Background
Cambodia
Health information systems: • Disease surveillance/monitoring and case reporting to the health centre • Keep a register of all children below 5 years of age in the village • Assist the health centre in collecting registration statistics including notification of pregnancies, births and deaths • Conduct verbal autopsies for deaths that occur in the village • Collect information on health and health-related problems in the community, inform and report to the health centre |
Provision and follow up of information and essential services: • Facilitate the identification of the poor for fee exemption • Provide health education, promote improved health practices and distribute health IEC materials including family planning, antenatal care, clean delivery, post-natal care, breastfeeding, complementary feeding, safe water, hygiene and sanitation, malaria and dengue control, HIV/AIDS/STIs, tuberculosis, immunizations, non-communicable and chronic diseases, mental health, tobacco and alcohol and gender-based and family violence • Mobilise families and assist health centre staff during outreach activities and health campaigns • Assist in the mobilisation of resources for sustainability of health centres • Assist families with early identification of the danger signs for severe/serious illnesses • Promote and strengthen the health centre referral system and assist in logistics such as transportation |
Provision and follow-up of essential diagnosis and treatment services: • Promote correct home care for illnesses • Provide community-based first aid and rehabilitation • Identify, refer and follow up children with acute malnutrition • Provide home-based care |
In remote and difficult to access communities: • Provide early diagnosis and treatment for malaria • Diagnosis and treat acute respiratory infections with antibiotics in children |
Provision of essential commodities: • Distribute micronutrient and food supplementation • Distribute mebendazol and oral re-hydration treatment with zinc • Distribute condoms and family planning supplies • Distribute long-lasting insecticide-treated mosquito bed nets and hammock nets |
Methods
Analysis
Results
Characteristics | Focus group 1 | Focus group 2 |
---|---|---|
Gender | Five females, one male | Five females, one male |
Age | Range 25–52 years Average age 32 years | Range 24–44 years Average age 32 years |
Ethnicity/religion | 6 Khmer | 6 Khmer |
Time as a CHW | Range 2–10 years, average 7.8 years | All CHWs 1 year or less |
Characteristic | 10 community health workers |
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Gender | Eight females (6 Khmer and 2 Cham Muslims) Two males (Khmer) |
Age | Age range 26–65 years Average age 47 years |
Other roles | Village Chief, Deputy Village Chief, works for commune council, farmer and seller, carer for partner and mother |
Time as a CHW | Range between 4 and 24 years Average time as CHW 13 years |
Themes
CHW roles and responsibilities
My role includes giving information to the villagers as well as giving information to the health centre if there was a problem in the community. I instruct people to go to the health centre if they are sick, or for pregnancy check or for delivery. (Khmer, male, age 61, CHW for approximately 22 years)
…people come to my house when they are sick and tell me about their symptoms, sometimes I know and tell them to go to the health centre. If they have a cold they go to a private pharmacy. For malaria, vaccinations and pregnancy checks they go to the health centre. (Khmer, female, age 26, CHW for approximately 5 years)
I deliver letters to the mothers to tell them to take their children for a vaccine. I have a book of four vouchers that are for introducing people that have never been to the health centre before… (Muslim, female, age 53, CHW for approximately 15 years)
There are a lot of people who have poor cards in the village. Everyone who is eligible has a poor card. Because me and another villager makes sure that if people are away working at the time of the poor card selection process, we make sure their name is down. (Khmer, female, age 26, CHW for approximately 5 years)
If the villager is poor and no poor card and they are sick, I organise them to get free health care with the HC. (Khmer, female, age 39, CHW for 4 years)
Anything I learn from the workshops I then spread around the community, Malaria, TB, screening for pregnancy, new-born care, nutrition, vaccinations, vitamin A supplements and other health related information. I am a volunteer but I get paid $2 a day from the Provincial Health Department to find and refer infants for vaccinations. (Khmer, female, age 51, CHW for approximately 22 years)
I give education to villager and sometimes in a group and sometimes only 1 or 2 people. If people come to the shop to buy something I tell them the health info I have learnt. Last month I was giving advice about mosquito nets and to make sure there are no holes. I was giving education to people who go to cut the bamboo and told them they must take the mosquito net with them along with the hammock and to put it across the trees. Also, to wear clothes that has long sleeves to cover their body from mosquito. (Khmer, Female, age unknown, CHW for over 10 years)
We have a meeting with [named NGO] every two months where we are required to submit a report and to make plans for the following months. (Khmer, female, age unknown, CHW for over 10 years)
Two [NGO] organisations gave me the training and it was about pregnancy health and post-natal health. The training was three days long. I could only attend two days as the third day I gave birth to my son. After the training, I collect all the pregnant women and spread the messages I receive... (Khmer, female, age 26, CHW for approximately 5 years)
Challenges
Systemic challenges
Personal challenges
Community challenges
I tell the women not to smoke in the house or the children get asthma bad and I tell them it is because of the smoke but they don’t believe it. (Muslim, female, age 34, CHW for 15 years)
Challenges to engaging the community in health promotion sessions | |
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1. Community members are busy with work and home duties and so do not have time to engage in group education 2. Community members do not believe health promotion messages or do not respect CHW knowledge 3. Community members are not interested in health topics 4. No incentives for community members to attend health promotion sessions 5. Difficulty in understanding the link between poor health practices and ill health |
Solutions
Challenge | CHW-suggested improvements |
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Low community attendance at health promotion session | Spend time before health promotion sessions informing community members of the importance of the session and the link between ill health and the public health issue |
Offer incentives to attract people to group sessions (bar of soap, small snack) | |
Encourage respected members of the community to promote education sessions, i.e. village chiefs and deputies, monks, school staff | |
Have repeated health promotion sessions to enable more community members to attend and to help engrain new messages for those with low education levels | |
Keep all health promotion language simple and consistent | |
Provide CHWs with a uniform and fully integrate into the health system to increase respect from the community | |
Behaviour change outcomes | Work in partnership with other providers, for instance, NGOs working on sustainable crop programmes can help community members to grow their own produce to reduce malnutrition in under-five |
Follow-up group health promotion sessions with individual home visits and observations | |
Reinforce messages using TV/radio and other media | |
Show real-life examples of local people who have made the change and what the benefits are for them | |
CHW training | Offer training sessions multiple times to increase CHW attendance and offer refresher training regularly |
Ensure payment to attend training days is sufficient for CHWs to attend | |
Resources and ongoing support | Provide full resources to mobilise programmes including equipment, a travel mode, fuel fund and media resources such as leaflets and posters |
Local government to raise the importance of health issues and demonstrate their support to local communities | |
Raise health issues at commune meetings to generate interest and support | |
Local health officials to recognise CHWs and provide them with an identity | |
Difficulty in reporting | Include verbal reporting mechanisms to decrease the amount of time spent by CHWs on written reports |