Bestuursverslag en Jaarrekening 2013

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1 Bestuursverslag en Jaarrekening 2013 Stichting Medisch Comité Nederland-Vietnam Weteringschans SH Amsterdam T: E: W:

2 I BESTUURSVERSLAG

3 I BESTUURSVERSLAG 2013 LIJST VAN GEBRUIKTE AFKORTINGEN INLEIDING BELEID EN STRATEGIE MISSIE BESTAANSRECHT SOCIALE DETERMINANTEN VAN GEZONDHEID STRATEGISCHE BEGRIPPEN STRATEGISCHE ALLIANTIES PROGRAMMA BESCHRIJVING COMMUNITY MANAGED HEALTH AND LIVELIHOOD DEVELOPMENT (CMHLD) COMMUNITY MANAGED HEALTH DEVELOPMENT (CMHD) Community Managed Health Development (CMHD) with a focus on nutrition DISABILITY PROGRAM (CBR) SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS (SRHR) WOMEN EMPOWERMENT (WE) TRANSITION IN THE EAST ALLIANCE (TEA) Lao PDR Vietnam Georgië, Sri Lanka en Tajikistan HUMAN RESOURCES FOR HEALTH (HRH) MALARIA PERSONNEL BUDGET ADVISOR KNOWLEDGE BROKERING UNIT (KBU) MCNV - ORGANISATIE EN KWANTITATIEVE GEGEVENS BESTUURLIJKE VERANTWOORDING UITVOERENDE ORGANISATIE: MCNV-STAF EN -KANTOREN VRIJWILLIGERS BIJ HET MCNV TRANSPARANTIE EN ACCOUNTABILITY KWALITEIT VAN DE ORGANISATIE KLANTTEVREDENHEID EXTERNE KLACHTEN COMMUNICATIE, VOORLICHTING & FONDSENWERVING POLICY MORE FOCUS ON FUNDRAISING, COMMUNICATION AND PR IN VIETNAM EVENTS AS A TOOL FOR FUNDRAISING CONTINUE MAJOR DONOR PROGRAM RESULTS FINANCIEEL BELEID & MANAGEMENT EN KWANTITATIEVE GEGEVENS BEGROTING EN REALISATIE PLANNEN CONTRACTVERWERKING FINANCIËLE ADMINISTRATIE ONTWIKKELING VERMOGEN EN BESTEMMINGSFONDSEN BELEGGINGSBELEID INKOMSTEN BEGROTING 2014, UITKOMST 2013 EN BEGROTING VERSCHILLEN ANALYSE KENGETALLEN KOSTEN VOOR FONDSENWERVING EN ANDERE KENGETALLEN

4 BIJLAGEN B-1 BEZOLDIGING DIRECTEUR B-2 GEVOLGDE CURSUSSEN, TRAININGEN EN SEMINARS DOOR MCNV STAFLEDEN B-3 ACTIVITIES COMMUNICATION AND FUNDRAISING II JAARREKENING BALANS PER 31 DECEMBER STAAT VAN BATEN EN LASTEN OVER DE PERIODE TOT EN MET GRONDSLAGEN VOOR DE FINANCIELE VERSLAGGEVING TOELICHTINGEN OP DE BALANS PER 31 DECEMBER TOELICHTING OP DE STAAT VAN BATEN EN LASTEN OVER TOELICHTING OP DE TEA BATEN / LASTEN MFS II OVERIGE GEGEVENS ACCOUNTANTSVERKLARING BIJLAGEN F-I NADERE TOELICHTING OP DE BEDRIJFSKOSTEN PER LOCATIE F-II UITGAVEN PROJECTEN IN AMSTERDAM VOOR IN 2013 LOPENDE CONTRACTEN

5 LIJST VAN GEBRUIKTE AFKORTINGEN ADB CBF CBO CBR-IE CMH(L)D CWD DPO Fte GIP HRH IG(A) IMPE INFI ISO KBU KNCV MCNV MFS MHP MT (I) NGO OPA PBA PFZW PDR (Laos) PM&E PWD RvT SDC SMS SRHR TEA VHW(A) WE WG WHO Asian Development Bank Centraal Bureau Fondsenwerving Community Based Organisation Community Based Rehabilitation - Inclusive Education Community Managed Health (Livelihood) Development Children with Disability Disabled People s Organisation Full time equivalent Global Initiative for Psychiatry Human Resources for Health Income Generating (Activity) Institute of Malariology, Parasitology and Entomology (in Qui Nhon) Innovation in Financial Inclusion International Organization for Standardization Knowledge Brokering Unit Koninklijke Nederlandse Centrale Vereniging voor tuberculosebestrijding Medisch Comité Nederland-Vietnam Mede Financiering Stelsel Mental Health Problems Management Team (Internationale) Niet Gouvernementele Organisatie Older People s Association Personnel Budget Advisor Pensioenfonds Zorg en Welzijn People s Democratic Republic Planning, Monitoring & Evaluation People with Disability Raad van Toezicht Swiss Cooperation Office for Vietnam (SDC) Secondary Medical School Sexual and Reproductive Health and Rights program Transition in the East Alliance Village Health Workers (Association) Women Empowerment WorldGranny World Health Organisation - 5 -

