DECISION ON APPROVINGNATIONAL MASTER PLAN FOR PROTECTION, CARE AND PROMOTION OFADOLESCENT AND YOUTH HEALTH FOR THE PERIOD 2006-2010AND STRATEGIC ORIENTATION UNTIL 2020

To approve the “National Master Plan for Protection, Care and Promotion of adolescent and youth health for the period 2006-2010 and strategic orientation until 2020” with the following

AND STRATEGIC ORIENTATION UNTIL 2020

THE MINISTER OF HEALTH

DECIDES:

Article 1.

To approve the “National Master Plan for Protection, Care and Promotion of

adolescent and youth health for the period 2006-2010 and strategic orientation until 2020” with the following principal contents:

1 Objectives

a General objective

To maintain and promote the physical and mental health of young people.Specifically, to improve and increase access to quality health care services, especially forsexual and reproductive health and prevention of STDs and HIV/AIDS, to reduceunwanted abortion, to prevent accidents and injuries, decrease the prevalence of substanceabuse, and reduce rmental health problems Targets for 2010 include:

- the reduction of the number of unwanted pregnancies among adolescents and youth(A and Y) by 30%

- the reduction of the number of new HIV infections among A and Y by 30%

- the reduction of the number of injuries among A & Y by 30%

- the reduction of the number of A & Y using substances (drugs, alcohol andcigarettes) by 30%

40% of A & Y experiencing psychological disorders are able to speak with othersabout their disorders

- Creating and implementing a detailed plan for budget mobilization that considersthe state budget and international aid for the implementation of the NationalMasterplan.

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b 2008-2010 Period

Activities in this period will include the scaling up of intervention models based onexperiences gathered in the first phase and the provision of technical support, supervision,and refresher trainings by the central level to the lower levels to improve capacity

c Vision for the period 2010-2020:

Creating supportive environment and minimizing health risks will continue tocreate opportunities for A and Y to improve their health and develop in such a way to makepositive contributions to society as well as the country and ensure their individualhappiness

Interventions for this period should focus on seeking solutions through activities asfollows:

- Strengthening IEC and BCC

- Extending the model of comprehensive friendly services (provision of information,counselling and clinical services) to disadvantaged and remote areas

- Improving research, supervision and evaluation skills for central and provinciallevels to support the adjustment and updating of policies and interventions

4 Budget

The estimated minimum budget for the Master Plan implementation for the period2006-2010 is 6,290,000 USD equal to 100,640,000,000 VND This budget will bemobilized from the following sources:

a Coordination and management

Establishing coordinating bodies at various levels for the protection, care and promotion of A and Y health

To implement the National Strategy for Reproductive Health being approved bythe Prime Minister, coordinating bodies for the protection, care and promotion of A and Yhealth will be established within committees from the central to peripheral levels Thesecoordinating bodies will include administrators from different MoH related departmentsand representatives of other ministries/ sectors/ social organizations A secretariat will becreated to work for the central coordinating body and the Ministry of Health to coordinatethe implementation of the master plan

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Technical support:

There shall be a technical assistance group established that will includerepresentatives from various health sector fields such as OB/Gyn physicians, pediatricians,public health specialists, IEC experts, social scientists, psychologists and international andnational experts from various international and national NGOs

b Integrated mechanisms

Programs, projects and activities in the health sector related to the protection, care,and promotion of A and Y health should be coordinated and integrated Examples includereproductive health programs, safe motherhood programs, family planning programs, youthfriendly health services, HIV/AIDS prevention, accident and injury prevention as well asIEC/BCC programs that target A&Y run by other agencies Other agencies will implementprograms/projects related to A & Y health through their vertical systems This coordinationrequires technical assistance, comments for plan of action, management, supervision andmonitoring/evaluation to ensure that the objectives of the MP will be followed Programs,projects and activities that have to be carried out at the primary health care level, should be

in accordance with the guidelines and direction of the MoH for the implementation ofconcrete interventions

Article 2 The Reproductive Health Department is assigned by the Ministry of Health

to be the focal point for the coordination and implementation of the Master Planapproved in Article 1 of this decision and should report periodically to the Minister ofHealth about the implementation process

Article 3 This decision will have full effect 15 days after being issued.

Article 4 The Director of the Office of Ministry of Health, Directors of VAAC,

VAPM, RH Department, Science and Training, Financial and Planning, InternationalCooperation, Therapy Departments and related organizations are to implement thisdecision

For the Minister of Health

Vice Minister

Signed

Tran Chi Liem

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In accordance with the WHO report, the world population now accounts for 6billions Of those, there are 1.2 billions adolescent and youth totaling one fifth of thepopulation The Vietnam, Demographic and Health Survey 1999 (DHS 1999) reports theadolescent and youth groups combined make up one third of the population Young peopleare a vital resource of the society and will play an important role in determining thecountries future Therefore, adolescent and youth health and development have been paidspecial attention from the Government of Vietnam However, due to a lack of adequateknowledge and life skills, this age group faces numerous risks and challenges Theseinclude RSH, HIV/AIDS, early pregnancy, unwanted pregnancy, unsafe abortion, trafficaccidents and substance abuse

The Prime Minister’s decision No: 136/2000/QD-TTg dated November 28, 2000approves the National Strategy on Reproductive Health Care for the period 2001-2010 Inthis document, reproductive health care (RH care) for adolescents and youth includingRTIs/STIs is one of the prioritized interventions that should be implemented at all levels.More over, the strategy also points out the strategic measures to improve reproductive andsexual health in adolescent and youth through education and counseling as well asprovision of Youth Friendly Services (YFS) To implement this strategy, the MOH hasissued National Standard Guideline (NSGs) on RH care and the provision of YFS includingcounseling on RSH, appropriate contraceptive distribution, safe motherhood, safe abortion,prevention of RTIs/STIs

The development and promulgation of the National Master Plan on Protection,Care, and Promotion of Adolescent and Youth Health (MP on ADHD) provides asignificant focus to guide interventions to improve the reproductive health status for theadolescent and youth group in the years to come The MP on ADHD will contribute toachieving the National Strategy on RH Care objectives that were approved by the PrimeMinister

This is the first time the MOH has developed a comprehensive and long term Planfor protection, care, and promotion of adolescent and youth health This plan providesclear objectives, targets, indicators, strategic measures, implementing measures, and abudget estimation to carry out the Plans’ activities

This is an important document facilitating decision makers and managers to haveclear guidance in carrying out the interventions related to protection, care, and promotion ofadolescent and youth health The Master Plan is also a background for agencies dealingwith adolescent and youth health to wisely plan and select the most appropriate areas forinvestment in adolescent and youth health

The MOH would like to take this opportunity to express our special thanks to SIDAand WHO for their financial and technical supports, and all the related agencies during theprocess of the development of this Master Plan

Dr Tran Chi Liem

Vice Minister of Health

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NATIONAL MASTER PLAN FOR PROTECTION, CARE AND PROMOTION OF ADOLESCENT AND YOUTH HEALTH FOR THE

PERIOD 2006-2010 AND STRATEGIC ORIENTATION UNTIL 2020

Introduction

Issues related to adolescent and youth health are becoming a common concern inVietnam as well as in many other countries This National Master Plan for Protection, Careand Promotion of Adolescent and Youth Health for the period of 2006-2010 (referred to asMPAYH) deals with health concerns surrounding this very important human transitiontime, which has in the past received limited attention Commitment by the VietnamGovernment to adolescent and youth health has been expressed clearly in various strategicdocuments on youth and health These strategies confirm the important role of youngpeople both adolescent and youth (A & Y) in the industrialization and modernizationprocess as well as in the development of future generations for the country At the sametime, the strategies raise issues for Vietnam during its integration and globalizationprocess, which lead to new opportunities and challenges for young people Theseopportunities and challenges include education, occupation, work, promotion, family lifeand health concerns such as HIV/AIDS, accident injuries, use and abuse of alcohol,tobacco, drugs and other social problems

