2008年-世界发展银行全球_Enabling_Environment_Assessment_and_Baseline_for_Scaling_Up_Handwashing_Programs___Vietnam_57页_1mb

Enabling Environment Assessment and Baseline for Scaling Up Handwashing Programs: Vietnam

Core Content

This report is part of the Water and Sanitation Program (WSP)'s Scaling Up Handwashing Project, funded by the Bill & Melinda Gates Foundation. The project aims to test innovative promotional approaches to increase handwashing with soap (HWWS) at critical times among the poor and vulnerable in Peru, Senegal, Tanzania, and Vietnam. The report specifically focuses on Vietnam, detailing the enabling environment assessment and baseline findings to support the scaling up of HWWS programs.

The project seeks to inculcate the HWWS habit among 2.3 million poor women of fertile age (15-49) and poor children ages 5-9 within two years of implementation. It emphasizes the need for sustainable and scalable programs that can continue beyond the initial grant period.

Main Objectives

• Design and support innovative, large-scale, sustainable handwashing programs.
• Document and learn about the impact and sustainability of such programs.
• Identify the most effective and sustainable approaches to promote handwashing behaviors.
• Promote the adoption of effective handwashing programs in other countries and position handwashing as a global public health priority.

Key Findings and Conclusions

1. Policy, Strategy, and Direction

• Opportunities: Favorable political environment, potential for integrating HWWS into ongoing programs.
• Limitations: Lack of a national handwashing strategy and shared vision.
• Recommendation: Develop and share a national strategy and move policy to parliamentary levels.

2. Partnerships

• Opportunities: Strong interest in cooperation and collaboration.
• Limitations: Insufficient understanding and emphasis on the partnership concept.
• Recommendation: Establish a clear protocol for stakeholders, assign roles and responsibilities, and ensure buy-in and ownership.

3. Institutional Arrangements

• Opportunities: Clear government networks with defined roles and responsibilities.
• Limitations: Most potential partners still view the Handwashing Initiative as vague.
• Recommendation: Promote MOH leadership, delineate a stakeholder map, and organize a seven-person task force to identify roles and responsibilities.

4. Program Methodology

• Opportunities: Interest in learning and applying new behavior change (BC) techniques.
• Limitations: Unclear shared program methodology among stakeholders.
• Recommendation: Conduct a BC workshop on new techniques and models, and provide opportunities to practice and implement these methods.

5. Implementation Capacity

• Opportunities: Existing capacity and expertise for cost-effectiveness studies.
• Limitations: Limited capacity to scale up.
• Recommendation: Map staffing structures, develop a distribution system, and create a training and capacity-building plan.

6. Availability of Products and Tools

• Opportunities: Soap is not a barrier.
• Limitations: Access to clean water is inconsistent, and handwashing facilities are lacking in schools.
• Recommendation: Reexamine market and conditions research, assess and ensure necessary conditions (water, facilities), and design innovative solutions.

7. Financing

• Opportunities: Sufficient for initial provinces.
• Limitations: Insufficient attention to financing for handwashing facilities and products.
• Recommendation: Investigate additional funding sources, encourage budget line items for handwashing in organizational budgets, and develop a focused budget format.

8. Cost-Effective Implementation

• Opportunities: Existing capacity to conduct cost-effectiveness studies.
• Limitations: Study is required.
• Recommendation: Include cost-effectiveness study in impact evaluation.

9. Monitoring and Evaluation (M&E)

• Opportunities: Capability to develop and use M&E systems.
• Limitations: Inconsistent behavior change indicators and lack of established methodologies.
• Recommendation: Develop three to five behavioral indicators and establish a handwashing M&E working group.

Current Handwashing Initiatives in Vietnam

1. National Handwashing Initiative (WSP-supported):

   • Active since January 2006.
   • Funded by Danish Embassy ($1 million) and Gates Foundation ($1.6 million).
   • Aims to influence mothers of children under five and primary school children in 250 communes across eight provinces.
   • Uses national and community-level behavior change communication (BCC).
   • Hosted discussion workshops and is in the process of selecting a communications agency.

2. "Share Love Not Germs" Campaign (Unilever-supported):

   • Active since 2006, in conjunction with the MOH Department of Preventive Medicine (DPM).
   • Funded with $2.6 million over five years (2006–2010).
   • Utilizes mass media and community communication activities.
   • Employs a social marketing approach and creative BC techniques.

Key Challenges

• Low HWWS rates among the population, particularly among mothers and children.
• Limited access to clean water and handwashing facilities, especially in schools.
• Lack of consistent behavior change indicators and M&E methodologies.
• Insufficient national strategy and stakeholder alignment.

Recommendations

• Develop and share a national handwashing strategy.
• Create a clear protocol for stakeholder roles and responsibilities.
• Establish a stakeholder map and a seven-person task force.
• Conduct BC workshops and provide training and capacity-building.
• Reexamine market research and conditions for handwashing.
• Investigate additional funding sources and ensure budget focus.
• Include cost-effectiveness studies in impact evaluations.
• Develop behavioral indicators and a handwashing M&E working group.

Conclusion

Vietnam has the vitality, expertise, and drive to create a successful and sustainable HWWS program. The country has a favorable political environment and existing infrastructure, but stakeholder alignment, consistent M&E, and scaled-up implementation are still needed to ensure long-term success. This baseline assessment provides a roadmap for improving the enabling environment and achieving the project’s key targets.

Appendix: Summary of Dimensions, Opportunities, Limitations, and Recommendations