Vietnamese researchers point to eight major risks to optimal early childhood brain development around the time of birth in resource-constrained settings: intrauterine growth restriction, stunting, iron deficiency anaemia, iodine deficiency, unresponsive caregiving, insufficient cognitive stimulation, maternal mental health problems and exposure to family violence.

Capitalizing on more than 15 years of experience in rural Vietnam, the Learning Clubs for Women and Infants innovation aims to pioneer a low-cost initiative addressing all eight risks to optimal early childhood brain development through a structured, universal program combining information, learning activities and social support with groups of women at the same life stage.

The program will comprise of five modules with 24 sessions. Each session involving small group discussions with visual material aids, including DVD, posters, leaflet. The club facilitators initiate discussion, and then DVD watching to learn knowledge and skill, after that the practice of skills in child care or women exercises in class, and short talks. The sessions provide women and their families the correct knowledge of women and child care, appropriate skills with practice on dolls and real children and change their attitudes toward early childhood development. We aim for community behavior changes.

Innovation in program contents:

This is the first time ever in Vietnam, knowledge and skills in early childhood development are offered to pregnant and child-bearing women in rural Vietnam in a visual-based comprehensive package. The educational package includes five modules, consisting of 24 sessions.  Module 1 (four sessions) is for women in their early or mid-pregnancy. Module 2 (five sessions) targets late-pregnancy and newborn care. Module 3 (four sessions) aims to provide women with children 0-6 months of age child care knowledge and skills. Module 4 (five sessions) engages with families who have  children 7-12 months of age, and the final Module 5 (six sessions) targets families with  children 13-24 months. All 24 sessions aim to change the behaviors of families toward better care for pregnant women and children, to stimulate child growth and brain development.. The psycho-social educational package includes the 24 topics listed below:

Educational package includes a DVD with instructions for skills formation, together with posters and take-home leaflets. Contents are developed based on the international standard packages such as the Care for Child Development (WHO and UNICEF), Thinking Healthy Program, Pregnancy Childbirth Postpartum and Newborn Care – A guide for essential practice (WHO), Mental Health-GAP Instruction Guide (WHO), Integrated Management of Child Illness (WHO), and the national feeding program (NIN)

Innovation in approach:

Facilitators of the Learning Clubs will be Women’s Union staff (community-based lady social workers) and Commune Health Clinic staff (community-based medical doctor or nurses) who will be trained in 6 courses to deliver the programming. The first five courses will teach the program content, and focus on practicing facilitation. The last course will be about Learning Club operation, monitoring and supervision.

Learning Clubs are organized at the community meeting hall and the community health clinic site. DVD players are provided by the local authorities. Laptop and projectors are provided by the project.

Facilitators will promote the DVD watching to learn skills, instruct the practice of new skills on dolls and on children directly, facilitate the discussions after practice and provide take-home messages and flyers.  Each session lasts for about 90 to 120 minutes.

After the class session, facilitators will visit households to identify how women adopt the new skills at home and provide additional supports until new skills become habits. Women with mental disorders, sick children, difficult toddlers, or poor skills in personal and child care, and women who suffer from domestic violence, extreme financial hardship, or family crises, will be prioritized to receive a home visit.

Vision for changes:

This model will go through three phases: development, and field and pilot testing on a small scale (2014-2015), a randomized control trial to examine the effectiveness and cost effectiveness of the program (2016-2018), and finally advocacy for the project to be fully integrated into a national policy on care for child development by the year 2020.

From 2014-2015 the project will focus on producing a low-cost, easily understood, structured curriculum for the Learning Clubs to be operated by the Community Women’s Union with evidence from field and pilot testing in  three rural communes randomly selected in Ha nam province.

By the end of 2015, the five modules, the manuals and materials, and the Learning Clubs Operation manual will be ready for scale.