1 Definitions of adolescence and youth

According to the WHO, “adolescents” are young people aged 10-19 years “Youth”include young people in the age group 15-24 The term “young people” is an umbrella termthat includes both adolescents and youth thereby including those 10-24 years of age ThisMaster Plan concerns the age group 10-24 acknowledging the three sub-groups 10-14, 15-

19 and 20-24

2 Rationale and background for the development of the Master Plan

The 4th Resolution of The VII Party Congress on youth development in the newperiod confirms that: "Youth development is a vital issue of the nation, one of the factorsdetermining the success of the revolution" The Strategy for Socio-economic Development

of the Vietnam Communist Party for the period 2001-2010 has clearly stated aims: "To

improve capacity and to provide opportunities for all so that everybody could work at the best of the acquired competency contributing to the development process and could enjoy products of the development” "To develop rapidly Vietnamese human resources to meet higher and higher standards” and "To enhance the reform in order to motivate the liberation and the use of all resources "1, in which it is important that A & Y be considered

as key factors for future socio-economic development and as a potentially great force forthe growth and the prosperity of the country Recently, Resolution No 46 of the PoliticBureau also mentions limitations and constraints for the protection, care and promotion ofpeople’s health to include A & Y health Health protection and care in our country stillhave many constraints and weaknesses The quality of health services has not yet metpeople’s health needs, which are becoming more and more diversified A proportion of thepopulation has not yet developed in their mind the habit for self-health protection, care and

1 - Strategy for socio-economic development 2001-2010.- Official document of the IX Commuist Pary Congress- Notioanl Politic Editions 2001 pp 163-165 (Chiến lợc phát triển kinh tế xã hội 2001-2010 - Văn kiện đại hội đại biểu toàn quốc lần thứ IX Đảng Cộng sản Việt Nam, Nhà Xuất bản Chính trị Quốc gia, Hà Nội, 2001, trang 163, 165).

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promotion There are not yet effective measures for the mobilization of community andsocial resources for health protection and care Some authorities of the party andgovernment have not yet taken into consideration their leadership and guidanceresponsibilities for the protection, care and promotion of people health

The WHO in the Western Pacific Region recommends to regional policy makersthat adolescent and youth health and development issues should be prioritized by 3strategies:

1 To develop national policies for health and development of young people

2 To integrate issues of health and development of A & Y into national policies for theprotection, care and promotion of public health

3 To integrate issues of health and development of A & Y into national policies fornational development

Vietnam has implemented strategies 2 and 3 by the integration of A&Y health intomany national health and development policies However, a specific policy for theprotection, care and promotion of A&Y has not yet been developed

The National Strategy on Reproductive Health Care for the period 2001-2010 issued

by the Prime Minister dated November 28, 2000 (decision No:136/2000/QD-TTg) hasidentified that reproductive health care and prevention of reproductive tract infectionsincluding STDs in the adolescent group are the main components that need to beimplemented The strategy also suggested possible solutions to improving adolescent RSH(Reproductive and Sexual Health) including IEC (Information, Education andCommunication), counseling and the provision of YFS (Youth Friendly Services)

Based on health directives and orientations of the Vietnam Communist Party and onthe current status of A & Y health, the Ministry of Health has decided to develop a

“National Master Plan for the Protection, Care and Promotion of Adolescent and Youth Health for the period 2006-2010 and strategic orientations until 2010”

To develop and issue this Master Plan are the key steps to guiding the protection,care and promotion of health for the A&Y in the years to come The Master Plan alsocontributes to achieving the objectives of the National Strategy on Reproductive HealthCare promulgated by the Prime Minister

This is the first time that MOH has developed a long term, comprehensive andconcrete plan that has clear objectives, targets and indicators and the budget estimationneeded to reach those objectives.

The Master Plan not only solves health problems but also identifies opportunities forthe government and communities to contribute to the development of A & Y morecomprehensively One important purpose of this plan is to strengthen the co-ordinationbetween families, schools, ministries, sectors, social organizations and communities

The development of the Master Plan has been based on results of “The National

Health Survey 2000-2001”, “Survey Assessment of Vietnamese Youth 2003 (SAVY)” 2

This plan aims to guide common efforts of ministries, sectors, social institutions andorganizations to serve the specific health needs of A & Y The plan suggests policy makersidentify significant and appropriate interventions for A & Y health, to make plans toimplement interventions and to mobilize resources for those interventions in the years tocome

The Master Plan is also based on previous research results particularly the draft

documents of Strategies for Adolescent and Youth Health prepared by the Centre for Rural

Population and Health (not yet approved) This Master Plan addresses related elements2

- SAVY (Survey Assesment of Vietnamese Youth), Eds MoH and GSO (do Tæng côc Thèng kª vµ Bé Y tÕ tiÕn hµnh)

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raised by previous existing strategies including the Strategy for Adolescents and Youth

2002 3 , Strategy for Care and Protection of People’s Health, National Strategy for

Reproductive Health Care for the period 2001-1010, National Strategy for nutrition, Strategy for Population Development, Strategy for the Prevention of HIV/AIDS until 2010 and vision until 2020, National Policy for tobacco control, and National Policy for the Prevention and Control of Accidents and Injuries The Master Plan could contribute to the

implementation of The Youth Laws, which were passed and issued by the NationalAssembly The Master Plan is concerned with concepts pertaining to general health andincludes reproductive health

According to the WHO definition, “Health is not only a state free of diseases anddisabilities, but also a state of well being physically, mentally and socially”4

Reproductive health is defined as “a state of total physical, mental and social wellbeing, free of diseases and disabilities of the reproductive system” This implies that peoplehave the right to receive information and have access to health services and safe, effectiveand acceptable family planning services according to their choice This would ensurewomen have safe pregnancies and deliveries, providing the best opportunities for couples

to have healthy babies In the Master Plan, reproductive health (RH) is understood toinclude sexual health

The Master Plan is built on the understanding of Vietnamese young people’spersonality and demography characteristics This assures the focus to youth developmentand the influence of this group to the future of our nation This plan could also response tothe reform and the globalisation of Vietnam in the industrialization and modernizationprocess

The Master Plan is also built on an analysis of A&Y’s physical and emotionalchanges Puberty used to be determined only by physiological factors, however the pubertydefinition needs to be widened to include all physical, social and emotional changes

A & Y usually try to develop and sustain their own value systems They becomemore independent, more resilient to face physical, social and emotional changes5 in aneffort to assert their own value in their journey through the transition years to maturity.This is a period in which A & Y could experience potentially risk-taking behaviors Whilemany A & Y successfully navigate this period, some of them will engage in such behaviorsthat are potentially harmful to their health6

The second decade of life is the time when young people develop to maturity.Young people no longer face children’s diseases, instead they are confronted by new risksrelating to their physiological, psychological and social well being Physical changes inpuberty and sexual development raise many emotional issues This is a period full ofparadox and conflicts requiring strong support from families and communities

3 Master Plan development process

In 2003 the Department of Reproductive Health - MOH established a workinggroup to co-ordinate the drafting of the national Master Plan The process of developmentincluded a review of national and international documents, a rapid field study in 4provinces (Ninh Binh, Hue, Ho Chi Minh City and An Giang), consultative meetings withthe participation of adolescents and youth and meetings with the participation of policy

3 Ho Chi Minh Youth Federation, 2002, Strategy for rhe development of youth and children (Đoàn Thanh niên Cộng sản

Hồ Chí Minh, 2002, Chiến lợc thanh thiếu niên và nhi đồng)

4

WHO, Alma Ata declaration, 1978 (Tuyên ngôn Alma Ata, 1978).

