The changing role of village health volunteers in northeast Thailand: an ethnographic field study

Autor: Karen S. Kauffman, Donna Hicks Myers
Rok vydání: 1997
Předmět:
Zdroj: International journal of nursing studies. 34(4)
ISSN: 0020-7489
Popis: The system of Primary Health care (PHC) in Thailand is one of the oldest in the world and is known worldwide for its success. Supporting the concept of community involvement, the Village Health Volunteer (VHV) is the backbone of this health care delivery system. In December 1994, an ethnographic field study was conducted in a village in Northeast Thailand to explore the implementation and acceptance of the role of the VHV. The VHVs displayed appropriate knowledge of their role but reported decreased use of their services by residents due to the close proximity of the village to a major urban area where health services were readily available. The majority of the villagers who were interviewed did not know the VHVs in their community and few had used their services. They relied on self-treatment and self-referral for their health care concerns. With increasing urbanization of this once rural village, the VHV no longer serves as the point of entry into the health care system. While still a vital part of the PCH system, the role of the VHV will need to adapt to the changing needs of the community it serves.Primary health care (PHC), the major strategy in the effort to reach the goal of "Health for All by the Year 2000," depends upon community participation and engenders community empowerment. Thailand's PHC system, one of the oldest and most successful in the world, grew from a 1966 pilot program to a full-fledged program of universal health care in 1980. Community health workers, known in Thailand as village health volunteers (VHVs), are an essential part of the PHC model as they link the community to the organized health system. The VHVs must fulfill certain criteria and undergo training to fulfill their health promotion and disease prevention functions. An ethnographic field study was undertaken in a rural Thai village in 1994 to determine 1) how VHVs view their role, 2) how villagers view the VHVs' role, and 3) if VHVs and the current PHC model leads to universal access to health care. Data were collected via focus groups, semi-structured interviews with VHVs and villagers, and observations during a 2-week period. It was found that the VHVs believed their role to be vitally important but found it difficult to obtain continuing education. Increasing urbanization, however, led most villagers to bypass the VHVs and seek health care in a neighboring city. Villagers reported minimal use of VHVs, and most could not identify the VHVs, depending instead upon self-treatment and self-referral. While this study is preliminary only, it was concluded that the role of the VHVs has diminished in importance and should be adapted to address evolving social problems resulting from urbanization such as 1) the impact of migration on family structure, 2) intergenerational discord, 3) risk factors associated with old age, 4) increased exposure to sexually transmitted diseases and HIV/AIDS, 5) widening economic disparities, and 6) increasing domestic and social violence.
Databáze: OpenAIRE
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