6 INLEIDING In 2013 heeft het MCNV zich gericht op de uitvoering van projecten om de leef- en gezondheidssituatie te verbeteren van bevolkingsgroepen in Vietnam in een achterstandspositie, met name voor de mensen, die niet profiteren van de economische ontwikkelingen. Deze groepen wonen veelal in de bergen en ver afgelegen gebieden. Daarnaast is het MCNV, als penvoerder van de Transition in the East Alliance (TEA), actief in: Georgië, Laos, Sri Lanka en Tajikistan. In de Transition in the East Alliance werkt het MCNV samen met het Global Initiative for Psychiatry (GIP) en WorldGranny (WG). Dankzij de steun van velen: donateurs, institutionele donoren en het Ministerie van Buitenlandse Zaken is het MCNV in staat om haar werk uit te voeren. Het MCNV is dankbaar voor allen die vaak al jarenlang met hun bijdragen het werk van het MCNV mogelijk maken. In 2013 heeft het MCNV ieder kwartaal over haar activiteiten gerapporteerd in de MCNV nieuwsbrief. De nieuwsbrief is mede dankzij de inzet van enkele vrijwillige redacteuren tot stand gekomen. Daarnaast is eind 2013 een foto-kalender/verjaardagskalender verschenen. Voor het MCNV is kwaliteit van haar programma s en transparantie heel belangrijk. Om dit te kunnen bereiken is het essentieel dat de organisatie goed functioneert en dat de kwaliteit van de organisatie op een objectieve manier wordt getoetst. Daarom is het MCNV aangesloten bij het keurmerkinstituut CBF. Bovendien heeft het MCNV sinds eind 2009 het ISO certificaat 9001:2008. MCNV is lid van branchevereniging Partos, een vereniging voor alle Nederlandse ontwikkelingsorganisaties, die veel waarde hecht aan organisatiekwaliteit van haar lid organisaties. De branchevereniging heeft de Partos 9001 norm ontwikkeld, vanwege de directe relatie met de effectiviteit en doelmatigheid van de sector, maar ook met het oog op het publieksvertrouwen in de sector. Deze sectorspecifieke toepassing van de ISO 9001 bestaat uit een vertaling van de norm op de onderdelen, die sectorspecifieke toepassing vereisen. Het MCNV heeft deze extra kwaliteitsnorm met succes meegenomen tijdens de hertoetsing in 2013 voor het ISO certificaat. MCNV heeft als tweede Nederlandse ontwikkelingsorganisatie deze norm gehaald. Dit bestuursverslag en de jaarrekening zijn opgesteld in overeenstemming met de richtlijnen van het keurmerkinstituut CBF. Het grootste deel van het bestuursverslag is in het Nederlands opgesteld, bepaalde teksten zijn echter in het Engels weergegeven, denk aan de omschrijving van de programma s en haar activiteiten. Deze informatie wordt in het Engels aangeleverd vanuit Vietnam en Laos en op deze wijze gerapporteerd. Ook het hoofdstuk Communicatie, Fondsenwerving en Voorlichting is Engelstalig, aangezien deze activiteiten zowel in Nederland als in Vietnam worden uitgevoerd. Uiteraard kunt u contact opnemen met het MCNV voor een toelichting op deze stukken in het Nederlands. Het bestuursverslag is gelinkt aan het strategisch plan van het MCNV. Naast de strategie, de doelen en de programma s staat in dit bestuursverslag ook de MCNV organisatie beschreven, alsmede de communicatie, voorlichting en fondsenwerving. Alle door het MCNV gepubliceerde documenten zijn terug te vinden op Waaronder ook het bi-annual report (Engelstalig) en informatiefolders over de programma s. Pamela Wright Directeur-Bestuurder MCNV - 6 -

7 1. BELEID EN STRATEGIE 1.1 Missie Het MCNV helpt achtergestelde groepen in landen in transitie in Zuidoost Azië om toegang te krijgen tot de sociale determinanten van gezondheid, zoals primaire gezondheidszorg, werkgelegenheid, onderwijs, huisvesting en voedselveiligheid. Naast Vietnam, zal het MCNV zich richten op het bestaande programma in Laos en eventueel op termijn op Cambodja en/of Myanmar, mits dit wenselijk en haalbaar is en past bij de expertise en doelstellingen van het MCNV. De missie uit het strategisch plan : to contribute to the structural improvement of the health of disadvantaged groups in South East Asia by developing evidence-based participatory models that build capacity and focus on the major determinants of population health. 1.2 Bestaansrecht Het MCNV heeft bestaansrecht dit blijkt uit de ongeveer individuele en familie donateurs, maar ook institutionele donoren, zoals het Ministerie van Buitenlandse Zaken, die in 2013 ons werk financieel hebben ondersteund. Zij vertrouwen erop dat het MCNV effectieve en efficiënte projecten voor de beneficianten realiseert. Bovendien wordt het MCNV door haar bestaande, maar ook door nieuwe partners in Vietnam en Laos gevraagd te helpen met het vergroten van hun capaciteit en het verbeteren van de kwaliteit van hun gezondheidszorg, daar waar hun eigen regering en gezondheidsdiensten de mogelijkheden niet hebben. Verschillende landen in Zuidoost Azië maken een economische groei door, maar hun sociale ontwikkeling blijft achter. De gemarginaliseerde groepen, maar ook de autoriteiten, hebben behoefte aan goede praktijkvoorbeelden om te kunnen omgaan met de toenemende verschillen tussen de sociale groepen, als gevolg van de snelle en ongelijke economische groei. Het MCNV heeft bestaansrecht, omdat zij zich richt op de kwetsbare groepen, die niet in staat zijn om van deze groei te profiteren. Problemen en ziektes houden geen rekening met landsgrenzen, daarom vroegen de Vietnamese gezondheidsdiensten het MCNV om in de aan Vietnam grenzende provincie Savannakhet in Laos te gaan werken. Er was voldoende bestaansrecht om in Laos aan de slag te gaan. In Laos is het ontwikkelingsniveau veel lager dan in Vietnam. De bestuurlijke structuur en het gezondheidsstelsel zijn vergelijkbaar, evenals de cultuur van de etnische minderheden in Savannakhet. Hierdoor is de ervaring en expertise die het MCNV heeft opgebouwd goed bruikbaar in Laos. In het TEA programma in Savannakhet ligt de focus op plattelandsontwikkeling en empowerment van gemarginaliseerde groepen, zoals etnische minderheden, ouderen en mensen met psychische problemen. Het programma in Laos is nu een integraal onderdeel van het werk van het MCNV en de vraag naar ondersteuning is nog steeds volop aanwezig