5 UNICEF (2002) Adolescent: A time that matters Located at

www.unicef.org/program/adap/assets/adolescence.pdf

6 - SAVY, 2005

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makers and researchers The working group has also developed research tools for thecollection of reliable and significant data The Master Plan includes the participation ofmany national organizations and international agencies with interests in A & Y health.

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Part 1 Overview

1 Situational analysis

Young people in the age group 10-24 years old make up approximately 32% of thepopulation This age group is the largest (about 27 million) among various age groups inVietnam and represents the biggest sub-group within the population7 Recent studies(SAVY 2005 and 9 SAVY Policy briefs8) have shown that today’s younger Vietnamesegeneration is optimistic and hopeful With few exceptions the majority of young peoplereport they see more opportunities for the future than previous generations in areas such aseducation, income, wealth opportunities, developmental capabilities, career developmentand opportunities for international exchanges Besides such opportunities, these youngpeople also face many risks and challenges with relation to issues concerning STDs, HIV/AIDS, early pregnancy, unwanted pregnancy, unsafe abortion, substance use and abuse andaccidents and injuries including domestic violence and traffic accidents

1.1 Physical growth and nutrition:

Any strategy or plan for health protection, care and promotion of A & Y shouldconsider the following: physical and mental development, morbidity and disability,infectious and chronic diseases, general health status compared with those of young people

in other countries and age groups

The assessment of the physical growth of young people is often based onmeasurements of weight, height and chest size A study in 2001 showed that the height ofVietnamese in late 1990s was higher than that recorded in 19759 However the average

height today is still lower than the standard height recommended by the WHO The averageheight of a young Vietnamese male and female is 155.5 cm and 151cm respectively whilethe WHO standard height is 169cm and 161.8cm Similarly, the average weight of a youngVietnamese male and female is 46.9kg and 40.7kg respectively while the WHO standardweight is 56.7kg and 53.7kg Similarly, many other studies show that Vietnamese A & Yare not only lower in height and weight but also weaker in muscular strength andendurance and stamina in comparison with A & Y of other countries in the region

Malnutrition rates have decreased significantly in last 5 years with economicgrowth Surveys by UNICEF and NIN shown a sharp decrease in malnutrition in childrenbased on weight/age from 33.8% in 2000 to 31.9% (2001), 30.1% (2002), 28.4% (2003),26.6% (2004) and 25.2% (2005)10 On the contrary, obesity is becoming a public healthproblem in urban areas and among children in better-off families This situation relates toenergy-dense, rich-fat diets and also to sedentary lifestyles

1.2 Puberty

Some studies show that puberty in Vietnam today occurs at an earlier age than inthe past11 Comparison of data between 1970 and 2000 found that the age of puberty had

7 Report on Adolescent Reproductive Health Department-Ministry of Health, Hanoi 2003.

8 SAVY report, and 10 policy briefs for Adolecent health Reproductive Health Department-Ministry of Health, Hanoi 2005.

9 Tran Van Minh and al 2001 Anthropometric measures Final report of the project for baseline data of biological indicators of Vietnamese in the 1990 decade Hanoi Medical University ( TrÇn V¨n Minh vµ céng sù,

2001, Nhãm c¸c chØ tiªu nh©n tr¸c B¸o c¸o toµn v¨n ‘Dù ¸n ®iÒu tra c¬ b¶n c¸c chØ sè sinh häc ngêi ViÖt Nam thËp kû

90 §¹i häc Y Hµ-néi, 2001)

10 National Institute of Nutrition, UNICEF.

11 Viveca U., 2004, Speech in the seminar on ”adolescent and youth health” MoH and WHO in Hanoi 2003 (Ph¸t biÓu t¹i Héi th¶o ‘Søc khoÎ vÞ thµnh niªn vµ thanh niªn ’ do Vô Søc khoÎ sinh s¶n (Bé Y tÕ) vµ WHO tæ chøc t¹i Hµ-néi th¸ng 3- 2004)

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decreased by 1 year12 Recent SAVY data shows the average age of first menstruation is

14.5 for young females and the first wet dream for young males occurs on average at 15.6

At age 13, 3% of male children experience their first wet dream and 17% of femalechildren experience their first menstruation At age 15, 50% of male children experiencetheir first wet dream and 79% of female children experience their first menstruation.SAVY data also shows there is little difference in puberty age between urban males andrural males, but the difference between urban females and rural females is relativelysignificant The average puberty age in urban females is 14 while in rural females it is 14.6.This could be related to malnutrition among rural female children as well as otherinfluencing social factors Never go to school rate of ethnic minority young women everattending school were the highest

1.3 Education and intellectual development

It is important to recognize that the rate of young people’s literacy is significantlyhigh According to SAVY, 96.2% of people participating in the survey said they had atsome stage attended school This rate was 98.6% in urban areas and 95.4% in rural areas.The survey also showed similar primary school attendance rates for both sexes: 97% formales and 95% for females It is worth noting that school attendance and achievements ateach grade were also similar in both sexes13 SAVY observed lower school attendance ratesamong A & Y in poor regions, rural areas and among ethnic minority groups Ethnicminority young women who had at some time attended school, the “never go to school”rate was highest (19%) This was followed by ethnic minority young men (10%) and Kinhyoung men ( 2%) Young people’s literacy rates were high at 97% in urban and 91.5% inrural areas This included 3.4% of those who attended school but were still illiterate Thissuggests that literacy skills can be lost if young people drop out of school early and/or donot frequently practise reading and writing It is noteworthy that disadvantaged street anddisabled children have lower rates of literacy, and high re-illiteracy

In 2000, a study on the classification of school children according to IQ(Intelligence Quotien)14 was conducted in Hanoi, Ho Chi Minh City and Hue The studyfound encouraging results on intellectual development including IQ indicators, abstractioncapability, memory and ability for concentration at work However, the study also showedthat 50% of school children were within the group of mezzo and low IQ

1.4 Self-image, self-respect, hope and ambition

Recent studies show that young people in Vietnam today are optimistic andhopeful; they have a positive self-image The majority of them could recover rapidly frompsychological traumas and could manage daily anxieties and challenges In general, theyare hard working people, who have vision, ambition and a close connection to theirfamilies They have strong support networks through their peers, their families and theircommunities to help them overcome challenges The family environment has a key role informing a young person’s personality Parents set examples, providing opportunities fortheir children and responding to their needs This environment includes concepts of incomestatus and family happiness and ideally an openness to discuss issues of puberty, sexualrelations and HIV

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Cao Quoc Viet and Nguyen Phu Dat 2001 Final report of the project for baseline biological indicators of Vietnamese”

in 1990 Hanoi Medical University (library) ( Cao Quốc Việt và Nguyễn Phú Đạt, 2001, Báo cáo toàn văn ‘Dự án điều tra cơ bản các chỉ tiêu sinh học ngời Việt Nam thập kỷ 1990" Th viện Đại học Y Hà-nội)

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SAVY chap 2, pp 25 ( Điều tra quốc gia Vị thành niên và Thanh niên Việt Nam, Chơng 2, phần Giáo dục, trang 25).

