Vietnam

In recent years, Vietnam has made large gains toward the elimination of malaria—deaths related to the disease have declined by more than 85% nationwide since 2000. However, one out of every five of the country’s 90 million inhabitants continue to live in a high transmission area. To eliminate malaria, Vietnam needs to increase coverage of forest goers, a group at higher risk of contracting malaria due to the increased amount of time they spend in the forest, nearer to mosquitoes.

PSI Vietnam currently implements two malaria projects to support the Vietnamese government’s commitment to eliminate malaria by 2030 and to increase private sector and community contributions to malaria testing, treatment and reporting practices— Greater Mekong Elimination of Malaria through Surveillance (GEMS) and Regional Artemisinin Resistance Initiative-Elimination (RAI2). The two projects aim to:

1. Increase appropriate case management of suspected malaria cases within the private sector.
2. Increase private sector reporting of suspected and confirmed cases into national information systems.
3. Improve the evidence base for decision-making on effective strategies for private sector engagement and surveillance systems strengthening.

PSI Vietnam’s malaria elimination projects are being implemented in the Central Highlands and Southern Central provinces of Vietnam.

Vietnam’s abortion rate is the fifth highest in the world, with an estimated 300,000 cases every year among 15 to 19-year-olds. About 40% of pregnancies are terminated each year in Vietnam, and the women most likely to have an unmet need for contraception are young, unmarried and/or living in rural areas.

To facilitate Vietnamese women’s ability to choose which contraceptive method is right for them, Merck for Mothers, Family Planning 2020, Maverick Collective and PSI Vietnam have been working to: expand access to historically underused contraceptive methods in Vietnam, including injectables, post-partum IUDs and post-partum implants; create informed demand for contraceptive choice; generate increased public and private stakeholder support for the growth and diversification of the Vietnamese market for contraception; and employ a human-centered design approach to inform sexual and reproductive health solutions for young girls and women.

By the end of 2019, PSI Vietnam reached 1.2 million women with reproductive health messaging through its behavior change communication campaigns. Women exposed to these campaigns were 1.5 times more likely to know about modern contraceptive methods.

Although Vietnam’s HIV epidemic has stabilized at 0.4% of the adult population, HIV remains a public health threat. There were an estimated 7,000 new HIV infections, 7,000 AIDS-related deaths and an estimated 230,000 people living with HIV nationwide in 2017. The epidemic is concentrated in the Northern Economic Zones and Ho Chi Minh City metro areas among several at-risk populations: people who inject drugs, men who have sex with men, transgender men and female sex workers.

The 2018 Global Tuberculosis Report estimated that Vietnam had 124,000 new TB cases and 12,000 TB-related deaths in 2017. Vietnam ranks 16th in the world for the number of TB patients and ranks 13th for the number of drug-resistant TB patients.

Both HIV and TB programming in Vietnam have largely been channeled through the public health sector or civil society organizations, with limited investment in private sector outlets. In Vietnam, many clients prefer private health outlets due to perceived convenience, quality and simpler administrative processes.

PSI Vietnam has opened innovative new channels to address gaps in access to HIV prevention and diagnostic services among key populations. It works with a network of more than 1,000 tea stalls and other outlets which are open late at night, after pharmacies close, in order to improve access to low dead space needles and syringes (endorsed by World Health Organization for drastically reducing the risk of both HIV and the transmission of other infectious diseases), as well as HIV rapid diagnostic tests. Through PSI Vietnam’s project with the Elton John AIDS Foundation, over 10 million low dead space syringes have been sold, 12,584 people were tested and 876 (a yield rate of 7%) were referred to HIV treatment sites.

Through the TB REACH Project (Wave 2 and 4), more than 5,000 clients were diagnosed with TB and referred to treatment as a result of PSI Vietnam’s work with rural pharmacies, which sell antibiotics to those with TB symptoms. Private clinics serving low income communities at risk for TB also refer clients to treatment.

Non-communicable diseases (NCDs) are the leading cause of global mortality and account for 71% of deaths, the large majority of which occur in low- and

middle-income countries. In Vietnam, 25% of the adult population is estimated to have hypertension, one of the most common NCDs. It causes or contributes to most premature deaths. Management of hypertension is critical to preventing progression to cardiovascular disease; however, hypertension awareness, diagnosis and treatment rates remain low.

Since 2012, PSI Vietnam has used social marketing and social franchising techniques to boost private sector contributions—mainly at rural private clinics and pharmacies—for hypertension prevention through detection and management. Under the Healthy Communities Project funded by Pfizer, 60,000 adults were diagnosed with hypertension and referred to treatment by doctors trained under the program. Private sector investments in NCDs have proven to be a highly sustainable—even after specific project funding, clinics in this network continue to treat and report hypertension cases back to PSI Vietnam.

In 2015, PSI Vietnam launched a market-based rural sanitation initiative in the Mekong Delta and Central Highlands regions. At the start of the program, PSI Vietnam generated the first rural commercial sales for flood-proof plastic toilet tanks, endorsed by the Ministry of Health. They were locally manufactured by PSI Vietnam’s partner, ROTO, through retailers that stock ROTO tanks. By negotiating with ROTO to lower prices for rural consumers, recruiting outlets to pilot a flexible payment system for sanitation hardware purchases and by holding events to target the most impoverished families, PSI Vietnam continues to make sanitation an affordable reality for households most in need.

To further develop its rural sanitation supply chain, PSI Vietnam trains and incentivizes masons to grow the toilet installation segment of their businesses in compliance with quality and gender guidelines. PSI Vietnam’s supply-side operations are supplemented with a demand-generating social marketing campaign that uses visual media and community events designed to promote investment in sanitation to protect the dignity and privacy of women, who must often defecate in the open.