The evolution of domestic violence prevention and control in Vietnam from 2003 to 2018: a case study of policy development and implementation within the health system.

BACKGROUND: Internationally, mental health and social care systems face significant challenges when implementing policy to prevent and respond to domestic violence (DV). This paper reviews the policy process pertaining to the national law on domestic violence prevention and control (DVPC) within the health system in Vietnam from 2003 to 2018, and critically examines the policy-making process and content, the involvement of key actors and the barriers to implementation within the health system. METHODS: 63 policy documents, 36 key informant interviews and 4 focus group discussions were conducted in Hanoi city, Bac Giang and Hai Duong provinces. The policy triangle framework was used to analyse the development and implementation process of the Law on DVPC. RESULTS: The Vietnamese government developed the law on DVPC in response to the Millennium Development Goals reporting requirements. The development was a top-down process directed by state bodies, but it was the first time that international agencies and civil society groups had been involved in the health policy development process. The major themes that emerged in the analysis include: policy content, policymaking and implementation processes, the nature of actors' involvement, contexts, and mechanisms for policy implementation. Policy implementation was slow and delayed due to implementation being optional, decentralization, socio-cultural factors related especially to sensitivity, insufficient budgets, and insufficient cooperation between various actors within the health system and other related DV support systems. CONCLUSION: The initial development process for DVPC Law in Vietnam was pressured by external and internal demands, but the subsequent implementation within the health system experienced protracted delays. It is recommended that the policy be revised to emphasise a rights-based approach. Implementation would be more effective if monitoring and evaluation mechanisms are improved, the quality of training for health workers is enhanced, and cooperation between the health sector and related actors in the community is required and becomes routine in daily work.

Child health status and maternal and child care in Quangtri Province, Vietnam.

Save the Children's CS-18 Project implemented from 2003 to 2008 aimed to improve child health and nutritional status people in Quangtri Province through the increased use of life-saving health interventions, both behaviors and services. This baseline survey, conducted at the start of the project to provide data to evaluate the effectiveness of the intervention upon its completion. A household survey was conducted of four hundred mothers of children under 2 years of age. Logistic regression was used to determine the relationship between maternal care behaviours and child health, controlling for confounding variables. In-depth interviews with 27 mothers and 4 focus group discussions with 38 mothers were also conducted. The rate of childhood malnutrition was 40.5%. The percentage of mothers that gave birth at home was 56.5%, and only 35.4% of these used a clean home delivery kit. Health staff only attended approximately 17.7% deliveries. Few mothers and newborns (23.8%) were checked after delivery. About half the mothers 54% did not feed their child colostrum, and most mothers (81.6%) stopped breastfeeding before 18 months. 58.8% of the children were sick within a month of birth. Child malnutrition was associated with child sex, age, birth weight, ethnicity, and socio-economic status (P < .001). Low rates of safe delivery and child care practices and high rates of infant illness indicate a need for improved service provision and education. Health facilities should be staffed continuously, promote village health workers in villages. Health staff should carry out a health communication campaign about maternal and child health. Family members, especially husbands, should be encouraged to take care of recent mothers during pregnancy and delivery.

Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health.

BACKGROUND: 1) To elicit the opinions of the Public Health alumni of the MPH program; 2) To assess the applicability of the knowledge and skills acquired; 3) To identify the frequency of the public health competencies that the alumni performed. METHODS: We requested 187 graduates to complete a self-administered questionnaire and conducted in-depth interviews with 8 alumni as well as a focus group discussion with 14 alumni. RESULTS: In total 79.1% (148) of the MPH graduates completed and returned the questionnaire. Most alumni (91%) agreed that the MPH curriculum corresponded with the working requirements of public health professionals; and nearly all were satisfied with what they have learnt (96%). Most respondents said that the MPH program enabled them to develop relevant professional skills (95%) and that they were satisfied with the curriculum (90%). Notably fewer respondents (73%) felt that the MPH program structure was balanced and well designed. Most alumni (64.3%) were satisfied with Hanoi School of Public Health (HSPH) full-time lecturers; but even more (83%) were satisfied with visiting lecturers. The most commonly selected of the 34 pre-identified public health competencies were: applying computer skills (66.4%), planning and managing health programs (47.9%), communicating with the community and/or mobilizing the community to participate in health care (43.2%). Overall, the MPH alumni felt that HSPH emphasized research methods at the expense of some management and operational competencies. The most important challenges at work identified by the alumni were insufficient skills in: data analysis, decision making, inter-sectoral cooperation development, English language and training. CONCLUSION: The training program should be reviewed and revised to meet the needs of its graduates who enter diverse situations and positions. English language skills were identified as top priority for further emphasis. The training program should comply with a more advanced accreditation system and standards.