14 Tran Trong Thuy, Dao Thi Oanh and al 2000 Intellectual capacity of school children today MOET 2000 (Trần Trọng Thuỷ, Đào Thị Oanh và cộng sự, 2000, Trình độ trí tuệ của học sinh trung học hiện nay Đề tài trọng điểm cấp Bộ, mã số 98-49-TĐ42 Bộ Giáo dục - Đào tạo Hà-nội, 2000)

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Vietnamese young people have a positive view about school SAVY showed that90% of young people thought students had been treated equally and had opportunities toexpress their own ideas The majority of them were satisfied with their image and theirfuture According to SAVY, most A & Y were confident and evaluated themselvespositively 94.7% said they felt they were of value to their family whilst 98.4% thoughtthey had some virtues and 93.9% thought they were able to do anything that others could.Regarding the future, the top priority was to have a job (49.5%), then a stable income(23.3%) It was noteworthy that the number of people wishing for happiness in general or ahappy family was less than 10% (9.7% and 8.8%)15.

1.5 Perception of Values

The attitudes and values of young people today are vastly different to those ofprevious Vietnamese generations Social changes result in changes to perceptions onvalues Only when we understand what “A & Y’ are thinking, what they perceive as rightand wrong, good and bad (i.e their value representation), can we educate, guide and helpthem effectively This is why it is important for us to evaluate young people accurately

According to a study on “The Vietnamese and Doi Moi” 16, the slogan or mantra of

Vietnamese people before 1975 was Independence and Freedom After country

reunification the immediate need and highest priority was “Happiness” According to

Associate Professor Nguyen Quang Uan’s17 “Survey on the Values of Vietnamese People”,

traditional values up until Doi Moi were:

- The mental or psychological was valued above the material

- Feelings were valued above reason

- Community was valued above the individual

- Commerce and cultural arts had low consideration

- Intellectual and academic study was more highly appreciate than manuals andhandicrafts

Studies suggest that since Doi Moi, social values have changed One study involving

339 pupils, 400 students and 398 rural youths, shows 3 tables of values: core value, basicvalue and none basic value These are co-related to 3 social aspects: awareness, attitudeand behavior Results of the study show that young people’s fundamental or core valuestoday are different from those previously conceived

1 Core values of school students are ranked as:

2 Core values of university students

15 SAVY 2005

16 Tran Thanh Dam, 1993 the Vietnamese and the reform Pp 18 (Đôi nét chân dung một lớp ngời đổi mới, PGS Trần

Thanh Đạm, Con ngời Việt Nam và công cuộc đổi mới, Chơng trình KX-07,(do GS-TSKH Phạm Minh Hạc làm Chủ

nhiệm đề tài), Hà Nội, 1993, trang 18)

17 Vietnamese people and the reformation, KX-07 program, Hanoi, 1993, P 94

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9 Co-operation 10 Creative, critical

Key values are artistic, endurance, economic and bravery

3 Value concepts of rural youths

- Good relationship among family members - Traditional culture

Depending on differing subjects and environments, value concepts of A & Y arevaried However, all value concepts have changed considerably including traditional valuesand core values such as being peaceful, faithful, skilful etc These values are not asstrongly appreciated as in the past lead to significant differences in the dreams and hopes of

A & Y

Vietnamese families rely on their children to fulfil their expectations They hopethat their children will achieve more and have a better life or more education than previous

generations, thus leading naturally to a sense of happiness “A happy family is a family

where children are “more” than their parents” is a saying still appropriate today These

expectations have created a willingness and motivation for young people to develop theirpersonality, their career, their position and their successes for their future

1.6 Mental health

The WHO predicts that mental health issues and mental illness could become asignificant proportion of all disease by 202018 Citing numerous case studies, mass medianews report mental health issues and psychological stress, including suicide attempts andself-harm, are becoming increasingly serious issues for young people

According to SAVY, in Vietnam, while the majority of young people have goodmental health, rapid recovery from emotional trauma, good working capabilities and closerelationships with families and within schools, 1/3 of them from time to time have somedespair and no hope for their future Girls and women experience more sadness anddepression than boys and men The rate among young girls of minority ethnic groups is ashigh as 34% Reported data and hospital data show that young people have noticeable rates

of mental disorders Addicted young men have been associated with schizophrenia, whichposes a challenge for mental health services in the future International data shows somerelationship between mental disorder and genetic elements, psychotropic drugs andemotional trauma in life Young people with mental disorders are reluctant to access healthservices partly because they fear stigma

1.7 Disease and illness patterns

Recent data shows that young people in general are healthy and absenteeism fromwork and study due to sickness is low 39.7% of respondents in the SAVY reported 1 leavedue to sickness in the previous 12 months The 5 most frequent symptoms of sicknesswere: fever, cold, abdominal pain, respiratory infection and diarrhoea There was a cleardifference in the disease burden in young people of ethnic minority For example, young18

World Health Report 2003 WHO Geneva

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people from ethnic minorities had double the rate of asthma and digestive diseases andtriple the rate of goitre compared to the Kinh group Urban young people (14-17) had morevisual problems, 20% of urban girls and 13.6% of urban boys compared with 2.4% in ruralgirls and 1.7% in rural boys This difference could be explained partly by the higher urbanaccess to the specialists and facilities of ophthalmology, or by more opportunities created

in urban areas for studying, TV watching or playing games on computers

1.8 Sexual and reproductive health

Young people in Vietnam are reported to receive information about reproductivehealth and HIV from IEC campaigns and a wide range of sources and media However, theaccuracy of their knowledge is not really high Their understanding or in depth knowledgeabout elements of reproductive health is not in accordance with their awareness of theissue For example, young people had a high awareness of family planning but only 35% ofthem could define the fertile period of a menstruation cycle (SAVY) Young people in theethnic minority group had low knowledge on reproductive health and HIV/AIDS.According to SAVY, A & Y in Vietnam had high awareness on reproductive health butlow and incompatible knowledge and attitude in that area For example, having a negativeattitude to condom use and low knowledge of the conception time19

Sexual and reproductive health education is a sensitive issue in Vietnam Someparents and educators think sexual education could stimulate young people into early

sexual intercourse or “draw the way for the deer to run” The majority still have reluctant

feelings when sexual issues are raised However, SAVY showed that a high proportion ofyoung people received some information on reproductive health (65%) and HIV (80%)from their families Therefore, in reality, parents do have some participation in educatingtheir children about sensitive issues Research about parent and child communication ontopics of sexuality, puberty and reproductive health indicates that some parents do discussissues with young people although this is often with embarrassment and shyness from bothsides Some parents prefer not to discuss these sensitive issues with young people at all

The rate of sexual intercourse among young people within the age group 14-17 isrelatively low (under 0.5%)20 Therefore, when targeting this group, we can approach themajority of A & Y not yet sexually active Sexual intercourse however within the agegroup 18-24 is more frequent; males more frequent than females and urban more frequentthan rural About 10% of unmarried young people in the age group 18-24 said they hadexperienced sex at some stage The average age for first sexual intercourse was 19.6; therate of pre-marital intercourse in males 11.1% and females 4% The rate of pre-maritalintercourse in minority ethnic groups was higher, 40% in males and 26% in females

Among those who stated having pre-marital intercourse, 73% said they had theirfirst intercourse with their fiancés, boyfriends or girlfriends, 10% with a friend and 9%with a sex worker Young people in general accept the idea of pre-marital sexualintercourse, males more than females and young people of the age group 14-17 less thanolder age groups When young people are asked for their acceptance of pre-marital sexualintercourse agreed upon by both partners, 41% of males and 22% of females said “yes”.When the same question was raised regarding couples in love, only 15% of females and32% of males agreed with the idea (SAVY)

A very low rate (0.3%) reported sexually transmitted infections (STIs); 0.5% in amarried group and 0.2% in a singles group Most patients go to public clinics for treatmentand only a few attend private clinics A 1997 study showed that the number of STIs haddoubled in the previous 10 years It is commonly thought the number of STIs in reality is

19 SAVY, 2005

20 UNFPA and SAVY

14

much higher than reported The STI rate within the sex worker group was higher than inother groups; most of them were still young The interviewed staff of Ho Chi Minh CityVenereology and Dermatology Hospital said that half of their clients were male from 15-30and 20% of them bring their partners with them to have treatment.