8 1. Lerende 2. Onderzoek: 1.3 Sociale determinanten van gezondheid Het MCNV erkent het belang van de drie, door de WHO gedefinieerde, sociale determinanten van gezondheid. Deze hoofdstrategieën zijn ontwikkeld om de sociale ongelijkheden in de gezondheid op een meer effectieve wijze aan te pakken. Het MCNV verwacht van al haar programma s, dat ze een bijdrage leveren aan het beïnvloeden van één of meer van deze hoofdstrategieën: 1. De dagelijkse levensverwachtingen verbeteren, waarin mensen geboren worden, opgroeien, leven, werken en ouder worden. 2. Actie ondernemen tegen ongelijke verdeling van macht, geld en sociaal kapitaal wereldwijd, nationaal en lokaal. 3. Sociale ongelijkheid in kaart brengen en de impact van de ondernomen acties evalueren. Uitbreiden van de kennis basis, zorgen voor getraind personeel in de sociale determinanten van gezondheid en zorgdragen voor bewustwording van het publiek over de sociale determinanten van gezondheid. Ad 1) Alle programma s van het MCNV dragen bij door de toegang van gemarginaliseerde groepen te verbeteren tot betere gezondheidszorg, onderwijs en microkredieten. Ad 2) MCNV levert een bijdrage door lokale en nationale overheden op de hoogte te houden van haar projecten en ze te betrekken bij de planning en uitvoering. MCNV organiseert regelmatig een bezoek met overheden aan haar projecten en stimuleert overheidsorganisaties om deel te nemen aan deze projecten. Ook voegt het MCNV systematisch een lobby en advocacy dimensie toe aan haar programma s. Zo heeft het MCNV bijvoorbeeld bereikt dat ouderen in Vietnam nu wel microkredieten kunnen ontvangen. Ad 3) MCNV levert een bijdrage door goed te documenteren, door zelf onderzoeken uit te voeren, maar ook in samenwerking met verschillende universiteiten, door de evaluatie van programma s te en het verspreiden van de onderzoeksresultaten via de website en publicaties. De komende jaren blijven een aantal sector-overschrijdende thema s belangrijk, zoals de toepassing van de participatieve benadering in de programma s en gender gelijkheid. Daarnaast wordt extra aandacht besteed aan lobby en advocacy en netwerken vooral in Vietnam, maar ook daarbuiten in de regio Zuidoost Azië. Gebaseerd op de geschiedenis, kennis en ervaring van het MCNV blijft gezondheid het overkoepelende thema, met een focus op maatschappelijke ontwikkeling en empowerment van gemarginaliseerde groepen. Empowerment ziet het MCNV als de sleutel om te bereiken dat de gemarginaliseerde groepen toegang krijgen tot economische en andere ontwikkelingen. 1.4 Strategische begrippen Onze aanpak is gebaseerd op de volgende strategische begrippen. Comprehensive Approach: het MCNV zal, waar mogelijk, doorgaan met de toepassing van een comprehensive approach, omdat gezondheid niet los kan worden gezien van de sociale en economische context. organisatie: het MCNV zal in haar programma s, in de organisatie en in de samenwerking met haar partners expliciet aandacht besteden aan leren. het MCNV zal onderzoek systematisch en planmatig in de organisatie verankeren. Een structurele aanpak van (actie) onderzoek zal worden vastgesteld en gevolgd voor alle MCNV programma's

9 Planning, Monitoring en Evaluatie (PM&E): het MCNV is bezig een nieuw Planning, Monitoring en Evaluatie systeem te ontwikkelen, waarbij word gekeken naar de effectiviteit van het werk in relatie tot de visie, strategie en kernprincipes. Samenwerking: het MCNV zal haar krachten bundelen met andere organisaties, dit kan leiden tot nieuwe financieringsmogelijkheden voor bestaande en nieuwe programma s. Bovendien zal het MCNV investeren in het onderhouden van bestaande allianties, zoals de TEA, en zoeken naar eventuele nieuwe relaties en allianties. Het MCNV zal meer aandacht besteden aan de behoeften en de mogelijkheden van haar partners om onafhankelijk te kunnen worden van de financiële en technische steun door het MCNV. Modellen: De door het MCNV gehanteerde modellen en benaderingen worden geanalyseerd, beschreven en gedocumenteerd, waardoor replicatie beter mogelijk zal zijn. In hoofdstuk twee staat een evaluatie over de activiteiten van de in 2013 door het MCNV uitgevoerde programma s, waarbij expliciet aandacht wordt gegeven aan de hierboven genoemde strategische begrippen. 1.5 Strategische allianties Sinds 2011 vormt het MCNV, als penvoerder, een alliantie (TEA) met Global Initiative of Psychiatry (GIP) en WorldGranny (WG). GIP richt zich op de mentale gezondheidszorg en WG op ondersteuning van de ouderen en kansarmen. Het programma wordt uitgevoerd in vijf landen en gefinancierd door het Ministerie van Buitenlandse Zaken. De programma's in Georgië, Sri Lanka en Tajikistan worden uitgevoerd door de lokale partners van GIP en WorldGranny. Het MCNV voert de programma s in Laos en Vietnam uit met lokale MCNV kantoren. Werken in allianties of coalities met andere organisaties is een vruchtbare manier om nieuwe financieringsbronnen te openen en om de expertise uit te breiden in Zuidoost Azië. In 2013 heeft het MCNV samengewerkt met universiteiten, zoals de Hanoi en Hue Medische Universiteit in Vietnam en met het Athena instituut van de Vrije Universiteit in Nederland. Het werk van het MCNV is door deze samenwerking versterkt

