{"id":93043,"date":"2025-10-23T10:36:12","date_gmt":"2025-10-23T10:36:12","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/93043\/"},"modified":"2025-10-23T10:36:12","modified_gmt":"2025-10-23T10:36:12","slug":"working-in-pairs-male-female-village-health-volunteers-supporting-maternal-health-and-community-engagement-in-remote-and-ethnic-communities-of-lao-pdr-a-qualitative-study-tropical-m","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/93043\/","title":{"rendered":"Working in pairs: male\u2013female village health volunteers supporting maternal health and community engagement in remote and ethnic communities of Lao PDR\u2014a qualitative study | Tropical Medicine and Health"},"content":{"rendered":"

Community health workers (CHWs) are essential to improving access to primary health care (PHC) and achieving universal health coverage. According to the World Health Organization, CHWs are lay health personnel selected from the communities in which they work, accountable to those communities, and supported by the broader health system [1<\/a>]. Although CHWs often have lower levels of formal education and clinical training compared to professional health care providers, they form a crucial link in the health workforce. Evidence from both low- and middle-income as well as high-income countries demonstrates their effectiveness in expanding access to essential health services, particularly among underserved and marginalized populations [2<\/a>,3<\/a>,4<\/a>]. Their responsibilities span a wide range of activities, including health education, screening, facilitating access to PHC services, and engaging in disease-specific interventions such as medication treatment and basic first aid [5<\/a>]. In carrying out these tasks, CHWs\u2019 intimate knowledge of local cultural norms and social structures, along with their closeness to the community, constitutes a vital asset that enables them to provide contextually appropriate care [5<\/a>]. This unique positioning enables CHWs to address sociocultural barriers to care, which is particularly important for reducing health disparities, including for maternal and child health (MCH), and for strengthening equity-oriented health systems in marginalized settings [4<\/a>, 6<\/a>].<\/p>\n

Numerous studies have shown that CHWs have the potential to contribute to reducing maternal and neonatal morbidity by promoting timely access to essential health services at the community level. A systematic review indicated that newborn home visits by CHWs were associated with a 38% decrease in neonatal deaths in South Asia [7<\/a>]. Additionally, several studies have shown that CHWs contribute to improving women\u2019s health during the perinatal period through the early detection of pregnancy-related complications, such as pre-eclampsia and postpartum hemorrhage, and the referral of affected individuals to appropriate health facilities [8<\/a>, 9<\/a>]. The World Health Organization issued guidelines in 2015 advocating task-shifting strategies to CHWs, with the aim of enhancing their involvement in delivering essential care at the community level [1<\/a>].<\/p>\n

Despite the contributions of CHWs to MCH, their effectiveness in MCH is influenced by structural and contextual factors, including gender-related barriers. Gender dynamics affect how CHWs are perceived, how they perform, and how they engage with communities. From the CHWs\u2019 standpoint, several gender-related factors can influence how effectively they function in the field. In some settings, female CHWs may face mobility constraints due to concerns about personal safety, religious or cultural norms that prohibit women from walking alone, or the need to obtain permission from family members to travel [10<\/a>,11<\/a>,12<\/a>]. From the community\u2019s perspective, gender also influences the quality of interaction and trust building. Particularly in the domain of reproductive, maternal, and child health, female CHWs often have greater access to women, enabling more open communication about sensitive topics such as family planning, breastfeeding, and postpartum care [13<\/a>, 14<\/a>]. For example, a study conducted in Tanzania suggested that male CHWs may feel more comfortable discussing sexual and reproductive health issues with men; however, due to prevailing gender dynamics and social norms, they are often less accepted by women when addressing these topics, which limits their impact on the use of reproductive and maternal health services [13<\/a>]. Conversely, while female CHWs may be more likely to receive early pregnancy disclosures from women, they frequently encounter difficulties in engaging with male partners and senior family members\u2014challenges that are similarly shaped by gendered power relations and sociocultural expectations within the household and community [11<\/a>]. In such contexts, working in male\u2013female pairs may help ensure safety, legitimacy, or community acceptance [11<\/a>,12<\/a>,13<\/a>, 15<\/a>].<\/p>\n