20% of female respondents in the SAVY survey stated that they had had apregnancy at some stage The rate of abortion among A & Y was very low in SAVY data.The abortion rate was mainly found in the married group (1.3% of all female young peopleand 7.2% of young women among the young people who had ever been pregnant) (SAVY).Some other studies suggest estimates of 10%-30% abortion rates in urban women at age 19years or older Abortion is considered a bad thing, particularly pre-marital abortion.Therefore, abortion and pre-marital abortion could be under-reported According to MOHstatistics based on reports from public health facilities, the number of abortion cases was167,990 in 2002 and 174,505 in 2003 The number of cases having a “menstruationregulation” (early abortion before the 7th week of pregnancy) was 404,435 in 2002 and365,872 in 200321

The rate of sexual intercourse with sex workers among young people was low(5.3%) and among married young men lower (1%) compared to single young men (21.5%).Sexual intercourse with sex workers in urban areas was more frequent than in rural areas.The majority of sex workers are young women although some reports maintain that sexworkers are also young males but no reliable evidence is available 10% of sex workersunder the age of 16 years were reported in Thu Duc centre for rehabilitation for dignity andsocial re education.22 Some other studies mention the situation of sex work in the MekongDelta among single people and migrant people as well as the situation of male sex workersfor males and old females23 Unfortunately, there is only arbitrary data on these issues.Some respondents to the SAVY thought that sex workers were shameful, however, someactually became sex workers due to situations out of their control Generally, it can be saidthat young people somehow understand the complicated factors leading to prostitution

1.9 HIV/AIDS, knowledge, attitude and practice

HIV/AIDS is an emerging concern for young people HIV infections among youngpeople are also alarming The report of MOH dated 14 March, 2005 stated that up to thatdate there were 90,844 HIV infected people, 14,560 AIDS cases and 8,494 deaths Of thedeaths, 0.84% were under 13 years, 8.36% 13-19 years and 55.76% 20- 29 years24

Awareness of HIV/AIDS among young people in general is high The SAVYsurvey showed that 97% of young people in general and 100% of urban young people hadheard about HIV/AIDS However, a further study found that 24% of A & Y who hadreported never attending school had not heard about HIV/AIDS This observation showsthat this group should be targeted by IEC Young people have access to information onHIV/AIDS through various channels include mass media, parents, friends, health services,schools, family planning activists, etc Urban young people have access to moreinformation channels than rural young people Groups of young people who have the leastopportunity for access to information on HIV/AIDS are rural female young people andethnic minority A & Y

SAVY showed that while access to information on HIV/AIDS was high, levels ofawareness were not Many studies prove that knowledge alone is not sufficient to protect

21 MoH 2003 Health statisitic year book (Bộ Y tế, Niên giám thống kê, 2003)

22 Center for Social Work 1996 The current ststus of sexual life and prostitution among street children Youth Federation (Trung tâm công tác xã hội, 1996, Thực trạng tình dục và mại dâm trẻ em đờng phố Hội Liên hiệp Thanh niên Việt Nam 1996)

23 Ho Chi Minh Youth Federation and Care International, 2005 Review of disadvantage children ( Nghiên cứu Tổng quan về Nhóm trẻ thiệt thòi: Đoàn Thanh Niên CSHCM và Care In’t T3/2005)

24 Tran Chi Liem: HIV/AIDS situation March, 2005

15

young people from HIV/AIDS These studies reach the conclusion that it is necessary toemphasize the prevention of high risk behaviors, particularly unsafe sexual intercourse andintravenous drug use as well as the promotion of protective behaviors and skills such as theuse of condoms and sterile syringes etc Interventions for the prevention of HIV/AIDSshould take into consideration the view of young people on HIV/AIDS and their high-riskbehaviors

A study in the Mekong Delta shows that young people there undertake high-riskbehaviors (sexual intercourse with sex workers) but believe they could not be infected fromothers and would not transmit HIV to others25 Regarding the attitude “living withHIV/AIDS”, young people believe they could accept necessary care and support butexpress fear for the actual disease Respondents (1 out of 8) say they are so afraid that theycould not help HIV cases in their communities

1.10 Substance use and abuse

Drugs

The number of people using and abusing drugs is increasing rapidly in Vietnam26.Young people who use and abuse drugs risk HIV infection due to the habit of sharingsyringes for drug injections The rate of HIV positive infections among drug injectingpeople increased from 9.4% in 1996 to 29.3% in 2002 According to 2000 data, the rate ofHIV positive cases who use intravenous drugs is 85.5% Half of these live in towns, citiesand industrial areas National policies for the control of HIV/AIDS put an emphasis onthese aspects.27 The cost of addiction is severe for communities, affecting the health anddevelopment of its young people It also causes many social problems such as raisingfamily conflicts, the number of street children, law violations, expenditure on education,HIV and hepatitis and infections

According to SAVY, the majority of young people (85%) had heard about drugs.Urban young people had a higher rate than rural (91% against 79%) 1/4 of respondentssaid they knew someone who was using and abusing drugs in the neighbourhood Manystudies in Vietnam as well as other Asian countries show that urban young people are agroup at high risk of drug use and abuse.28

A study in Quang Ninh and Hanoi targeting school children found that the majoritybelieve education in schools regarding drug injection is not adequate in either content orcommunication methods The study also showed the importance of reliable and attractivedirect communication for young people in schools

Cigarette smoking and alcohol

Many studies show that the majority of young people have easy access to cigarettesand alcohol The studies also show gender differences in use and abuse of cigarettes andalcohol The majority of those using and abusing cigarettes and alcohol are males due tothe acceptance of traditional culture as well as acceptance by their peers (peer influence).The WHO provides an alarming projection that 2/3 of young people living in Asia todaywill die prematurely in the future as a consequence of smoking and related diseases Thesealarming figures along with results from various related studies in Vietnam show that it istime to implement interventions for the reduction of cigarette and alcohol by young people.The culture and history of Vietnam do not accept cigarette smoking and alcoholism among

25 Adolescent Migrants and Reproductive Health in the greater Mekong Region: A Preliminary Analysis

26 Vu Quang Vinh 2000 Comments on prevention of addiction among children Seminar on Strengthening of adolescent health for the period 2000-2010 MoH (Vò Quang Vinh, 2000, Tham luËn vÒ phßng chèng sö dông ma tuý trong trÎ em Héi th¶o quèc gia x©y dùng chiÕn lîc t¨ng cêng søc khoÎ vÞ thµnh niªn giai ®o¹n 2000-2010 Bé Y tÕ Hµ-néi 1/2000)

27 Brown, Tim HIV in Asia Pacific Issues Analysis from the East West Centre No 68, East West Centre Honolulu

28

Brown, Tim HIV in Asia Pacific Issues Analysis from the East West Centre No 68, East West Centre Honolulu

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female young people This is a protective factor for the prevention of cigarette smoking andalcoholism among females

Cigarette smoking:

The rate of cigarette smoking among female young people is low (1.2%) Maleyoung people smoke more and the rate of smoking increases with age About 1/5 (22%) ofyoung people in the age group 14-17 in urban areas smoke This rate increases up to 58%

in the age group 18-21 and up to 3/4 at the age group 22-25 years old The average age ayoung man first smokes is 16.9 years Factors contributing to cigarette smoking amongyoung people include smoking friends, smoking parents, smoking habits in socialrelationships, and smoking habits among other people In Vietnamese culture, smoking isconsidered a means to relax and socialise, to show that one has money and is a man29