10 2. PROGRAMMA BESCHRIJVING In dit hoofdstuk wordt het doel van ieder programma, de in 2013 uitgevoerde activiteiten en een toekomstparagraaf beschreven. De informatie is in het Engels geschreven, omdat de informatie is aangeleverd door onze staf in Vietnam en Laos. In paragraaf 6.7 is weergegeven hoeveel voor ieder programma is begroot en wat er is gecontracteerd in Community Managed Health and Livelihood Development (CMHLD) Objective: improve livelihoods of marginalized ethnic minority communities through community-managed processes. On September 26th 2013 a new District Program Management Board was officially installed and able to sign contracts, leaving too little time in 2013 to make plans and sign contracts for the total budget in However, even without contracts, due to our longstanding cooperation and goodwill, the staff could still continue with coaching and monitoring in the villages and with farmers. MCNV conducted a round of Participatory Rural Appraisals in 11 villages (one per commune), together with the new district partners. This was needed to learn the new partners how the CMH&LD program works and provide a more detailed picture of the present situation in the villages. As a result of the appraisals a number of new village development were identified by the people and facilitated to develop. Coaching and strengthening the para-vet network supported chicken and black pig rearing and chicken hatcheries. Several lessons were learned: 1) scale of chicken rearing/household should not be too large and should work with overlapping generations; 2) small-scale hatcheries fit best with ethnic farmers conditions. This year good progress could be recorded in spontaneous knowledge transfer and independent replication by neighbouring farmers based on Village Extension Workers coaching interested farmers to develop integrated gardening (fruit trees) and livestock rearing models. Impact of CMH&LD: a very positive trend was found in regards of livelihood diversification. Many of the MCNV trained Village Extension Workers are still active. Some have had great influence on encouraging other farmers to start growing fruit trees, making fish ponds, improving their livestock rearing, mostly outside of direct project funding. People are buying tree seedlings produced by the Village Extension Workers. Ethnic farmers started to make vegetable gardens. The lesson learned is that desired changes in livelihood may require a lot of time to ripen. Several of the Village Extension Workers have become local experts in one or more of the new livelihood options, thereby stimulating others. An external factor, the continuing low price for cassava, likely helped by forcing many people to start doing other things. Strategic objective I: improve the conditions of daily life the circumstances in which people are born, grow, live, work, and age. Indicator: number of households that added new, or improved existing, livelihoods (livestock rearing, gardening,...) Plan 2013: Report 2013: 86 households with new livelihood activities (white pig and chicken rearing, Acacia planting). In reality more families benefited, by imitating successful villagers without project inputs or loans so not in the records, but will be higher than the target of 100. Indicator: number of ethnic farmer households with improved access to the market (i.e. through the village shops) Plan 2013: + 30% Report 2013: number of clients increased from 2409 households to 2594 (+8%) compared to Client buying times increased from 6383 to 6755 (6%). Indicator: number of malnourished children who had access to supplementary food for at least three months Plan 2013: 1200 Report 2013: no powder produced/used for Khanh Vinh district because of licensing delay and project administrative reform issue. But sold 180 kg to Phu Yen province for testing there

11 Strategic objective II: tackle the inequitable distribution of power, money, and resources the structural drivers of those conditions of daily life globally, nationally, and locally Indicator: extent to which the model of village-managed shops contributed to a more equitable distribution of power in the rural market situation of poor ethnic minority farmers Plan 2013: in depth studied before replication of model can be promoted Report 2013: an in-depth development-economic evaluation of the village shops by an external expert. The quantitative study provided good data about the effectiveness and the qualitative parts of this study provided insights in why some shops did not take off and unforeseen problems that the successful ones are facing. The report showed evidence for the impact of the shops: broken the monopoly of the private shops and more fair trade experienced by farmers. Strategic objective III: measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about social determinants of health Indicator: effectiveness of the village-managed shops to improve access to the market for poor ethnic farmers and other empowerment development impacts Plan 2013: in-depth evaluation of village shops by external expert Report 2013: external evaluation report measured and demonstrated the effectiveness of the village shops Indicator: effect of the locally produced cereal powder on prevention/ rehabilitation of malnourished children Plan 2013: evaluate Report 2013: analysis of the results of 7 months of supplemental food distribution to 600 the effect of malnourished under-five year old children that ended in December 2012, compared with a powder distribution sample from 400 malnourished children in communes that were not included. The results on malnourished showed 30% reduction of malnourishment in the intervention area compared with 12% in children, compared the control area; a statistically highly significant effect. The hard evidence provides strong with a control encouragement to expand this intervention. We plan to ask the government to provide the group additional funding, but this takes time and formalities, such as official production licenses. Future directions During the coming two years, micro-finance and local development plans will be continued, always with a focus on empowering the ethnic minority communities with knowledge and skills, but now with more attention to local food security and the use of traditional seeds and livestock, as a way to become more independent from the market fluctuations and weather shocks. Close coordination with the programs of the provincial Government to the poor in these ethnic minority communities is being strengthened, to channel their support through the same community-managed approach. 2.2 Community Managed Health Development (CMHD) Objective: to improve the health and welfare of the people through empowering communities, promoting equity in development and improving the quality of life of disadvantaged people. CMHD developed activities in 3 provinces: Cao Bang, Quang Tri and Phu Yen. Emphasis was given to setting up and building capacity of Community Based Organisations (CBOs) and NGOs, including disabled people s organizations (DPO), older people s associations (OPA), and village health workers associations (VHWA). Result area 1: Civil Society Strengthening 3 NGOs and 33 CBOs are involved in the CMHD program. In 2013, all of these NGOs and CBOs went through the second cycle of learning in the organisational development process. They used outcome journals as a tool to review and adapt their plans of change. A review of these journals showed that all the NGOs and CBOs were in good progress of strengthening the capabilities they prioritised. The program helps the local CBOs and NGOs to benefit from policy changes but also enables them to contribute better to the general socio-economic development of their localities

