Village Health Volunteers, the Link between Health Centres and the Community in Lao PDR

UNICEF in partnership with the Ministry of Health, UNFPA, and WHO under the UN Joint Programme, supported by the Government of Luxembourg, are working together to enhance the capacity of VHVs to better deliver health services to communities

Siliphot Sihaphom
health workers
UNICEF Laos/2020
17 May 2021

Ms. Mun, 25, is a resident of Pha Oudom district, Bokeo province, who was recently deployed as a village health volunteer (VHV) in her community. Her job as a VHV consists of supporting the local health centre in providing health services to the community.

“I recently joined the VHV workforce after I graduated from high school,” said Mun.

She was also one of the VHVs who participated in the  Community Integrated Management of Newborn and Childhood Illness (CIMNCI) training in Pha Oudom district, which was supported by the UN Joint Programme (UNJP). This was Mun’s first ever training as a VHV, which involved learning how to identify sick newborns and children in the communities they serve and supporting families in their timely referral to the nearest health facility.

“I decided to become a VHV because in my heart, working to improve community health is something I know I want to do.”

VHVs conducting a home visit.
UNICEF Laos/2020
VHVs conducting a home visit.

Mun is one of the newer female recruits in Lao PDR’s VHV workforce. She and other younger VHVs are following in the footsteps of more experienced VHVs in the community such as Mr. Singlien Malinthone, 38, who is also working in Pha Oudum district. He has worked as a VHV since 2009 and as part of his responsibilities, he regularly visits families in their homes to provide counselling about reproductive, maternal, new born and child health (RMNCAH) and other health concerns. Occasionally, he also gets called into the local health centre to help with vaccinations as well.

“I also decided to become a VHV because it’s a line of work that I truly love. I want to help the community, especially those in remote rural areas who lack awareness about good health practices,” said Singlien.

As such, VHVs like Mun and Singlien act as a very important link between the health system and the community by providing the first line of advice and health care to communities. Speaking about his experiences working as a VHV for more than a decade, Singlien notes that his own community still face several challenges, especially regarding community awareness about maternal and child health issues.

"A number of women in my community still practice unassisted childbirth instead of going to the hospital. Some parents, particularly those from non Lao-Tai ethnic groups, are also still hesitant about getting their children vaccinated as there are still false preconceptions about vaccination,” he said.

In working to help raise awareness about these issues, Singlien himself also deals with challenges in conveying information on these topics to families.

“While many families from non Lao-Tai ethnic groups in my community can speak Lao language, there are still some people who do not speak Lao. When I provide counselling to these families, it can be really challenging for me to communicate with them,” he admitted.

Training
UNICEF Laos/2020
VHVs engaging in a group exercise during the CIMNCI Training held in Pha Oudom district of Bokeo province from 4 to 8 January 2020

To enhance the capacity of VHVs like Mun and Singlien in order to improve maternal and child health, the Ministry of Health (MOH), with support from the Government of Luxembourg, UNFPA, UNICEF and WHO, are working together under the UN Joint Programme (UNJP) to strengthen the community health system for Primary Health Care (PHC), particularly to strengthen the link between health centres and the communities it serves. Under the UNJP, trainings on community-based integrated management of childhood illness (CIMNCI) were organised to help VHV’s identify key messages to be delivered during 11 critical home contacts that the VHVs would provide to mothers during the first 1000 days of her child’s life. The training also contributed to the creation of accompanying job-aids which could be used to help convey these messages during home visits. UNICEF has provided technical support in fine-tuning these key messages to cover various topics, including RMNCAH, nutrition, early childhood development (ECD) and water, sanitation and hygiene (WASH).

“Communicating with the families on various topics will be much easier with the use of these job aids, especially when I provide counselling to those who may not speak the same language. I think the cards help people visualize the points I am trying to convey better,” observed Singlien.

In addition to this, UNICEF and WHO supported MOH in the geospatial analysis mapping and the capacity assessment of health facilities and VHVs. This assessment particularly generated critical data on VHVs, such as age, ethnicity and training status, to helps health planners strategize on how best to maximize existing health infrastructure and community health workforce to improve access, utilization, and quality of care. The mapping and capacity assessment was implemented in September 2020 and has help developed a set of core indicators that can be used to compare performance for community health programming nationwide while contributing to MOH’s efforts to revitalize the VHV workforce as part of the revised PHC policy.

The assessment also highlighted a number of important findings about the nature of the VHV workforce in Lao PDR, including the fact that the number of male VHVs still outnumber that of females, at 51 and 41 per cent respectively, and that the majority of the workforce is aging.

In response, MOH is also recruiting more female VHVs, with 51 per cent of newer recruits now being female. Younger people and adolescents are also being promoted in the VHV workforce since their contribution could potentially yield new ideas that could change village discourse around health. Furthermore, younger people are also more likely to speak local and official languages and can help link the formal health system to ethnic communities.

The UN Joint Programme contributes to improving the health of women, newborns, children and adolescents in Lao PDR through supporting the implementation of the National Strategy and Action Plan for Integrated Services on Reproductive, Maternal, Newborn, Child and Adolescent Health (2016-2025).