Vietnam is dealing with the double burden of malnutrition, with growing incidences of obesity in urban areas and undernourishment and stunting affecting many in its poorer rural populations. The Government of Vietnam has responded to this situation through its National Institute of Nutrition (NIN), establishing a national policy to address malnutrition which includes an action plan for reducing micronutrient deficiencies amongst its infant and young child population.
Last year, GAIN embarked on a pilot project to improve infant and young child feeding (IYCF) and care practices, which contribute to stunting in one in four Vietnamese children and zinc deficiency rates as high as 70% among children under five. The pilot was carried out in 300 communes across four provinces, and represented a real departure and innovation in terms of its design and practice.
One singular innovation was that this project introduced home fortification of complementary foods - the first time a government has produced its own multi-nutrient powder (MNP) to be mixed with foods prepared in the home. The product contains 15 essential micronutrients and meets WHO quality standards. The product is for those 6 months and over and can be used alongside complementary breastfeeding.
The product, packaging, branding and pricing were consumer tested to ensure they met acceptability criteria before piloting. It was important that the product appealed to its target audience, was relevant and convenient and attractively priced.
The brand – Bibomix - which is a locally relevant brand name that mothers associate with a product for babies, was developed to be easily understandable for the target audience.
Health claims and simple usage instructions were clearly displayed on attractive and locally appealing packaging. Another important consideration was sizing, using a range of selling units. One was a box of 60 which is a six month supply; an intermediate one month supply in 10 pouch sachets; and individual sachets for daily use. This gave consumers flexibility based on their interest in the product and their purchasing power, which contrasts with the standard practice of many other government products, which come in one generic 20 sachet boxes.
Having government directly associated with the manufacture of the vitamin and mineral powder was a major advantage in terms of product reputation and credibility. Most products at the pharmacy come from wholesalers or other sources and have very little quality control. With a Ministry of Health or NIN endorsement on the pack, consumers trust and know this is coming from their government and accordingly there is a very high credibility rating for the product.
In terms of distribution, this pilot represented the first time ever in Vietnam that the health system, comprising provincial district and commune level health centres, was used as the point of delivery for sale of the vitamin and mineral powders.
GAIN and NIN devised a sustainable cost recovery model, with production and distribution costs being covered by sales at health centres. The caregivers are told about the product in the context of regular counselling activities and they are able to buy the product upon the counsellor’s recommendation. That’s a real innovation in terms of a completely sustainable model. Using health centres is practical and effective because in Vietnam they are well attended, with estimates suggesting that up to 90% of mothers make at least two visits to a health centre within the first year of their child’s birth.
The other significant innovation was that this pilot was completely embedded in the government’s micronutrient deficiency strategy, so not a standalone programme sitting in its own silo. It’s intrinsic to the government’s efforts to educate mothers on infant and young child nutrition practices. As such, it benefits from all the other sensitisation activities going on nationally around nutrition education, such as Vietnam’s two ‘micronutrient days’, where pre-schoolers are given Vitamin A supplements to boost their immunity to disease and mothers participate in community cooking demonstrations.
The pilot has been very well received; with already over 1.5 million sachets distributed in the commune health centres in less than six months. Furthermore, on 27 November, 2014, before the pilot phase had even completed – Vietnam’s national Ministry of Health endorsed Bibomix in its strategy for micronutrient deficiency prevention.
There is commitment from the government to add provinces when the project rolls out and there has also been interest from other NGOs to include the multi-nutrient powder and the delivery channel that we piloted here into their own interventions as well.
Interest has also been shown from other countries in the region – Laos, and Cambodia - to replicate this innovative delivery mechanism. As a model, this sustainable targeted method of delivering vitamins and minerals to fill the nutrient gaps in the diets of pre-schoolers is probably best utilised in countries with well-developed health systems infrastructure.
GAIN have just launched a real-time digital map allowing viewers to see the true scale of malnutrition problem by geographic location. Read the full story on the GAIN website here.
GAIN supports early initiation of breastfeeding, exclusive breastfeeding through age 6 months and continued breastfeeding through age 24 months with the introduction of appropriate, adequately nutritious complementary foods from 6 months of age. GAIN also supports the Code of Marketing of Breastmilk Substitutes and the importance of its articulation in national legislation to promote and protect optimal infant and young child nutrition
Content on this page is paid for and provided by GAIN, a sponsor of the Guardian Global Development Professionals Network.
