SPEECH PATHOLOGY TRAINING IN VIET NAM: Implications of the WHO World Report on Disability for Curriculum Development, Sustainability and Impact A/Prof Lindy McAllister, School of Medicine, The University of Queensland and Director Trinh Foundation Australia Ms Marie Atherton, Speech Therapy Program Director, Pham Ngoc Thach University of Medicine, Viet Nam Ms Karen Wylie, University of Queensland, Australia Mrs Sue Woodward, Director Trinh Foundation Australia Dr Alison Winkworth, Director Trinh Foundation Australia

Disability Prevalence of between 5.8% (World Health Survey, ), 6% (Ministry of Labour & Social Affairs, ) and 6.4% (national survey, 2005) Communication & swallowing difficulties can be expected to affect about 13 million people in Viet Nam (WHO 2009) (about 1 in 7 of the population)

Speech Therapy Training in Viet Nam 1 st University based ‘Speech Therapy Training Program’ opens with 18 students at Pham Ngoc Thach University of Medicine, HCMC, Sept 2010 Partnership between PNTU, ENT Hospital of HCMC, AVI and TFA

RESULTING CHANGE EXTERNAL PRESSURES INTERNAL PRESSURES TOP DOWN BOTTOM UP Based on Dunphy, Griffiths and Benn (2003)

External Drivers for speech therapy services & courses UN Millenium Development Goals – primary motivator to reduce poverty – education seen as one means to achieve MDGs Globalisation IT and Internet access NGOs and foreign aid agendas

Speech Therapy in Developing Contexts: Some Examples of Internal Drivers 1.Policy and legislation changes 2.Increasing diversification and specialization of medical professions 3.Political stability and safety 4.Increasing affluence 5.Increasing education levels 6.Increasing awareness of disability issues 7.Advocacy and grass roots organisations

Internal Drivers for Speech Therapy Training & Services in Viet Nam VN Government Education Reform Agenda – VN has more than doubled its spending on education since 2000 – Fastest growth in education sector has been at upper levels of education (World Bank, 2009) The emergence of the private higher education sector Socio-economic Development Plan

Internal Drivers cont’d Health professionals already providing speech therapy services -> profile of the profession raised, together with community expectations Shifting perception of disability Grass roots organisations resulting in increasing advocacy for services

Who leads and sustains the change? 1.Change Initiator 2.Change Agent 3.Sponsor 4.Champion (McNamara, 2005)

The Change Initiators & Champions for Speech Therapy Training

The Program 2 years duration – alternating 3 months at PNTU, 3 months in workplaces with work- based clinical education Lectures provided by staff at PNTU (Anatomy, Linguistics, Normal Speech Development, Audiology, Psychology) Lectures for specific speech pathology subjects provided by Program Coordinator and visiting lecturers from Australia Clinical education supervision provided by visiting Australian clinicians supported by TFA

18 students - graduate doctors, nurses and physiotherapists

How is it relevant to the local culture & conditions? How does it realistically become self- sustaining? How do you best ensure population health impacts? What needs to be done…. (and why)…? Is ‘my way’ the ‘best’ way for this situation? Does it ‘fit’ with development & disabiltiy framewo rks

Implications of the WHO World Report For an SLT program in a medical school ICF is used as curriculum framework Disability issues are foregrounded Interprofessional team work is foregrounded and all 3 are very well understood by the students So we have students educated to work within a framework of values and practice at odds to that of the medical school and to the hospitals and health care system to which they will return PNTU is investing in the development of specialist programs and services (WRD Recommendation 2) in speech therapy BUT sees this as preparing a new profession as a ‘sub-specialty of medicine’ Does Viet Nam need speech therapists OR speech therapy services?

What about PWD who need services outside hospitals? – unmet need How can the program work within a medical model but prepare graduates to meet the ‘unmet need’? – Involvement of PWD and families in the teaching program (WRD Recommendation 4) – Prepare students for health promotion and education roles within the community, and lobbying and advocacy roles (WRD Recommendation 7) – Provide students with research skills to collect data on prevalence, incidence, needs, QOL etc of People with Communication and Swallowing Disability (WRD Recommendation 8) and research on lives of PWD and appropriate, effective and affordable speech therapy services for Viet Nam (WRD Recommendation 9) Also need to work with Vietnamese agencies to develop standards for training at different levels (WRD Rec 5) – mid-level workers, assistants