Community Health Clubs Tackle Climate Change Impacts in Vietnam

Community groups take on public health issues related to climate change: flooding, drought, and mosquitos carrying dengue fever

By Kathleen Pierce

A health club member going over the dengue prevention checklist. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

A health club member going over the dengue prevention checklist. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

Can Tho, Vietnam, is a rapidly growing urban area of more than one million people. Climate change here is bringing heavier, more unpredictable rain storms, blurring the line between the traditional rainy and dry seasons. This additional moisture expands breeding opportunities for mosquitoes, driving an uptick in cases of the mosquito-borne virus dengue fever.

In parallel with this worsening problem, a potential solution has arisen in the form of “health clubs,” community-based organizations that emphasize group consensus to improve public health standards. The model for these clubs originated in Africa with projects to improve hygiene and sanitation, and in 2009 and 2010 health clubs were formed in three northern Vietnamese provinces, creating a trusted link between communities and local health authorities. Through educational interventions on handwashing, safe water storage, kitchen hygiene and solid waste, the clubs were successful in radically improving hygiene habits and community sanitation in the Son La, Phu Tho and Ha Tinh districts.

Inspired by those early successes, public health researchers in Can Tho realized that health clubs could be a potent weapon against dengue fever outbreaks and other climate change impacts in the city.

Stemming the spread of dengue

Health club members encourage plastic sheeting over water storage tanks to prevent mosquitoes from breeding. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

Health club members encourage plastic sheeting over water storage tanks to prevent mosquitoes from breeding. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

Dengue fever is painful, debilitating and sometimes fatal. A recent study tied a rise in Can Tho dengue cases to the increase of humidity and precipitation from the changing climate. In response, scientists from The Institute for Social and Environmental Transition-International (ISET-International), Can Tho’s Preventive Health Centre and the Can Tho Climate Change Coordination Office combined health club influence, household monitoring and a public education campaign to change local attitudes about preventing dengue fever in four city wards.

“This is the first time different stakeholders and community members from different districts joined together for one effort,” said Nguyen Ngoc Huy, a member of ISET-International’s technical staff in Vietnam. “Before, only the official health staff was in charge of dengue fever prevention, but now there is a link between the health staff and the local communities.”

Each of the four wards created a health club staffed with roughly 50 volunteers, mostly women. After receiving education in dengue fever prevention, the health club members monitored the conditions in homes in their ward and taught residents how to eliminate mosquitos and larvae. They also administered checklists of 19 specific dengue-prevention actions. The checklists were a surprising hit among the residents, who faithfully recorded what their households were doing to prevent the spread of dengue.

Thanks to their emphasis on group consensus, the involvement of community members and the power of peer pressure, the health clubs encountered few obstacles. In one ward, however, residents complained when they discovered that members of their health club didn’t live in their neighborhood; in response, project administrators worked quickly to recruit new members from that specific neighborhood to improve relations.

The collaboration between ISET-International, the Preventive Health Centre and the Climate Change Coordination Office included several other components in addition to the work done through health clubs. Monitoring mosquito and larvae counts in indoor and outdoor water storage containers helped reduce the mosquito population. Team members also trained local nurses and doctors to identify and report dengue cases to get a jump on potential outbreaks. The project partners also created a handbook for residents with specific actions to take in the event of an outbreak.

Another way the project truly engaged its target community was through local schools. Making use of the Can Tho Department of Health’s annual campaigns for Den

A health club ayurvedic movement class. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

A health club ayurvedic movement class. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

gue Fever Prevention, the project integrated the campaigns into lessons for primary school children in grades 3 through 5, even including a competition to see which students had absorbed the most information. In addition, teams made up of health staff from schools, wards and health club members ensured that the students’ families were incorporating dengue fever prevention practices in their homes. According to Le Quang Duat, a facilitator of the project, “These collaborations between the Department of Health, the schools, ward health stations and health clubs were essential to the whole cycle of planning, monitoring and supervision.”

Despite continued population growth and climate unpredictability in Can Tho, cases of dengue fever were down in the target wards in 2014 and 2015. Project coordinators say community involvement was vital to this successful outcome because the health clubs provided the missing link between homes and health officials.

“The key lesson we learned is that you need to find the benefit for the local people. When they see the benefits of your project, they will make it work,” said Nguyen.

Seeking solutions for clean water

Fish farming instruction at a school. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

Fish farming instruction at a school. (Photo courtesy of Nguyen Van Viet/Can Tho Preventive Health Centre)

Rivers and canals are an integral part of daily life in Can Tho, a sea-level city built on the banks of the Hau River. Yet the city’s relationship with water has become increasingly fraught. Climate change and fast-paced urban growth have led to severe riverbank erosion. Heavy rains, severe and frequent storms, and unpredictable river tides are contributing to flooding as well as pollution and sanitation problems in the city’s water supply. At the same time, Can Tho is in the midst of a severe drought and suffering from increased saltwater intrusion in its freshwater aquifers. All of this has created the worst water conditions in nearly a century.

In response, the World Bank is mobilizing community health clubs to improve water and sanitation in Can Tho and across the country. The project is part of a holistic effort to enhance climate resiliency in Vietnam that also involves building water systems that are more resilient to climate change, and designing sewage systems that minimize energy use and greenhouse gas emissions. Although this effort is only just now getting under way, World Bank team members and their community partners are optimistic about the ability to make a real impact, thanks to the country’s strong network of health clubs and community-government collaborations.

Additional Resources:
Report: Climate Change Complicates Dengue Fever Prevention in Can Tho
Video: Dengue Fever Prevention in the Context of Climate Change in Can Tho city, Vietnam

Kathleen Pierce is a contributing writer for Creative Science Writing and the Thriving Earth Exchange.