Improving local health through community health workers in Cambodia: challenges and solutions

Abstract

BackgroundVolunteer community health workers (CHWs) are an important link between the public health system and the community. The ‘Community Participation Policy for Health’ in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives.MethodsQualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres.ResultsFindings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers.ConclusionsThe fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.

Access to Adolescent Pregnancy Prevention Information and Services in Ghana: A Community-Based Case-Control Study

“…Not different from previous studies [e.g., Maravilla et al (53)], non-pregnant adolescents in the current study were more likely to have access to pregnancy prevention information from health facilities and health workers compared to pregnant adolescents. Available literature has shown that health workers are effective in the provision of community health information to both young and old people on SRH issues to develop not only adolescent reproductive health but also a wider range of maternal and child health issues (67)(68)(69). Similarly, although studies have shown that adolescents feel ashamed going to these health centers for information or services relating to sex and contraception due the perception of unwelcoming attitude at the facility (70,71), there is evidence that delivering quality services that are tailored to adolescents needs (e.g., extension in operation hours, reduction in prices of SRH services, transforming physical design to promote privacy or confidentiality) may result in an improvement in service use, adherence to contraceptive methods, and increase the probability of seeking on-going health care (1,72).…”

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

“…The sociocultural environment was another critical factor for optimizing CHW functionality. In Cambodia, kinship, social hierarchical structures, religion, patron-client relations and collectivism were shown to impact the ability of CHWs to form relationships and in uence decision-making for service utilization [45]. The CHW system in Cambodia fosters a strong identity with a structured induction training and support led by local government bodies that includes basic skills, such as communication and behavior change technique [45].…”

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

“…The sociocultural environment was another critical factor for optimizing CHW functionality. In Cambodia, kinship, social hierarchical structures, religion, patron-client relations and collectivism were shown to impact the ability of CHWs to form relationships and influence decision-making for service utilization [40]. The CHW system in Cambodia fosters a strong identity with a structured induction training and support led by local government bodies that includes basic skills, such as communication and behavior change technique [40].…”

“…In Cambodia, kinship, social hierarchical structures, religion, patron-client relations and collectivism were shown to impact the ability of CHWs to form relationships and influence decision-making for service utilization [40]. The CHW system in Cambodia fosters a strong identity with a structured induction training and support led by local government bodies that includes basic skills, such as communication and behavior change technique [40]. Furthermore, literature on the impact of CHW use of support tools demonstrates that having culturally appropriate tools, such as narratives available through videos and storybooks, can be an important, cost effective aid to CHWs, as illustrated in a study from Pakistan, where such tools facilitated dialogue between men and women to create greater awareness of maternal care [41,42].…”