12 Result area 2: Access to finance For the target groups to get loans for their income-generating activities, the program strengthens: 13 community development funds, 9 Disabled People Organisations development funds and 7 development funds of Older People's Associations. These income generation activities are at collective level and were diversified: weaving, tailors, souvenir shops, grocery, washing motorbikes. MCNV and her partners paid special attention to solve the unsatisfied capacity of the Community Based Organisations in management of the development funds and development of business plans, and better accessibility to the market. These issues were solved via regular field trips, trainings, workshops, coaching sessions and exchange meetings. For example, regulations of the funds were re-introduced to the management boards of the funds and borrowers, a tracking system for loans was developed and regularly used. Result area 3: Access to health CMHD has been working with 3 Village Health Workers Associations (VHWA) of Quang Tri, Phu Yen and Cao Bang provinces to provide health education and communication for the target groups. The Village Health Workers Associations cooperated with Older People Associations and Disabled People Organizations to organise health education and communication events interacting with the target groups about common health issues such as hypertension, diabetes, healthy eating behaviours and mental health. The NGOs applied innovative methods such as drama, folk-music, participatory video, puppets and photo-voice to get people at the communities involved in those health promotion activities. Because of these methods more community people joined in those events. Besides health communication events with the community people in general, the Village Health Workers Associations also collaborated closely with Community Based Organisations (DPO, OPA, HIV group) to raise community people s awareness about the roles of these disadvantaged groups in the society. The Village Health Workers Association of Quang Tri also organised a training in writing news and short reporting articles, aiming at enabling and encouraging the Village Health Workers to share their activities through mass media and the organisation s website. Until now, 20 news and short articles have been widely shared. In 2014, this training will also be provided for Village Health Workers in Cao Bang and Phu Yen provinces. For improvement of health service, the CMHD program supported the targeted district and commune health centres to cooperate with the Village Health Workers Associations, Disabled People Organizations and Older People Associations to implement 3 comprehensive community-based health care projects: 1) Community-based rehabilitation for people with disability: The program provided trainings on rehabilitation for Village Health Workers and health workers of the commune and district in Quang Tri and Phu Yen. After training they were able to help 279 people with disability in 2013 to prepare a personal development plan. 2) Comprehensive care for people with mental health problems In 2013, MCNV strengthened its collaboration with Da Nang mental health hospital to provide capacity development for health staff of Quang Tri province. The program trained 52 health staff from village to provincial level on diagnosis, assessment, medication and rehabilitation for people with mental health problems. With technical support of GIP, a key group of 8 doctors developed a guide on working with families with people with mental health problems. With this handbook the Village Health Workers can set up a selfhelp group of families with people with mental health problems, and facilitate the group to learn to deal with their problems. The key group provided training in use of the guide, and supported the meetings with the families

13 3) Comprehensive care for older people in Quang Tri and Phu Yen provinces. In 2013, the program provided health check-up for older people. Commune health centers found 319 older people with cataract, 201 with diabetes, 383 with hypertension, and many people with other health problems. The program could provide hospital operations for 38 older people who had cataract and home-based care for 262 older people who had chronic health problems. Strategic objective I: Improve the conditions of daily life the circumstances in which people are born, grow, live, work, and age Indicators Plan 2013 Report 2013 Outcome Objective 1.1 Improved health for disadvantaged people Increase number of older people who get general health check-up yearly Increase number of people (age 18-65) who get mental health check-up (screening) Increase number of people benefiting from home-based care project Increase number of children under five years old improved nutrition status (excluding the 392 children of CMHD nutrition program Dong Xuan reported elsewhere) (of whom 348 needed further diagnosis & received treatment) Outcome Objective 1.2 Improved income for disadvantaged people Increase number of beneficiaries reached by income generating activities Outcome Objective 1.3 Improved living conditions of disadvantaged people Increase number of people accessing to clean water Maintain the water supply system Outcome Objective 1.4 Increased incorporation and social inclusion of the people Increased number of common interest and community groups family with members having mental health 3 groups 3 groups (12 meetings - 50 families) problem Increased number of community events (people work together and help each other) 20 events 20 events Strategic objective II: tackle the inequitable distribution of power, money, and resources the structural drivers of those conditions of daily life globally, nationally, and locally Indicators Plan 2013 Report 2013 Outcome Objective 2.1: Improved accessibilities of services (for all) and resources Increase number of health facilities improved referral system, and better quality and range of services (more diverse/ comprehensible) 5 commune health centers, 2 rehabilitation departments 5 commune health centers, 2 rehabilitation departments Increase number of health workers getting (refresher) training Outcome Objective 2.2: Improved empowerment and ability to access to services (for all) and resources that meet their needs Increase number of CBOs/NGOs and strengthen capacities of those CBOs/NGOs, so that they function in advocacy with and for disadvantaged people 3 NGOs, 33 CBOs 3 NGOs, 33 CBOs Increase number of CBOs of the disadvantaged people that are involved in local mainstream processes 4 DPOs 4 DPOs Increased number of disadvantaged people are informed about possibilities for access to health services 3000 people reached by events 7313 people attended 248 events

14 Outcome Objective 2.3: Improved enabling environment Needs of disadvantaged people are included in policies, regulations, etc at different levels Enabling policies are translated into number of action plans More opportunity for disadvantaged people/groups to communicate their ideas to policy makers and implementers 2 (health check-up and loans for older people) Follow up the previous regulations and policies 2 plans 2 plans 2 forums/events 2 forums/events Strategic objective III: Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about social determinants of health Indicators Plan 2013 Report 2013 Outcome Objective 3.1: Lessons learnt from MCNV interventions and similar interventions outside MCNV, are translated into improvement of programs, MCNV policies and/or advocacy work Lessons learnt are a basis for changes in practice Lessons learnt are a basis for changes in practice Lessons learnt from PM&E of each project are shared and documented in the office teams at least once a year Evaluation of the program will be carried out in October researches, 3 action learning agendas 3 lessons learnt applied from result area Research on empowerment of VHWs done by a Dutch master student - Action learning/research on result area 1 - Action learning/research on result area 2 - Action learning/research on result area 3 - Research on management of DPO s development fund done by a Dutch master student - Improve the program based on the result of the action learning/research on result area 1 - Improve the program based on the result of the action learning/research on result area 2 - Improve the program based on the result of the action learning/research on result area 3 Reflecting and learning through practicing 3 action learning agendas mid-term review of the program Mid-term review was done and the results were used for improving the program and final evaluation Future directions Continued strengthening of the civil society organisations is combined with community participation in development decisions and implementation of development plans. The CMHD approach will be expanded within existing project provinces, and efforts will be made to link the community development to more income-generating activities and production groups, to ensure that the disadvantaged groups can also join in the economic development in Vietnam Community Managed Health Development (CMHD) with a focus on nutrition Objective: to improve the health status of children under five years old in ethnic minority communities in Dong Xuan district, Phu Yen province. The program is mainly managed by the district health centre. The funds were raised by a gala dinner in Phu Yen in 2012 from which all the donations went to support the children in Dong Xuan. MCNV budgeted an amount for technical assistance to support the partners to monitor the use of the donations. The program strengthened 45 self-help groups of parents with children under 5 years old. During monthly meeting, the parents monitor growth and development of the children, learn basic health care skills from village health workers and learn good practices from each other. Village and commune health workers were trained to make personal nutrition development plans for malnourished children and transferred their knowledge to the parents in the groups.