According to SAVY data, more than half of smoking young people have smokingfathers As smoking increases with age, interventions for smoking prevention should bedirected at young people Interventions should target young people at the 16 year and underage group Smoking is a difficult habit to give up SAVY data shows that 70% of smokingmales and 80% of smoking females had made efforts to give up smoking at least once.While current programs for cigarette control have not yet embraced support techniques tostop smoking, data on high smoking rates among young people suggest that such supportshould be considered

Alcohol:

Regarding alcohol use, 69% of young males say they have taken some alcohol atsome stage in their lives and 58% of them say they have been drunk 28% of youngfemales say they have taken alcohol and 30% of them say they have been drunk (SAVY).Drinking is more frequent in urban than rural areas and increases with age People in theage group 14-17 say that 3 out of 10 among them had taken some alcohol whilst people inthe age group 18-25 say that 6 out of 10 among them had ever taken it

Many studies show significant relationships between alcohol use and accidents andinjuries, illegal motorbike races, depression, self-harm and other risk-taking behaviors.Some studies show some relationship between alcohol use and violence and also betweenalcohol use and risky sexual behaviors and unwanted pregnancies, mental problems andunsafe sexual intercourse On the view of public health and A&Y health, if interventionsonly targeted people who drank, messages and strategies would be limited withincampaigns seeking to reduce the number of people who use and abuse alcohol That 30%

of young females have had alcohol at some stage in their lives shows that society todayaccepts and even encourages young females to drink Increasing alcohol use amongfemales is popular in countries with developed economies In addition, it is observed thatuse and abuse of alcohol usually begins at a young age The increasing rate of alcohol useand abuse in countries of high incomes and easy access to alcohol usually accompanies theincrease of social and health problems Therefore, the control of alcohol use and abuseshould target youth for more sustainable and long-term results

Limiting access to addictive products (legal and illegal) should be an importantstrategy in reducing the harm caused by the use and abuse of those products

1.11 Accidents and injuries

During the 10 year period 1989-1999, traffic accidents had a 4 fold increase inVietnam resulting in 43.000 deaths and 137,000 injuries30 The main causes of death amongthe 10-24 year group were trafficaccidents followed by occupational accidents According

29 Institute of Sociology

Archives Library

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to SAVY, 14% of interviewees had had at least one accident in their life; the rate was 27%

in urban areas, much higher than the 10% in rural areas The number of accident and injurydeaths is rapidly increasing (12,956 deaths in 2000 and 20,847 in 200331)

Many studies forecast that traffic accidents will continue to increase before reaching

a stable level Young people riding motorbikes face risks of traffic accidents for themselvesand other passengers Some studies found that more than half of young people have ridden

a motorbike after drinking at some stage in their lives The majority of young people (andadults) ride motorbikes without safety helmets The use of security helmets would be moreaccepted if it was obligatory by law, if the rider had experiences of danger (close calls) or

if the rider had a relative involved in a serious accident The SAVY survey showed that thecurrent mass media messages promoting the wearing of helmets do not seem to reachyoung people They also do not pay attention to any marketing information about helmetswhich are fashionable, easy to wear and cheap or free of charge - as well as advice onhelmet use emanating from schools Only 25% of motorbike riders wear safety helmets –

an obviously low figure The SAVY shows that 25% of urban A&Y and 14% of A&Y ingeneral say they have had a traffic accident in the past Urban young people have moretraffic accidents (26.6%) than rural young people (10.2%) It is not surprising that themajority of traffic accidents are caused by motor-bikes and traffic accidents are really aproblem of A&Y Many statistics show that traffic accidents are the number one mortalitycause among young people in the age group 15-2432 Risk-taking behavior by motorbikeriders is as an important aspect and leading cause of injury and death for A&Y, particularlyamong young men

1.12 Child violence

Records of the Peoples Court of Appeal in 2001 showed that 1,407 cases ofviolation had been on the bar in 1998 50% of these were child violations 33 From results of

a study conducted by the Party Central Committee Commission for Science and Education

in collaboration with the Ho Chi Minh Communist Youth from 1993 to 1997, 1,000 cases

of child violations had been judged at the court of appeal and 2,644 cases at local courts It

is well known that figures on child violation and abuse in Vietnam as well as in othercountries are lower than the real number because it is under-reported

1.13 Criminal behavior affecting health

A study in 1999 showed that criminal behavior of young people in Hanoi hadincreased34 This criminal behavior included involvement in various gangs, carryingweapons, violations of social order and illegal motorbike races Rape is a crime thatseriously affects the victims who are often young Interventions aimed at this target groupcould be implemented by heightening the protective factors within families andcommunities Some studies show that criminal acts are reduced by half if young peopleparticipate in activities such as those supported by The Youth Federation and Children’sAssociation

30

Luu Hoai Chuan, 2000 accidental injuries among children and education for safe community in schools National seminar for the formulation of policies to improve adolescent health for the period 2000-2010 MoH, Hanoi 1/2000 (Lu Hoài Chuẩn, 2000, Vấn đề tai nạn thơng tích của học sinh và việc tuyên truyền giáo dục về an toàn nhà trờng Hội thảo quốc gia xây dựng chiến lợc tăng cờng sức khoẻ vị thành niên giai đoạn 2000-2010 Bộ Y tế Hà-nội, 1/2000)

31 Health statistic, MOH 2003.

32 UNICEF and Hanoi School Public Health 2003

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Do Nang Khanh, 2001 Current status of child abuse and prevention measures Seminar on Improving adolescent health Hanoi 1/2001 (Đỗ Năng Khánh, 2001, Thực trạng tình hình lạm dụng tình dục trẻ em và phơng hớng các giải pháp phòng chống Kỷ yếu hội thảo quốc gia xây dựng chiến lợc tăng cờng sức khoẻ vị thành niên Chơng trình hợp tác y tế Việt Nam- Thuỵ Điển Bộ Y tế Hà-nội 1/2001)

34 Tran Duc Cham, 1999 Current status of crimes among young people in Hanoi MSc thesis, National University (Trần

Đức Châm, 1999, Tình trạng phạm tội của thanh thiếu niên hiên nay ở nội Luận văn thạc sỹ Đại học Quốc gia nội 1999)

Hà-18

1.14 A & Y in families and in schools

Results of the SAVY show that A & Y in Vietnam are generally close to theirfamilies In comparison with data from other countries, the divorce rate among parents islower and family structure is little affected The majority of newly married couples stillmaintain the habit of living with the husband’s family A & Y participate in almost allfamily activities; their ideas are listened to by older family members; they play animportant role in the family and they feel that they are valuable As in other Asiancountries, “happiness” is the most expected goal of Vietnamese people if they could choosebetween “happiness”, “wealth” and “longevity” According to Vietnamese traditionalbeliefs, “happiness” means children for the future and the continuity of a future generation

Family is a place to feed, to educate and to train children as well as a place tocontinue traditional culture, a place where children shape their personality - this is a strongprotective factor for A & Y SAVY data does show family conflicts between parents andchildren, but the figure is relatively low ( 8.9% on the total sample)

Data on education is encouraging because schooling and literacy rates ofVietnamese A&Y are high According to the SAVY survey, concepts and attitude of A &

Y about schools and teachers were positive in their thoughts and evaluations 90% thoughtthat teachers were keeping an equitable attitude towards their school children and studentsand 90% said they had opportunities to raise their own voice in schools It is worth notingthat 90% of investigated adolescents said that they expected to study in a university orcollege while in reality only 10% among them could do so Therefore, 80% of A & Y couldnot reach their expectation The education environment is itself a protective and supportiveenvironment for A & Y, especially for young females

