Abstract
In the Lao People's Democratic Republic (Lao PDR), village health volunteers play an important role in providing health services including those to reduce the burden of malaria. Over the last two decades, the volunteer network has expanded to bring malaria services closer to communities and contributed to the reduction of malaria cases. However, as malaria test positivity rates decreased, many volunteers have lost motivation to continue providing routine malaria services, and other services they provide may not reflect growing healthcare demands for common diseases in the community. This study explored the perspectives, knowledge and inputs of key health stakeholders and community members in southern Lao PDR on community-delivered models in order to refine the volunteer model in the context of Lao PDR's primary health care sector and malaria elimination goals. Semi-structured interviews with multi-level health stakeholders, participatory workshops with community leaders, and focus group discussions with community members and current village health volunteers were conducted. Deductive followed by inductive thematic analysis was used to explore and categorise stakeholders' perspectives on community-delivered models for malaria elimination. Both stakeholders and community members agreed that village health volunteers are essential providers of malaria services in rural communities. Apart from malaria, community members identified dengue, diarrhoea, influenza, skin infections and tuberculosis as priorities (in descending order of importance) and requested community-based primary health care for these diseases. Stakeholders and community members suggested integrating prevention, diagnosis, and treatment services for the five priority diseases into the current malaria volunteer model. A divergence was identified between community members' expectations of health services and the services currently provided by village health volunteers. Stakeholders proposed an integrated model of healthcare to meet the needs of the community and help to maintain volunteers' motivation and the long-term sustainability of the role. An evidence-based, integrated community-delivered model of healthcare should be developed to balance the needs of both community members and stakeholders, with consideration of available resources and current health policies in Lao PDR.
Highlights
In 2020, nearly half of the world’s population was at risk of malaria, while an estimated 241 million malaria cases and 627,000 malaria-associated deaths were reported globally [1]
Both community members and health stakeholders recommended the development of a community-delivered integrated malaria elimination model for Lao Lao People’s Democratic Republic (PDR)
In addition to malaria elimination activities, interventions for the prevention, diagnosis and referral for treatment of cases of dengue, diarrhoea, influenza, skin infection and TB were recommended to be incorporated into the current Village Health Volunteer (VHV) model
Summary
In 2020, nearly half of the world’s population (approximately 3.4 billion people) was at risk of malaria, while an estimated 241 million malaria cases and 627,000 malaria-associated deaths were reported globally [1]. The Greater Mekong Sub-region (GMS), which comprises Cambodia, China (Yunnan Province), Lao People’s Democratic Republic (Lao PDR), Myanmar, Thailand and Viet Nam [2] has seen dramatic declines in malaria burden over previous decades: between 2000 and 2019, annual reported malaria cases fell by 90% [3,4]. In Lao PDR, this malaria elimination target may be feasible, given that reported national annual parasite incidence declined from 6.81 to 1.3 per 1,000 population between 2012 and 2018 [2]. In 2018, malaria transmission is low and sporadic in the northern provinces but higher in the southern provinces, which account for 95% of all malaria cases in the country [7]. The national strategic plan for malaria control and elimination 2016–2020 focuses on burden reduction in five southern provinces and targets elimination in 13 northern provinces [7,8]
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