15 Based on 133 plans for children with severe malnutrition, the program provided specific treatment for each child (vitamins, medicines, supplementary food). These children gained weight and 11 children achieved a healthy nutrition status. Strategic objective I: Improve the conditions of daily life the circumstances in which people are born, grow, live, work, and age Indicators Plan 2013 Report 2013 Outcome Objective 1.1 Improved health for disadvantaged people Increase number of children under five years improved nutrition status Outcome Objective 1.4 Increased incorporation and social inclusion of the people Increased number of community events (people work together, people help each other) Monthly meetings of 45 groups Monthly meetings of 45 groups Strategic objective II: tackle the inequitable distribution of power, money, and resources the structural drivers of those conditions of daily life globally, nationally, and locally Indicators Plan 2013 Report 2013 Outcome Objective 2.1: Improved accessibilities of services (for all) and resources Increase number of village health workers getting training and refresher training in use of innovative methods for behaviour changes and positive deviance-based approach Outcome Objective 2.2: Improved empowerment and ability to access to services (for all) and resources that meet their needs Increase number of CBOs/NGOs and strengthen capacities of those CBOs/NGO, so that they function in advocacy with and for disadvantaged people. 45 self-help groups of parents with children under five years old 45 self-help groups of parents with children under five years old Increased number of disadvantaged people are informed about possibilities for access to health services 300 parents of children under five years old 388 parents of children under five years old Future directions Nutrition remains one of the challenges for community health especially in the remote mountainous areas where MCNV supports nutrition programs. We plan to continue to try new ways to tackle the problem especially among young children, involving social marketing of locally-made nutritional products such as yogurt and porridges. The challenge is great because each community has its own resources and preferences, so more research is needed to match solutions to communities. We would like to expand the range of districts where we address malnutrition in young children, starting with the pregnant women and through the first years of life. 2.3 Disability Program (CBR) Objective: to ensure that adults and children with disabilities receive comprehensive support to develop their potential and to create enabling conditions for their inclusion in community development. The disability program is implemented in Cao Bang, Dak Lak, Quang Tri, Khanh Hoa en Phu Yen provinces. The disability program consists of: Health care and medical rehabilitation for People with Disabilities (PWD) MCNV almost phased out support for the health sector in Dak Lak, Phu Yen and Quang Tri provinces, while the services of rehabilitation for people with disabilities in Cao Bang remains with a focus on 4 communities (TEA project areas). This year the disability program was introduced to Dien Bien province, where we will apply lessons learned from the other provinces. This is useful for our internal learning and for the support of policy development of ministries. In 2013 the cooperation with Dien Bien focused on a baseline survey to identify the needs of people with disabilities, the capacity of the existing service system and resources of community, as a basis for development of interventions in the year 2014.

16 Inclusive Education (IE) MCNV continued support for IE in Dak Lak, Cao Bang and Phu Yen. In 2013 MCNV supported her partners to focus on lessons learnt and documentation of procedures and guidelines in relation to service provision. Income Generation This activity was maintained in Cao Bang and Dak Lak. In Cao Bang MCNV provided 5.000,- from TEA for new loans for people with disabilities and their families. In Dak Lak no funds were provided for new loans, but the Women s Union of Dak Lak received a small budget to follow up utilization of existing credit at community level. Development of Community Based Organisation for Disabled People The program continued the support to strengthen the organisational capacity of the 14 existing Community Based Organisations for Disabled People in Dak Lak. MCNV supported these organisations through the Supportive Centre for Development of Inclusive Education. In Cao Bang 4 new Community Based Organisations for Disabled People received more intensive support as a part of the TEA program. Exchange, coaching and training for capacity building were applied. The Department of Population and Families (under Provincial Health Service) was our partner. Strategic objective I: Improve the conditions of daily life the circumstances in which people are born, grow, live, work, and age Indicators Plan 2013 Report 2013 Outcome Objective 1.1 Improved health for disadvantaged people Percentage of new disability cases detected and identified at early stage with correct 75% 80% diagnoses in project areas Outcome Objective 1.2 Improved income for disadvantaged people Number (cumulative) of PWD and their families in Dak Lak that have increased income as a result of IGA with financial and technical support from MCNV Number (cumulative) of PWD and their families in Cao Bang that have increased income as a result of IGA with financial and technical support from MCNV Outcome Objective 1.3 Improved living conditions of disadvantaged people Percentage of PWD in Cao Bang and Dak Lak who have need will be supported to 30% 25% adapt house to improve quality of life Outcome Objective 1.4 Increased incorporation and social inclusion of the people Percentage of PWD in project areas (Dak Lak, Cao Bang and Dien Bien) participate in 45% 43% social and sport activities at local and national level (at least once) Percentage of CWD participate in festival, event for children 65% 60% Percentage of adult with disability in Daklak can be economically independent in life 40% 35% Number of PWD who are member of DPO or mass organization Outcome Objective 1.5 Children to attend in school Percentage of CWD in school age that have access to appropriate education in project area (3 provinces: Cao Bang, Dak Lak, and Phu Yen) 90% 88% Strategic objective II: Tackle the inequitable distribution of power, money, and resources the structural drivers of those conditions of daily life globally, nationally, and locally Indicators Plan 2013 Report 2013 Outcome Objective 2.1: Improved accessibilities of services (for all) and resources Percentage of PWD and CWD who need rehabilitation in Cao Bang benefit from home based rehabilitation or referral services 93% 90% Number of CWD 0-6 age who are enrolled in Early Intervention in supportive Centres (in Cao Bang, Dak Lak, and Phu Yen) Percentage of CWD 0-6 years old in program areas who are identified early as having development delays are referred to and checked at higher level of health care system 95% 90% Percentage of PWD and CWD in Cao Bang have improvement of daily living skills. 80% 80%

