Project mid-term assessment “Improving maternal and child health of ethnic groups

To assess impacts and identify possible drawbacks after two years of implementation of the project “Improving maternal and child health of ethnic groups through adopted healthier behavior”, at the end of 2013, Center for Community Health Research and Development (CCRD) collaborated with Provincial Health Services of three project provinces, i.e. Dien Bien, Yen Bai and Dak Lak, to conduct mid-term assessment of the project. Findings will be used to adjust future interventions with focus on specific health problems of each province so that resources will be allocated properly to assure project targets and sustainability are achieved.
For this assessment, CCRD and Provincial Health Services chose to combine qualitative research and quantitative data reported by village health workers (VHW) to collect comprehensive information about the implementation status and effectiveness of project activities. Specifically, in-depth interviews were conducted with various subjects from provincial levels to villages such as provincial and district project staff, VHWs, project target groups including pregnant women, women with children under five, husbands and other family members. The interviews were customized for each group with focus on the main objectives of the project, which are building capacity for provincial and district staff, change in knowledge and practice of the community in maternal and child health care (MCH). Beside qualitative data, indicators of maternal mortality, child mortality, age of pregnancy, number of pregnancy and delivery, newborn weight, child malnutrition were collected through VHWs.
Main findings
In general, the assessment results demonstrate positive changes in maternal and child health in all project districts. More importantly, they also point out the need for further customization of interventions to response to specific health problem of each province in the last 2 years of the project. In details:

Dien Bien province: Most significant is the decrease in maternal mortality rate in both project districts. In Dien Bien Dong, maternal mortality rate dropped from 2,000 to 83/100,000 live births and in Muong Cha from 1,000 to 117/100,000 live births. Under-one child mortality rate also decreases in both districts. The percentage of women attended by health workers during delivery increases; however, the rate of home birth delivery is still very high. Information from in-depth interviews attributes the changes to close collaboration between CCRD and Provincial and District Health Services to enhance the quality of home visits of VHWs – a direct channel contributing to the improvement of knowledge and practice in MCH especially among H’Mong ethnic group. Nonetheless, in the next stage, the project has to put more efforts to further improve maternal mortality, under-one child mortality due to acute respiratory infection and premature birth, and home birth delivery.

Yen Bai province: Most of the indicators have been improved compared to baseline. For example, under-one child mortality rate in 2 project districts decreases to only 25-60% of baseline, incidence of diarrhea among children under five drops 6% on average, the rate of home birth delivery went down by 6.9% in Luc Yen and 13.2% in Van Yen, the percentage of women attended by health workers during deliveries increases and reaches 93% and above. The undeniable factor driving the above changes is the combination of diversified BCC activities, especially those involving community participation like folk art performance – the most well-received and supported activity by local government and people. Beside the achievements, malnutrition is still high at the rate of above 20% in both districts; therefore, it will be the focus of project intervention in Yen Bai in the next 2 years.

Dak Lak province: Many indicators including home birth delivery, newborn underweight, deliveries attended by health workers, and malnutrition have been significantly improved. Particularly, malnutrition rate among under-five children has decreased from 29.1% to 23.3% in Krong Bong district and 24.4% to 19.9% in Ea Sup district. According to local leaders and local people, the improvement results from increased frequency of communication through radio and loudspeakers, home visits, folk art performance and, very importantly, supportive activities such as provision of milk for malnourished children and micro credit. Although Dak Lak province has made much improvement, it still needs to concentrate efforts on reducing malnutrition and child mortality especially in Krong Bong district.

A common observation for all 3 provinces is that the participation and commitment of local governments at all levels and local community leaders have been enhanced significantly. Not only does it prove the effectiveness of the project’s capacity building component but also promises sustainability because the government and the community share a special concern about MCH for ethnic minorities in remote areas.

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