1.15 Work, jobs and vocational education

According to the SAVY, A & Y thought that good jobs and opportunities for jobswere their hope for their future, but realized that finding a job was not easy SAVY datashowed that almost 55% of the investigated A & Y stated they had at some stage appliedfor a job This proportion was similar between young men and women as well as betweenurban and rural respondents Although, survey data showed the majority of A & Y did notwork under 15 years of age (7% had) the number of rural young people who had was twice

as large as those in urban areas Regarding types of jobs, over 50% of respondents saidthey had simple jobs, next came traditional and family handicrafts and jobs in smallbusinesses More urban young people had positions that were higher technology relatedthan their rural counterparts The majority of A & Y said they were satisfied with theircurrent job (78.2%) Only 21.8% said they were seeking a more satisfying job It is worthnoting that 18.9% of respondents said they had attended a professional course at sometime, but only 66% had found related work

1.16 Disadvantaged and vulnerable A & Y

Disadvantaged and vulnerable young people include: street A & Y, A&Y inrehabilitation centres, A & Y in miscellaneous jobs, homosexual A & Y and disabled A &Y

Street A & Y

Since The SAVY was a household-based study, data on street A&Y was notadequately reported To identify the health risks as well as protective factors of vulnerableyouth, there is a need for a special approach A recent study analysing 4,558 street children

in Hanoi shows the majority are in the age group 12-15 years They have a low schooleducation although 90% have finished primary school - 3-4% are illiterate They come to

19

Hanoi from various provinces and earn their living by miscellaneous jobs including shoeshining, selling and begging.

Many studies show that street A & Y have more problems related to reproductiveand sexual health, drug, cigarette and alcohol use and abuse and child violence than anyother A&Y groups They easily become the victims of children and women traffickers.They also may have early sexual experiences, STDs and other infections and suffer morefrom sexual violence than other groups They need more knowledge and skills to protectthemselves but have a less than average knowledge capacity regarding their own health.Interestingly, these studies show that street A & Y have their own specific qualities Forexample, they are very active and highly sensitive Young sex workers run especially highhealth risks They risk HIV infection, often are the victims of violence and almost alwaysare in a state of poor mental health

Young people become street children for various reasons One of the most prominent

is the need to leave a violent family environment within which they have been abused orneglected, often after the loss of their parents Another is the need to earn money for theirfamily although the majority of these at least have a family to go back to Living conditions

on the streets make them feel inferior and under many threats

Working on the streets or on rubbish dumps make this group of young peoplesusceptible to disease and disability, especially respiratory diseases and accidental injuries.Lack of family support means they often suffer various psychological traumas

A & Y in unskilled casual jobs

Studies from various countries show that casual unskilled work holds many healthrisks, with young people working as domestic helpers holding especially vulnerablepositions In such working conditions, young people have certain difficulties seeking healthcare Their nutrition is often not good and they are usually not in a strong position tonegotiate a safer working environment, particularly living and working in the employers’home Young female domestic workers and those working in restaurants face the risk ofphysical harassment and sometimes sexual violence Feeling of loneliness among maleyoung people make them seek distraction in karaoke and beer sites, where they can easilyaccess alcohol and sex workers

Incarcerated A & Y

A study35 shows that young people in rehabilitation centres can have severe healthproblems and an above average need for health care 64% of young females in centres havebeen sex workers with high rates of STDs (47%)

Homosexual A & Y

Many studies show that homosexual young people live under a burden of distress.They are often severely depressed because they cannot openly divulge their sexual status.According to the SAVY, 60% of respondents knew what homosexuality was and 80.2% ofthem would not accept a homosexual as a friend Homosexuals often feel discouraged,leaving their families to become street people They drop out of school and tend to use andabuse alcohol, cigarettes and illicit drugs to escape feelings of isolation and despair

Disabled young people

Disabled children have fewer opportunities to attend school or receive support fromoutside the family environment Lack of knowledge and lack of finance makes their health

35 Involving vulnerable and disadvantaged adolescents and youth groups in sexual and reproductive health programs- preliminary review of available literature Care In’t and Youth Union, Hanoi March 2005

20

situation worse They often feel inferior to others and lack the confidence to assertthemselves beyond risk taking behaviors

The high risk, disadvantaged and vulnerable groups described above are only someexamples of A & Y people with difficulties and at high health risk They all neededucation and health care, protection and assistance to adapt to their conditions Thesegroups have few choices regarding health care When they are ill, they often buy medicineand treat themselves with guidance from friends or associates

2 Risks and challenges

A big challenge for Vietnam today is to maintain the health status and the mentalwell being of its young population while continuing to improve socio-economic conditions.Vietnamese young people will experience many changes due to rapidly evolving socio-economic conditions Identifying these challenges is an important stage in building thenational Master Plan This plan considers issues in which Vietnamese youth are protected

by their families, schools, friends and communities They can make choices to limit taking behaviors for the protection, care and promotion of their health If these challengescan be overcome, there is a possibility of lowering these the health risks facing Vietnamese

risk-A & Y The major risks for risk-A & Y health in Vietnam today include:

 Mental trauma and mental health-related problems

 Accidents and injuries, especially traffic accidents

 Substance use and abuse (drugs, cigarettes and alcohol)

 Sexual and reproductive health problems

 Nutrition and food safety problems

 Difficult access to health services and practices of self medication

In addition to the above there are challenges for many protective factors

These challenges will be:

 Raising the profile of adolescent and youth health

 Maintaining positive and protective factors of families and schools

 Organizing adequate vocational training for young people

 Formulating policies and regulations for improving A & Y health

 Delivering friendly services across the whole country

 Delivering services and support adapted to the needs of vulnerable and

disadvantaged youth

 Ensuring government as well as donor investment for A & Y

 Increasing the opportunities for young people themselves to participate informulating policies that affect their lives and particularly participate in planningand programming implementation in youth health areas

Although the health sector in its professional operations is mainly responsible forthe protection, care, and promotion of A & Y and for overcoming the above-mentionedchallenges through its interventions, this Master Plan defines those of the above healthfactors and areas that the health sector should solve, as well as factors and areas affectinghealth that are managed by other ministries and sectors and that the health sector canpropose, guide and participate as technical support

21

The youth health issues the Master Plan will address during the period 2006-2010 are:

 Reproductive health/sexual health

 HIV prevention

 Accidents and injuries

 Substance use

 Mental health

 Equal access to services for disadvantaged and vulnerable groups

3 Polices, constraints and gaps

In 2003, Vietnam issued the “Strategy for Youth Development” This document

was considered an overall strategy guiding the development of youth whilst respondingbetter to their needs The strategy covered issues of youth development in the context of

globalisation The strategy observed that current programs “ do not take into

consideration characteristics of youth; therefore, there is a lack of an appropriate approach and a lack of youth participation ” Objective 4 of the strategy aimed at

“Improving mental health and spiritual life, developing cultural life, eliminating social

evils and crimes among young people ” Specific objectives of the strategy were:

- To increase the number of A & Y participating in regular physical exercise

- To reduce mortality due to environment related diseases, nutrition related diseases,infectious diseases and occupational diseases

- To improve the general health status, to heighten the physical growth of both male andfemale young people by 3 cm in height and 4 kg in weight by 2010

- To ensure 100% of urban young people and 80% rural young people have an adequate

of A & Y health

Policies for the health of young people have been integrated in various nationalstrategies such as A & Y Development (Ho Chi Minh Communist Youth Federation), HIV/AIDS Prevention; Substance Abuse Control, Prostitution Control (Committee for theControl of Substance Abuse, Prostitution and HIV/AIDS), Policies for the Control ofCigarette Smoking and Policies for the Control of Accidental Injuries Various ministriesand organizations such as the Ministry of Education and Training, the Ministry of Labor,Invalids and Social Affairs, the Youth Federation, the Women’s Union and othercommunity organizations have interests in health issues of A & Y and continuouslydevelop policies and strategies as well as guide documents related to A & Y health