17 Outcome Objective 2.2: Improved empowerment and ability to access to services (for all) and resources that meet their needs Number of CBO of PWD in Cao Bang and Dak Lak are functioning Strategic objective III: Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health. In 2013 a research on the quality of life of disabled people in Dien Bien was planned to be conducted to improve the capacity of CBR staff and partner s staff to analyse the social determinants of health. Since there was no foreign or local student available the topic was postponed. In Cao Bang, a master student from VU Amsterdam conducted a research on stigma and discrimination against disability in Cao Bang and submitted a thesis report that was shared with local stakeholders. A review of the Income Generating Activities was done in 2013 by the Microfinance Officer of MCNV to identify strengths and weaknesses of that part of the program; results were used to strengthen the program. Future directions In the coming years, MCNV will apply the lessons learned from the programs in current project provinces to new areas where people with disabilities need it most. The support of MCNV will focus more on facilitating cooperation among Government partners, people with disabilities and other stakeholders to ensure that disability issues will be integrated fully in the general development agenda. Specific projects will be designed for PWD and their organisations to focus on advocacy and capacity of participation at policy formulation at different levels. MCNV will also pay more attention to cooperation with Ministries and institutions in the development of more and better human resources for the work with people with disabilities. In all the work, research and consultation will provide evidence on effective forms of support for people with disabilities to inform policy and program development. Special efforts will be made to document and publish the many lessons learned in the past few years in different provinces. 2.4 Sexual and Reproductive Health and Rights (SRHR) Objective: to protect the rights and promote the sexual and reproductive health of all including those who are underserved or marginalised, such as ethnic minorities, the disabled, and the young and the old, partly by providing access to up-to-date information and services. At the moment, the SRHR program includes only the HIV projects. By the end of the 7-year HIV program funded by the Royal Netherlands Embassy in June 2012, the project supported over 2500 women and children living with HIV in northern Vietnam. In 2013, the work plan was on a smaller scale, continuing a low level of financial support to those Sunflower groups that wanted to continue with their activities. The continued motivation of the members to attend meetings and to communicate with MCNV is a strong result, with the greatly reduced level of funding, activities and support now provided by the program. The main activity in 2013 was to provide training workshops on life skills for groups of about 30 children between 8 and 16 years, in five project provinces: Dien Bien, Quang Ninh, Ha Giang, Thai Nguyen and Yen Bai. Vietnamese consultants helped the children develop awareness of the problems they face in daily life, with their peers and with their parents, and helped them to develop skills to deal better with those issues. The program responded to the expressed needs of the Quang Ninh Sunflower 2 group, of grandparents supporting children orphaned by HIV/AIDS, who asked for help to guide and manage their grandchildren, and were provided with short training courses on parenting skills, adapted to their situation. These families were also provided with warm blankets, as they requested, for their comfort during the winter cold. Another response to an urgent material need was to provide fertiliser for the poor women farmers among the Sunflower Group in Nghia Lo, to ensure successful crops in the December planting

18 As to Strategic Objective II, the program contributed to tackling the inequitable distribution of power, money, and resources by helping the Sunflower groups help to ensure that the members gain and maintain confidence to manage their lives, and that health services are more aware of their needs and better able to meet them. Strategic Objective III requires monitoring and measurement of approaches used and dissemination of results. The big evaluation in 2012 provided information that is shared where possible. Two presentations on the Sunflowers approach were given at the National Conference on HIV organized at Hanoi Medical University and one was given at a Mekong Subregion public health conference in Myanmar. Future directions While the program with the self-help groups of HIV-positive women continues, we are planning to expand the program to provide support for reproductive and sexual health for the disabled, and for young people in the remote areas where the lack of information and services is greatest. We are also planning to expand the RH program in Laos, to improve the facilities and care available for women especially in remote areas. 2.5 Women Empowerment (WE) The Women Empowerment program currently consists of a micro credit and saving project in Binh Dai District Ben Tre province. The objective: sustainable and effective improvement in the lives and income of poor women in Binh Dai district, Ben Tre province through innovative and suitable micro-finance services and inclusive social support. In 2013, besides the MCNV committed funding, a donation was received from a family in Holland, in terms of a favourable loan. With this source the project expanded in 2 new communes (instead of 1 in the initial planning) and increased the regular clients from 480 in 2012 to 710 in Small support was provided to train staff and credit group leaders on management and livelihood models, to produce a video to share results with local media, and to provide social support (non-refundable) to women in extremely difficult situations. In 2013, the project management contributed the basic fund (from its own income) needed to build a friendship house for an extremely poor woman. In 2013, the project launched a new product loans to help poor women buy voluntary health insurance. These small loans will help at least 300 poor women to buy state health insurance. Most of the targets for 2013 were reached or surpassed, as seen in the table. The District Women s Union has full ownership of this project so they try their best to make it effective and sustainable. This project shows the high possibility for sustainable model and it plans to become an independent Social Fund, which is a model for social enterprise. Strategic objective I: Improve the conditions of daily life the circumstances in which people are born, grow, live, work, and age. Indicator: Improve awareness and practice on basic health issues for poor women who participate to project micro finance activities Plan 2013: health communication messages Report 2013: 100% meetings integrated with health provided to project members through health communication sessions. Communications on: Dengue prevention, communications in credit group meetings healthy living practices, food safety, HIV prevention, gender (82 credit groups x 12 meetings for 710 equity, children caring, nutrition, laws on women development regular clients) etc. have been provided in monthly group meetings. The communication is done by group leaders/credit officers free of charge. Indicator: Provide preferable loans to help poor women buy health insurance to protect them and their family members from health care risks and burdens Plan 2013: 300 persons could buy health insurance from the support of project ( ) Report 2013: The loan product was designed and contract signed with project managers at end 2013, so the result will be in

