A country struggling to overcome a long history of poverty and oppression, Vietnam faces a host of pressing issues. With most of its growing population of over 75 million people under the age of 30, family planning and reproductive health services are a top national priority.

Since 1991, AVSC has been helping the national family planning program of Vietnam improve reproductive health services. As one of the first U.S.-based reproductive health organizations to be invited to work with the Vietnamese Ministry of Health (MOH) on clinic service delivery, AVSC has witnessed the need for, and made a commitment to addressing, changes at the national, provincial, district, and commune levels.

Jane Wickstrom, AVSC's country director for Vietnam, opened AVSC's new office in Hanoi, the capital, in the spring of 1997. Though working in Vietnam poses many challenges, Wickstrom says that she has been inspired by her Vietnamese counterparts, who she says are some of "the hardest working, most dedicated people that I've ever met."

Upgrading Clinical and Counseling Services

The centerpiece of AVSC's current program is a quality-improvement initiative. AVSC staff give technical assistance to their Vietnamese counterparts in counseling, supervision, infection prevention, family planning technology, the diagnosis and treatment of sexually transmitted infections, and the establishment of linkages between family planning services and postabortion care.

Because of inadequate family planning services, most women in Vietnam have relied almost exclusively on the IUD as a family planning method and on abortion to regulate their fertility. AVSC and the MOH are working together to improve access to additional methods and information about services.

Wickstrom is witnessing a gradual change in public-sector health care: "At the national level, counseling and quality improvement in clinic services are becoming important concepts for the program. The Vietnamese are committed to improving quality for clients and believe that better medical and counseling services will be the key to success for their program."

Technical Training

One of AVSC's early accomplishments was assisting in the introduction of a national sterilization program. AVSC has helped to train obstetrician-gynecologists in current sterilization techniques (no-scalpel vasectomy and minilaparotomy using local anesthesia), and these doctors are now training their colleagues at the district level in these techniques.

The quality of care is expected to improve greatly if technical training continues to be implemented and disseminated throughout the provinces.

COPE, AVSC's low-cost method of helping health care staff assess services and improve quality, has been successful in Vietnam. Providers are looking at the services they offer, identifying problems, and working together to solve them. Says Wickstrom, "The country has a history of teams, of communes. COPE works well here."

Changes Seen Locally

To further promote quality services, AVSC is helping to upgrade health care facilities in Bac Kan and Binh Dinh, two provinces in which the range of services available in Vietnam can be seen. Bac Kan is a remote, mountainous region in the north. Roads are poor, and travel is difficult. Since family planning services have been limited, women often have numerous abortions.

The province of Binh Dinh presents a different picture. The clinic is well established and provides a full range of reproductive health services, including contraception, prenatal care, and a lab for diagnosing sexually transmitted infections. Staff there are working to improve service quality and to add a delivery ward to their facility.

AVSC is sponsoring three research studies now in progress in Vietnam. One study, which is being conducted in conjunction with the Reproductive Health Program, is examining client satisfaction with family planning services at four service sites. Another is studying how IUDs can be provided safely in settings where few resources are available to diagnose and treat sexually transmitted infections. And a third is evaluating sterilization service delivery. The results of these studies will be used to improve service delivery at AVSC-assisted sites and throughout the country.

Overcoming Obstacles

Vietnam has been isolated from the international community for many years and is currently one of the poorest countries in the world. But despite these hurdles, Wickstrom says the country is catching up with other Asian nations.

Pamela Beyer Harper is AVSC's director of communications.

Photos:
"A health care worker at Phu San Hanoi Ob-Gyn Hospital" --
"Clients returning from Tay Ninh Provincial MCH-FP Center" --