User-managed public health promotion in the Mekong Delta, Vietnam

Vietnam’s Mekong Delta area suffers from annual flooding, which is typically slow-onset, and inundates large areas. Floodwaters stay for up to two months before slowly receding. The Vietnamese government’s disaster-management strategy for the areas has been to live with these floods. Residential clusters have been developed near highways and river dykes, and families living in low-lying villages are being relocated to these areas. However, many of these residential clusters lack important water and sanitation (watsan) facilities.

To address these needs, Oxfam GB and the Dong Thap Province People’s Committee implemented a watsan public health promotion project in Dong Thap Province in 2003. One of the major objectives of the project was to persuade the government and donors to support similar watsan systems in every residential cluster. Two – Binh Phu Commune in Tan Hong District and Thanh Loi Commune in Thap Muoi District – were chosen for pilot projects. This article describes the watsan system managed by the Watsan Users’ Association in Binh Phu.

The project

Binh Phu is in Tan Hong District, Dong Thap Province. It lies near a road, about 6km from the district town. The watsan project was designed to serve 300 households, as well as government offices and schools (a total of 1,900 beneficiaries). The project was implemented by a Project Management Board (PMB) led by the Vietnam Red Cross in Dong Thap Province. A 300m-deep bore well with submersible pump was installed, along with a water tower (capacity ten cubic metres), a public tap water supply system and a sanitary system. A public health promotion component was also included, together with a management system. A baseline survey was performed at the start to collect data for subsequent use in impact assessment.

The watsan management system

Community management was an important part of the project from the start. Community participation was ensured in all areas of the project’s planning, implementation, monitoring and evaluation through consultative meetings, workshops and direct participation. As a first step, a Vietnamese consultant with experience of implementing a similar commune-managed system was brought in to facilitate orientation training. The Binh Phu Watsan Users’ Association was formed in February 2003, with 156 members. The Association participated in all aspects of the project, from helping to supervise construction to operational and maintenance management, financial management, health promotion and regular monitoring. A Management Board was formed, with 11 members, as well as a Supervisory Board of seven people, headed by the Vice-Chairman of the Commune People’s Committee. The Management Board is responsible for the day-to-day management of the Association, while the Supervisory Board has overall control.

Association activities

Construction monitoring

The members of the Management Board were involved in monitoring the construction of the water supply system. They communicated with the contractor and monitored the quality of the construction, the materials and the progress of construction works. They were involved in selecting beneficiaries and monitoring latrine installation.

Public health promotion

The public health promotion team (public health volunteers) prepared a monthly message-dissemination plan and submitted it to the Management Board. They then disseminated these messages under the guidance of the Board. They also organised group discussions and house visits. In subsequent visits, they monitored how people were applying public health knowledge.

Water distribution

A participatory approach was followed in respect of water fees, and the repair and maintenance of the system.

Financial management

An accountant and a treasurer manage the Association’s finances under a financial system defined by District and Commune regulations. They monitor all of the Association’s expenditure and income. Every month, they reconcile financial records and submit a report to the Management Board. The Association is responsible for collecting water fees, and holds regular meetings with all its members to share financial information.

Sewage and rubbish management

The Users’ Association divided the residential cluster into five blocks. Within each block, public health volunteers are responsible for drainage arrangements to dispose of household wastewater and rainwater into the main drainage system. The volunteers have organised campaigns for constructing and maintaining open sewage canals.

Gender mainstreaming

The Association has focused on providing equal participation for both women and men in all programme activities. While the Association was being formed, detailed discussions were held in which both men and women participated. However, out of 11 members of the Management Board, only three are women as it was not possible to find more women who could take up management responsibility. Gender and equality issues were covered in the training course for public health volunteers. This has helped them to understand the value of women’s contributions to the family and to society, even if they do not have money, and the importance within the family of discussion, and of sharing jobs, responsibilities, difficulties and benefits. A set of Information, Education and Communication (IEC) materials entitled ‘Gender Roles’ was produced for public health volunteers, the main messages of which were that both men and women can do typical household tasks like cleaning, shopping and gardening. This material was used in focus group discussions led by public health volunteers.

Project impact

All households in Binh Phu Commune now have safe water for drinking and domestic use. All recipients of sanitary latrines have improved family and individual health, and health awareness has been enhanced. There has been a significant decrease in cases of diarrhoea and skin infection. Diarrhoea has gone down from 31.3% in February 2003 (according to the baseline survey) to 4.3% in August 2003, and 3.3% in October 2003 (according to impact assessments). Skin infections fell from 7.2% (August 2003) to 4.4% (October 2003).

Lessons learned

Although the Watsan Users’ Association is involved in the management of the systems provided by the project, a bidding process for construction components was undertaken by the Project Management Board at the provincial level, with technical supervision by district officials. To ensure that the implementation system is and remains transparent and accountable, the participation of the Users’ Association remains essential. The cooperation of other departments, such as the Women’s Union, the Health Department and the Red Cross, at the district and commune levels, is vital if the WUA is to continue maintaining these systems effectively.

Conclusion

In this public health promotion project, Oxfam provided physical watsan facilities and public health awareness to residential clusters in the Mekong Delta. The Watsan Users’ Association formed at the cluster level is functioning effectively in managing both water supply and refuse disposal. District, provincial and national-level officials feel that the project has had a good impact in improving public health in these clusters. It is hoped that the national government as well as other donors will come forward to examine this experience and replicate these models in ways that are appropriate and relevant in other areas.

Provash Mondalis Oxfam GB Humanitarian Programme Coordinator in Vietnam. His email address is: pmondal@oxfam.org.uk.

References and further reading

Public Health Promotion Initiative – Dong Thap Province, Vietnam: Final Report, Oxfam GB, 2003.

Le Hong Hoa, Establishment and Initial Performance of the Watsan Users Association in Binh Phu Cluster, Experience Sharing Workshop, Dong Thap Province, March 2004.

Nguyen Thanh Tung, Inaugural Speech, Experience Sharing Workshop, Dong Thap Province, March 2004.