19 Indicator: Increase number of new poor women (new project clients) access to micro loans Plan 2013: 200 Report 2013: 230 Indicator: Improve the saving habit of the poor Plan 2013: 100% project clients practice Report 2013: 100% project clients practice saving saving Indicator: Increase number of loans provided to poor women by project (accumulated number) Plan 2013: Report 2013: Indicator: Build friendship houses for women living in extremely difficult conditions from project s income. Plan 2013: 1 Report 2013: 1 (from income of projects management charges) Indicator: Train credit groups leaders and members on group management and book keeping Plan 2013: 50 Report 2013: 90 Strategic objective II: Tackle the inequitable distribution of power, money, and resources the structural drivers of those conditions of daily life globally, nationally, and locally Indicator: Increase number of credit groups (total number) Plan 2013: 70 Report 2013: 82 (each credit group contains 5-10 client members) Indicator: Increase the seed-capital to the project (total amount) Plan 2013: 1.8 billion VND Report 2013: billion VND Strategic objective III: Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health Indicator: Conduct the impact evaluation of the project intervention Plan 2013: 1 Report 2013: 1 Indicator: Produce TV news to broadcast on Ben Tre TV about project activities and achievements Plan 2013: 2 Report 2013: 2 (TV news/ documentary) Future directions Gender will continue to be a point of attention in the development projects implemented by MCNV, and we will continue to support vulnerable women to escape from their vulnerable position, whatever its cause. Poverty usually plays a role in inequity, so microfinance is one key instrument to empower women and this area will expand in the coming years. In 2014, the Ben Tre project will approach Dutch businesses who are working in Vietnam. 2.6 Transition in the East Alliance (TEA) Binnen de TEA werkt het MCNV aan de verbetering van de leefomstandigheden van gemarginaliseerde groepen in Georgië, Laos, Sri Lanka, Tajikistan en Vietnam op vier resultaatgebieden: 1) Capaciteitsversterking van lokale organisaties 2) Inkomenszekerheid en microfinanciering 3) Gezondheidszorg 4) Alliantie synergie en leren Het programma wordt gefinancierd door het Ministerie van Buitenlandse zaken. De activiteiten van het MCNV binnen dit programma vinden voornamelijk in Laos en Vietnam plaats. De activiteiten in Sri Lanka worden vooral door de lokale partners van WorldGranny en de activiteiten in Georgië en Tajikistan door lokale partners van GIP uitgevoerd. Het TEA programma wordt uitgebreid verantwoord in een jaarrapportage TEA, welke digitaal is op te vragen via

20 Future directions The TEA program provides financial and technical support for the CMHD and CMHLD programs in Vietnam and to expand the community development program started in 2005 in Laos. In Vietnam, MCNV has added mental health to the community-based health care and human resources for health program which we plan to continue and expand in future. The financial inclusion approaches will also be expanded focusing on diverse marginalised groups. In Laos, the program has a strong food security component and this will receive more attention in future. We also plan to expand the MCNV program in Laos working from a new office in Vientiane. The cooperation within TEA has allowed MCNV to gain more expertise across borders. Under the wing of local alliance partners, MCNV supports modest programs in Georgia, Tajikistan and Sri Lanka, which most importantly have provided lessons about new themes and country contexts. Strategic alliances with other international NGOs and their local partners will continue to be a useful strategy for MCNV in future TEA Lao PDR MCNV is the lead organization in the Lao PDR for the Transition in the East Alliance where it aims to improve the lives of poor and disadvantaged people within Savannakhet province. Specifically, the target is 14 villages in remote Nong district on the border of Vietnam, whose population is mainly comprised of Mangkong and Ta Oil ethnic minorities. The project aims to improve the livelihood conditions of these communities in terms of food security and access to finance and better access to better healthcare in the district. At provincial level the project strengthens training for and practice of mental health care. In 2013 many activities were undertaken with good results in spite of adverse conditions such as severe flooding. Achievements included: 1. Increasing the number of target villages from 10 to Village Development Committees report that TEA helped them to strengthen their organizations households have used Village Rice Bank services to access tons of rice, to help address food shortages, and a system has been put in place to sustainably supply further rice to compensate for losses occurred in flooding during Animal husbandry services and skills have improved contributing to 66 households successfully rearing goats and further 36 households who are involved in raising cows households have been supplied with seedlings and gardening equipment and have been trained in how to establish organic gardens, and a district fish hatchery has been supported to stock suitable village ponds with hatchlings. A pilot mushroom farm was established in 1 village. These initiatives increase food variety and sources as well as providing sources of income villagers are actively engaged with village development funds which are making microloans that contribute to the development of small businesses, such as shops. 7. Regular monthly and quarterly meetings are now held between village, district and provincial health stakeholders improving co-ordination of services. 8. Village Health Volunteers and Traditional Birth Attendants in all 14 villages have their skills updated and refreshed and access to higher quality health services has increased. 9. In early 2013, a mental health assessment was conducted to assess the need and demand for quality health mental health services, which is a significant unmet need in the Lao PDR. 10. The TEA program has facilitated the update of mental health curricula and have trained 29 teachers in the use of this curricula at the Savannakhet School of Health Sciences. 11. The first mental health facility in the South of Laos was established in Savannakhet. TEA has supported its refurbishment, provision of equipment and is supported by three trained mental health professionals. Over 200 people living with mental health issues have attended the clinic. 12. TEA staff and stakeholders have been supported to attend international conferences to share their experiences and learn from other country teams within the TEA Program

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