Similar to many low- and middle-income countries, the Lao People\u2019s Democratic Republic (Lao PDR) continues to experience challenges in providing PHC, particularly in remote and ethnically diverse areas [16<\/a>, 17<\/a>]. Structural barriers such as limited human resources, constrained financing, poor infrastructure, and geographic isolation contribute to ongoing health disparities among ethnic minority populations living in mountainous and border regions [18<\/a>, 19<\/a>]. The 2023 Lao Social Indicator Survey (LSIS III) highlights persistent urban\u2013rural inequities in MCH. For instance, the infant mortality rate in rural areas is estimated to be 2.6 times higher than in urban settings [20<\/a>]. Additionally, while 86.7% of urban women received four or more antenatal care (ANC) visits, only 66.3% of rural women received four or more ANC visits. Institutional delivery rates were lower in rural areas (75.8%) than in urban ones (83.2%) [20<\/a>]. Similar gaps were observed in family planning and breastfeeding, with rural women consistently reporting lower coverage and poorer practices compared to urban women [20<\/a>]. Although health services are available, they remain underutilized due to poverty, language barriers, and entrenched gender norms that restrict women\u2019s autonomy in making health-related decisions [21<\/a>]. In response to these challenges, CHWs have been identified as key facilitators in improving access to maternal health services. A study conducted in remote and ethnic communities in Lao PDR reported a positive association between higher levels of trust in CHWs and increased utilization of postnatal care among mothers [22<\/a>]. The study suggests that, alongside enhancing maternal trust in VHVs\/VHWs, it may be important to systematically address restrictive gender norms through targeted male engagement strategies.<\/p>\n

In the Lao PDR, CHWs, known as village health workers or village health volunteers (VHWs\/VHVs), serve as the cornerstone of community-based PHC, particularly in remote and hard-to-reach areas. National policy ensures that each village should have at least one VHW\/VHV and is responsible for delivering primary health services including MCH [23<\/a>]. In Xepon District, an ethnically diverse, mountainous area in Savannakhet Province, approximately 90% of VHWs\/VHVs are male [24<\/a>]. This gender imbalance is largely attributed to national selection criteria that require basic literacy and completion of primary education. These qualifications have historically been inaccessible to many women in remote ethnic minority communities because of limited access to formal schooling. While male VHWs\/VHVs perform essential functions in health promotion, sociocultural norms in Xepon District limit the extent to which they can engage effectively with women on MCH issues such as ANC, birth preparedness, family planning, and breastfeeding. To address this limitation, a pilot activity led by the provincial health department was launched in 19 villages in the district in 2017. In each village, one male VHV and one newly selected female VHV were paired, resulting in a total of 38 volunteers. The intervention was implemented until 2019, suspended for approximately three years during the COVID-19 pandemic, and subsequently reinitiated in 2023. Currently, the model remains a provincially led initiative and has not yet been scaled up in other areas. Of the 14 health centers operating under the Xepon District Hospital, four were purposively selected based on their accessibility. From the catchment area of each selected health center, two to seven villages were identified in consultation with local health authorities, considering logistical feasibility and population needs. The pilot project introduced a male\u2013female paired VHW\/VHV model to strengthen MCH outreach. Under this model, female VHV\/VHWs were selected in each village and trained to collaborate with existing male VHWs\/VHVs. Together, they conducted home visits for pregnant and postpartum women, providing maternal health education and mobilizing community members during outreach visits by health center staff. Due to widespread literacy limitations among the female VHVs\/VHWs, the male VHWs\/VHVs had responsibility for completing monitoring forms and recording health information during home visits. A study conducted in these pilot villages found that mothers who received home visits from paired VHVs reported lower Edinburgh Postnatal Depression Scale (EPDS) scores compared with those visited by single male VHVs, suggesting potential benefits of the paired approach for maternal mental health [25<\/a>]. Nevertheless, how CHW engagement affects maternal health outcomes remains poorly understood and warrants further investigation.<\/p>\n

MCH indicators in Xepon District remain suboptimal despite national progress, with gaps in antenatal care, family planning, and breastfeeding particularly evident in remote, ethnically diverse settings. As approximately 90% of VHVs are male, gender norms may constrain their ability to engage women on sensitive MCH issues. To address this challenge, a provincial pilot introduced male\u2013female VHWs\/VHVs pairs to improve outreach and promote gender-sensitive service delivery. However, little is known about how these pairs function in their communities or how they are perceived by households and community members. This study, therefore, aimed to explore the functioning of male\u2013female VHWs\/VHVs pairs in Xepon District, focusing on their roles, interactions, and community responses.<\/p>\n

The findings may inform future policy and programmatic decisions to strengthen gender-sensitive health interventions in underserved, culturally diverse contexts.<\/p>\n","protected":false},"excerpt":{"rendered":"Community health workers (CHWs) are essential to improving access to primary health care (PHC) and achieving universal health…\n","protected":false},"author":2,"featured_media":93044,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[62556,62559,62558,163,85,4746,46,62557,44154,546,18495,6137],"class_list":["post-93043","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-community-health-workers","tag-ethnic-minority-communities","tag-gender-norms","tag-health","tag-il","tag-infectious-diseases","tag-israel","tag-male-female-pair-model","tag-maternal-and-child-health","tag-public-health","tag-tropical-medicine","tag-vaccine"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/93043","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=93043"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/93043\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/93044"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=93043"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=93043"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=93043"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}