Development of a village health worker care model to reduce cardiovascular risk in areas of armed conflict: Qualitative results from a participatory planning process in Myanmar
Cardiovascular disease (CVD) is the leading cause of death in Myanmar, but care models are lacking to deliver evidence-based treatments in areas of armed conflict. Village health workers (VHWs) bridge communities and clinics, but their role in CVD prevention and management in conflict-affected settings has not been clearly defined. This study aimed to identify VHW functions that could improve access to, and quality of, CVD care in conflict-affected Karen State, Myanmar.
33 key informant interviews were conducted with patients, VHWs, clinic staff, and other stakeholders, and findings were analysed thematically to explore barriers, facilitators, and potential leverage points for improving CVD care in conflict-affected settings. Participants reported that many people were unaware of CVD and its risks, and there were persistent gaps in CVD screening, medication adherence, and referral systems. Transport costs, medicine shortages, and security risks made clinic visits and continuity of care difficult. Respondents believed VHWs could play an important role in improving CVD care by providing health education sessions, screening for high blood pressure and diabetes, delivering medications and supporting adherence, and facilitating referrals.
Results showed expanding VHW roles could make CVD care more accessible, particularly where travel to clinics was unsafe or unaffordable. This study underscores the urgent need to develop and test community-based strategies to mitigate the growing burden of CVD in conflict-affected Eastern Myanmar. Targeted training and regular supervision of VHWs, coupled with structured systems for referral and follow-up, could enhance continuity of care, adherence to treatment, and community resilience to acute conflict events.
This article relates to R2HC funded study Implementation of a community-led strategy to reduce cardiovascular disease risk among conflict-affected populations in eastern Myanmar