Funders

• Grand Challenges Canada
• Research and Training Centre for Community Development (Vietnam)
• Jean Hailes Research Unit, Monash University (Australia)
• University of Melbourne (Australia)
• World Health Organization (Vietnam office)
• Ha Nam Women’s Union (Vietnam)
• Ha Nam Provincial Centre for Preventive Medicine (Vietnam)

Key Partners

• Research and Training Centre for Community Development (Vietnam)
• Ha Nam Women’s Union (Vietnam)
• Jean Hailes Research Unit, Monash University (Australia)
• Department of Medicine, University of Melbourne (Australia)

Key Drivers

• Strong collaboration with international agencies to provide technical backstopping for the innovation design (Monash University, University of Melbourne, and WHO Vietnam)
• The draft innovation structure was consulted with local authorities (Department of Health and Women’s Union)
• Endorsement and direct participation of local authority (Community People’s Committee) since the project commencement (workshop, implementation) to chair and coordinate the collaboration between community health clinic and women’s union.
• Endorsement and involvement of national-level agencies (Vietnam Medical Association, Hanoi Medical School, Women’s Union Federation, Ministry of Health-Department of Maternal and Child Health, Ministry of Labor – Department of Child Care and Protection and WHO Vietnam) at the project commencement will help ensure good path to scale and integration into national policy
• A good selection of active, innovative, and inspired local team members for the project implementation and management.

Challenges

Obtaining permission to translate and use the standard assessment tool (Bayley, ASQ) took time and prolonged the project preparation.

During the implementation of this project, we plan to:

• Share this resource with NGOs in Vietnam for scaling up.
• Share the innovation and resource to the Ministry of Health – Department of Maternal and Child Health for endorsement and usage for national-scale projects/programs.

At the end of this project, we plan to:

• Scale up this innovation to the whole province of Ha Nam at the end of this project

Offer this innovation and visual materials to the Provincial Medical High School (where all village health workers are trained) and to the National Women’s Union Management School (where all women’s union staff are trained) so that they would use our project materials as the key resource for community-based health/social workers to use to educate the rural population.

There will be three channels to evaluate the intervention impact:

1. Baseline and Final Assessment:

The project will apply the baseline and final assessment in both control and intervention sites. The baseline and final evaluation will be conducted in six communes (three intervention communities and 3 control communities). Assessment will be carried out in four target groups: (1) pregnant women; (2) families with children 0-6 months; (3) families with children 7-12 months and (4) families with children 13-24 months. Assessment tools compile the standard form such as Ages and Stages Questionnaire, HOME inventory, Depression Anxiety Stress Scale (DASS-21) anthropometry, and socio-economic status section.

2. Module-based assessment:

After each module completion, a small survey conducted by the independent team (Provincial Center for Preventive Medicine) will be carried out to measure the behavior changes in parents who attended the Learning Clubs, identify barriers for the behavior changes and generate suggestions for improvement.

3. Monitoring and supervision system:

Together with the assessment survey, the project will use a computer-based monitoring system where the rate of participation in Learning Club Sessions, number of home visits, and problems and recommendation for changes are recorded and emailed to district / province Women’s Union and the project management team. The monitoring outputs will provide additional background to explain the project results and figures.

It is now the tenth month of the project implementation.

• 60% visual materials have been developed and pre-tested.
• 2 training courses have been conducted for 30 facilitators. They will go through another 4 training courses from September to November 2014.

The first Learning Club session will be carried out in 30-31 August 2014 with over 150 women participating while in early-to-mid pregnancy.

Cost

The project will record the detailed and separated costs for (1) material development, review and approval; (2) capacity building – training courses; (3) learning club operation; (4) supervision; (5) dissemination and advocacy.

The financial recording system will ensure the project team to identify the needed costs for the scaling-up phase.

1. Tran, Thach D et al. (2014) Infant motor development in rural Vietnam and intrauterine exposures to anaemia, iron deficiency and common mental disorders: a prospective community-based study. BMC Pregnancy and Childbirth 01/2014; 14(1):8.
2. Tran, Thach Duc, et al. (2014) Perinatal common mental disorders among women and the social and emotional development of their infants in rural Vietnam. Journal of Affective Disorders 01/2014.
3. Hanieh, Sarah et al. (2014). Maternal Vitamin D Status and Infant Outcomes in Rural Vietnam: A Prospective Cohort Study. PLoS ONE 01/2014; 9(6):e99005.
4. Walker, S. P., et al. (2011). Inequality in early childhood: risk and protective factors for early child development. The Lancet, 378(9799), 1325-1338.
5. Engle, P. L. et al. (2011). Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. The Lancet, 378(9799), 1339-1353.