WHO-TDR Scholars Enjoying Street Food in Hanoi, Vietnam
In line with the course requirement, the students from WHO-TDR funded Master’s degree program in Implementation Research from Universitas Gadjah Mada (UGM) visited Hanoi University of Public Health (HUPH) at Hanoi, Vietnam from 18th to 21st of December 2016. The purpose of the visit was to exchange knowledge to better understand the principles of implementation research. Researchers at HUPH also shared their learning experiences based on the implementation researches they have carried out.
The 16 WHO-TDR students including 3 IR lecturers and 2 IR secretariats took the flight from Yogyakarta in the early morning of 18th December 2016 to Vietnam via Jakarta and arrived on the same day. The flight route was from JOG-Adi Sucipto to Jakarta Soekarno Hatta in the morning, and from Jakata Soekarno Hatta to Ho Chi Minh City in the later afternoon. The flight continued on from Ho Chi Minh and reached Hanoi City at late night. All students arrived safely and were picked up from the airport to the booked hotel in Hanoi city.
The first day of the visit to HUPH started shortly after the assembly of all students, lecturers and administrative staff from UGM and coordinators from HUPH at Antique hotel, Hanoi. On the way to HUPH, there were a lot of opportunities for informal interactions between UGM group and HUPH group.
A tour around HUPH
The team was escorted to different departments in the buildings including library and laboratory as well as their functions.
Introduction Session, Familiarization and Welcome Speech
Formal initiation with session started with introduction of UGM and the HUPH team. A welcome speech was given by Prof. Dr. Bui Thi Thu Ha, Rector, Head of HUPH. She also gave a brief history of Hanoi University of Public Health. In turn, the Implementation Research (IR) course coordinator from UGM, dr. Elsa Herdiana thanked HUPH team for their hospitality.
She also briefed about the purpose of UGM team visit to HUPH and general description of IR program at UGM. Following the speech by dr. Elsa, an overview presentation about UGM, including IR recruitment criteria, facilities provided, course contents and timeline of the courses was given by dr. Ari Probandari, one of the coordinators of UGM IR program.
Presentation 1: Introduction to Health System in Vietnam
The presentation began with the general overview of the WHO health systems framework and the essential components of general health systems. It also provided an overview of the principles and components of the health system in Vietnam, including how its health system and health care delivery system are organized. There was also a group discussion regarding the constraints faced by the health system in Vietnam.
Presentation 2: Introduction to IR Team and IR Projects in HUPH
The presentation included basics on IR and current IR projects under HUPH. The approaches, methods, outcomes and criteria for conducting high quality IR were discussed during the session. The discussion was supported by different relevant examples of IR that helped in making the students’ conception and understanding on IR clearer. Furthermore the presentation included some basic information about IR and ongoing IR projects of HUPH, including the approaches, methods, outcomes and criteria for high-quality IR. One on-going IR project of HUPH entitled “Strengthening Capacity for Implementation Research” (SCAPIR) was highlighted during the session.
Presentation 3: Sharing Experience: Preparation and Implementation of an IR
In the afternoon of the first day of the field visit, HUPH researchers shared their experience on the preparation and execution of an Implementation Research project. The presentation included: 1) Maternal neonatal health situationer, 2) Introduction of NeoKip project, 3) Facilitation process, 4) Data-collection, and 4) Achievements and challenges.
Field visit to Hanoi Center for HIV/AIDS Prevention
WHO-TDR Students during the lectures at Hanoi Center for HIV/AIDS Prevention
A field visit to Hanoi Center for HIV/AIDS Prevention was also scheduled on 20 December 2016. The clinic was financed before through donors but it is currently being managed by the City Council and Insurance in terms of facilitating medications and patient consultations. The clinic conducts voluntary testing, counseling, rehabilitation for drug users, treatment and research. Patients (drug users) are referred to them from hospitals, or by recommendations from friends. They could also go to the clinic voluntarily. Most patients were former Cocaine and Heroin users, but now go to the Hanoi Center on a daily basis to receive Methadone as a treatment.
All clients go through counseling and daily treatment. Referral is done if patients want to receive Methadone from another district and best efforts are done to prevent defaulters.
WHO-TDR students had the opportunity to interact with three clients of the Hanoi Center who have full-time jobs but are still given opportunities by their employers to leave their work daily to come to the clinic for treatment. This session was followed by interaction between HIV/AIDS Patient and IR Students.
Presentation 4: Implementation Research in Hanoi Center for HIV/AIDS Prevention
Methadone clinic is under Hanoi Center of HIV/AIDS prevention. It is led by a director and a vice director with seven departments, i.e. financial department, planning department, monitoring and evaluation department, communication and intervention, treatment management, infectious management and laboratory. This center is under Vietnam Administration of HIV/AIDS Control (VAAC) which has jurisdiction over 30 district HIV/AIDS centers, 19 HIV/AIDS steering committees, Vietnam and International NGO, other HIV/AIDS centers, HIV/AIDS peer- groups and clubs and 577 communal HIV/AIDS centers.
Main activities of this center include behavior communication change, developing communication materials, printing and publishing material, implementing intervention programs for harm reduction for high-risk group (IDUs, sex workers, MSM, mobile population, etc.) include needle and syringe programs, condom distribution, methadone treatment, and other care and treatment for people with HIV, program monitoring and evaluation, counseling and testing, prevention of mother to child transmission, management and treatment of sexually transmitted infection; international cooperation program.
The Center also conducts implementation research regarding HIV/AIDS prevention to support the existing program. Their research is conducted based on the gaps and barriers of program implementation in the field. According to the Center’s staff, some problems they faced include hindered active participation of clients as a result of the need to strictly follow policies and circulars. They also have human resource shortage such that only two staff deliver counseling to 200 to 400 patients.
The Center proposed client centered services based on the “peer-to-peer counseling” model as the intervention for patients undergoing Methadone treatment. They chose this strategy because they observed that it is easier for clients to disclose with peers similar to them than to medical staff. They hypothesized that this may lead to more in-depth counseling and will better address the barriers of the consultation process. The specific objectives of this research are (1) to evaluate the peer-to-peer counseling model in performing counseling for patients who receive methadone treatment and (2) to evaluate challenges in implementing peer-to-peer counseling model. They proposed a mixed-method study design combining a pre- and post-test design that is complemented with qualitative methods to elaborate the challenges of peer-to-peer implementation. Data collection tools that will be used include questionnaire for patients, self-assessment questionnaire for quality of life assessment, secondary data records, observations and focus group discussion for the qualitative. This research will begin by January 2017 until December 2017 with an indicative budget of US$10,000.
Some potential barriers identified include issues with regard to follow up of the patients, time for peer-to-peer counseling, and financial barriers. However, this research is expected to result in several outcomes which include an evaluation of the effectiveness of the “peer-to-peer counseling” model, development of client support system, reduced work burnout and overload for health providers, and improved patient participation.
THE FAREWELL DINNER
The Hanoi University of Public Health dean and staff ended the study visit by preparing a special dinner in Sen 60 Ly Thai To restaurant in the Old Quarters area. The said restaurant is filled with a variety of Asian and European delicacies with over 60 traditional dishes from three regions in Vietnam.
Towards the end of the farewell dinner, the dean of HUPH gave closing remarks and thanked the delegation from UGM for the very fruitful study visit. HUPH and UGM participants also exchanged souvenirs thereafter.