A seminar involving authorities from different levels, mass organizations, socialorganizations and some national and international donors was conducted in Da Nang in

1999 The seminar reached the conclusions that a majority of authorities at various levels,

many policy makers and others responsible in this field think that A & Y reproductive health is simply a problem related to social, meaningless habits and life styles and that

22

health protection, care, and promotion is simply an issue related to the health sector Therefore, A & Y should be protected by more sensible measures and should be guided when necessary36

This analysis shows that there are still actually some constraints and gaps in A & Y healthprotection, care and promotion

Constraints include:

- Perceptions and interests of organizations and individuals who are responsible have notyet been enhanced Supportive environments for A & Y health have not yet beendeveloped

- Characteristics of A & Y have not yet been taken into consideration in the development

of policies related to them

- Responsibilities of related ministries and sectors have not yet been clearly identified

- Health and social issues have not yet been well co-ordinated

Gaps include:

- Lack of an appropriate approach to protect, care and promote A & Y health

- Lack of inter-sector actions for the protection, care and promotion of A & Y health

- Lack of A & Y participation in the development and implementation of policies related

to the protection, care and promotion of their health

- Lack of an integrated action plan for the protection, care and promotion of A & Yhealth

36 Ho Chi Minh Youth Federation, 1999 Seminar for policy makers of adolescent health Da nang 1999 (Đoàn

TNCSHCM, 1999, Hội thảo các nhà hoạch định chính sách SKVTN Đà nẵng 1999)

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Part 2Action plan

1 Objectives

General objective

The general objective for the “National Master Plan for the Protection, Care and

Promotion of Adolescent and Youth Health” will be to maintain and promote the health

status (physical and mental) of young people and to improve and increase access to qualityhealth care services These measures will especially be concerned with sexual andreproductive health, prevention of STDs and HIV/AIDS, the prevention of accidents andinjuries and substance abuse

- Age groups: 10-14, 15-19 and 20-24

- Specific needs among male and female adolescent and youth

- Specific needs among urban and rural adolescent and youth

- Specific needs among disadvantaged and vulnerable groups

3 Operational Strategies

Some operational strategies aimed at achieving the above objectives include:

1 Co-ordinate and integrate all activities, programs and projects which are related toadolescent and youth health such as sexual and reproductive programs, safe motherhood,family planning, HIV/AIDS control and prevention, programs for controlling substance(drug, alcohol and cigarettes) use and abuse and accident and injury prevention programs.This includes adolescent and youth health IEC programs run by other ministries, sectorsand mass organizations

2 Mobilize the involvement of families, communities, mass organizations, ministries andsectors in the protection, care and promotion of adolescent and youth health activitiesincluding education, jobs and healthy lifestyles on the basis of identifying protective andrisk factors

24

3 Encourage and facilitate adolescent and youth to take part in the process of developingand making policies, designing, implementing and evaluating intervention programs on thebasis that A & Y understand their rights and responsibilities.

4 Mobilize internal resources and international investment Priorities should be given tothe solution of emerging issues e.g reproductive health, HIV/AIDS, accidents/injuries,substance use and abuse and psychological disorders

The choice of measure for the implementation targets of this Master Plan will be based onexperiences of "best practice" in Vietnam and other countries as well as related scientificknowledge (e.g interventions that have been found to be effective)

Guiding Principals for the implementation of the Master Plan:

- Projects should be solidly built, should be planned and appropriately budgetedavoiding expensive and non-necessary interventions

- Implementation duration should be within a period of 3-5 years

- Several strategies that combine effects should be used

- The follow-up of output should be based on indicators to evaluate theknowledge, attitudes and practices of target group

- Targets and indicators for evaluation should be defined

Intervention guidelines:

- Intervention measures are required in families and schools

- Friendly services are to be provided for A & Y in communities

- Support from parents should be improved through the strengthening ofexchange and communication with their children

- Access to drugs, alcohol and cigarettes should be limited through theintervention of law and legislative agencies

- A & Y should be involved in social activities such as youth clubs, culture andsport activities and other collective activities

- Peer education to be applied particularly for “older” young people and formarginalized young people

- Communication messages should be developed based on real events This will

be more effective than those based on ethical norms or fearful images

4 IMPLEMENTING MEASURES

4.1 IEC for behavioral change

The IEC for behavioral changes is a most important measure The above-describedsituational analysis shows many supportive and harmful factors effecting A & Y infamilies, schools and society It is necessary to maintain supportive and positiveperceptions for A & Y so they can choose healthy behaviors over harmful Among variouscommunication channels, mass media may be the most effective The supply of knowledgefor change in attitudes and behavior concerning self-care among A & Y as well as amongproviders of services and communities (parents, teachers, youth federation activists) is veryimportant

This measure has been based on analysis of audience and communication channels as well

as the development and dissemination of appropriate messages The evaluation of the

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implementation should be based not only on indicators of knowledge but also on indicators

of attitudes and practices In this measure, it is required that there is co-ordination ofinvolved sectors and identification of appropriate educational and communication meansfor each specific target group i.e A & Y in rural and urban areas, on the plains and inmountainous regions as well as male and female groups Due to differences in thepsychobiological characteristics of each age group specific IEC contents and formats must

be relevant In addition, it is necessary to have appropriate IEC and BCC interventionstargeted for specific groups such as street youth, young urban men and ethnic youngwomen

4.2 Social measures

Social measures in the Master Plan for the Protection, Care and Promotion of A &

Y Health aim at mobilizing all national and international resources for the implementation

of the objectives In addition, the Party, government, mass organizations and communitiesshould be mobilized to participate in A & Y health care activities to create acomprehensive and favorable environment in which to identify the needs and the responses

to needs for the protection, care and promotion of A & Y health Social measures include:

4.2.1 Heightening the role, position and responsibilities of families and communities

Families have a very important position in A & Y health Families are places whereindividuals are born, grow up and where their personalities are shaped The family is themain environment for the transfer of traditional culture from one generation to the other.Therefore, families should be a key element utilized to participate in the Master Plan Likefamilies, communities too have a very important role to play in making changes to theperceptions and behaviors related to the protection, care and promotion of A & Y health.Community participation is a decentralized measure for the sharing and allocating of tasksamong the state and the people The state and the people have to implement together theMaster Plan for the protection, care and promotion of A & Y health

4.2.2 Leadership of the Party and commitment of authorities at various levels

The implementation of the Master Plan should involve the leading Party, thecommitment of authorities and government investment

4.2.3 Inter-sector action

The implementation of the Master Plan for the protection, care and promotion of A

& Y health requires the participation of many ministries and sectors such as the Ministry ofHealth, the Ministry of Finance, the Ministry of Education and Training, the Ministry ofCulture and Information, the Ministry of Labor, Invalids and Social Affairs, the Ministry ofPolice, the National Committee for Population, Families and Children and the mass media.Inter-sector action is a social measure for enhancing the responsibilities of relatedministries and sectors It also requires the combined strength of Vietnamese society inorder to optimally utilize the potential and experiences of all sectors

4.2.4 Mobilization of mass organizations for their participation

The participation of various mass organizations such as the Vietnamese FatherlandFront, the Ho Chi Minh Communist Youth, the Women’s’ Union, the Ho Chi MinhPioneer Organization etc is a crucial element for ensuring the success of the Master Plan.Community organizations such as the Students’ Association, Education Promotion’sAssociation, Old People’s Association, Farmers’ Association and the Veterans’Association also have important voices in the implementation of the Master Plan

4.2.5 Diversification and enlargement of the service network

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