vietnam. On project completion these centres had the capacity and skills to continue to provide these much needed services. The Nam Dinh, Thai Binh and Ha Tinh centres have continued to expand increasing client numbers by 774, 121 and 90 respectively in 2001. Furthermore they remain in a position to continue to provide outreach services within the wider community. Thus the grant from the Galton Institute continues even after project completion to assist in meeting the otherwise unmet need for FP and RH services in Vietnam.

Marie Stopes International would like to take this opportunity to once again thank the Galton Institute for its invaluable support in improving the quality and range of services and to meet the reproductive health challenges that persist in Vietnam. Vietnam is a country struggling to recover from thirty years of war and international isolation during which little or no investment in public services took place. As a result the government of Vietnam is severely under-resourced to provide the services required by its rapidly increasing population.

Providing individuals with the information and services to plan their families safely and effectively and protect themselves from contracting STIs is of vital importance in increasing life expectancy and reducing maternal mortality rates. Increasing access to RH services can also have wider social and economic benefits. Repeated cycles of childbearing deny women the opportunity to pursue an education or economic activities and vital workforces are depleted as maternal mortality affects women within the reproductive ages. MSI and MSIVN have the experience, knowledge and commitment to tackle these issues in Vietnam and have been able to carry out this essential work thanks to the continued support of concerned donors like the Institute.