Village Health Workers (Cambodia)
Nomad RSI designed this project based upon three years of applied research and the insights gained from a variety of previous projects. It was a new form of village-level intervention, adapted to the context of medical pluralism particular to Mondulkiri.
There are a wide range of health practitioners in the province, including various kinds of biomedical practitioners and a variety of ‘traditional’ healers (herbalists, mediums, etc). The province is thus characterised by the coexistence, and hybridization, of numerous representations of health and disease. Access to biomedical services is very limited and the skills and resources available to biomedical health actors remain minimal.
The project began in November 2002 with the training of Village Health Workers (VHWs) and Village Health Committees (VHCs) in nine villages. The training concentrated on the most serious and common public health problems experienced in remote villages.
VHWs are supervised by the VHCs, which include different medical practitioners (biomedical and others) and village authorities / elders. The aim of the VHWs and the committees is to improve communication between the diversity of health providers and the patients, and to help guide patients along the most suitable therapeutic path (biomedical and/or ’traditional’). These therapeutic itineraries may include a stage of biomedical disease control (at a local health centre) and a stage of social management (through recourse to one of the local traditional healers, or by spiritual or ritual activities).
The project thus expresses a double objective: to reduce the impact of the most prevalent pathologies through communication and advice about appropriate treatment paths, and to limit the social and cultural costs associated with the introduction of biomedicine.
The effectiveness of the project was confirmed in 2010 in an external evaluation completed for Nomad-RSI’s partner Health Unlimited, by Suon Seng and Lim Soviet of the Centre for Development Oriented Research in Agriculture and Livelihood Systems (CENTDOR). This included a comparative study of the Mondulkiri model with another one HU started with ethnic minorities in neighbouring Rattanakiri province with its large ethnic minority population.
Village Health Workers, along with Traditional Health Practitioners and Traditional Birth Attendants are now taking on and enjoying more diversified roles in the development of their communities – please see Capacity-Building Project