Wednesday, April 22, 2015

Volunteers crucial to health delivery in remote Cambodian provinces

By Pauline Yongeun Ahn

© UNICEF Cambodia/2015/Martina Tomassini
Pel Nean (26 years old, pictured with her baby) is a Village Health Support Group volunteer in the remote Koh Nhek district of Mondulkiri province, northeast Cambodia.

MONDULKIRI, Cambodia, 24 February 2015  In counselling women during and after pregnancy, village health support group volunteer Pel Nean plays a vital role in bridging the knowledge, resource, and transport gaps in the community, and in connecting the community with the health system.

When a mother in the remote Poutert village in Mondulkiri province had long passed her expected delivery date, it was Nean that she called, and who took her to the health centre for a check-up. The mother gave birth to a healthy son after an induced birth.  Mothers living in sparsely populated villages as these feel that without Nean they would not have had the proper knowledge, nor the resources, to get to the health centre.

“In this remote village of Mondulkiri Province, it strains me to go from one house to the next on my motorbike, trying to convince mothers to simply ask for medical help. Things have improved, though. More mothers now know how to recognize danger signs and seek my help for referrals,” says Nean.

Nean is one of the two health volunteers in the Koh Nhek District of Mondulkiri Province and, as a mother of two children herself, she is passionate about supporting mothers in the village and teaching them how to recognize danger signs and seek healthcare for themselves and their young children.

Mondulkiri is a remote province in the northeast of Cambodia and is predominantly inhabited by the Phnong ethnic minority. From the capital, Phnom Penh, it takes about six hours on the recently paved road and another hour on bumpy unpaved road to the closest houses.

A snapshot of an average family in Mondulkiri is a couple with five children, tending a small rice field which produces just enough food for their subsistence with a little extra to sell in the local market. When the mother is pregnant, she usually consults her neighbours and relatives who will in turn advise her to visit the traditional birth attendant with any queries related to pregnancy and delivery.

Village Health Support Groups (VHSG) are part of a health behavior change communication initiative supported by UNICEF and the European Union (EU), with funding support from the Korea International Cooperation Agency, KOICA. On average, each village has one or two village health support volunteers to look after 100 households or more. They are elected by their community members with responsibility for educating and training village members on basic health care and making referrals to available health services and facilities.

Volunteers not only are destitute themselves but also struggle in their day to day work. Multiple jobs, farms in faraway areas and migration to urban centres prevent many mothers from regularly attending community training events and receiving consistent monitoring, but these challenges do not deter VSHG volunteers.

“Even if it means paying for my own fuel to transport mothers on dusty roads, as long as I am saving lives, I’ll continue my work in the village. Seeing visible behavioral changes in them is what keeps me going as a volunteer,” says Nean.

How to motivate health volunteers without hurting the spirit of volunteerism?

UNICEF periodically invites volunteers for practical trainings on preventive care and health promotion in the communities. In the interim, practical community-based support schemes are not entirely out of reach. Communes can facilitate the management of a pulled community fund to support volunteers with transportation from and to households for regular home visits and referrals. Alternative transportation methods such as durable motorbikes can be purchased and distributed to sparsely populated areas in homes with capable drivers to assist volunteers in case of emergency. Ultimately, we need solutions that stem from the community itself and are managed with the spirit of volunteerism.

The web of health services in Mondulkiri is severely fragile due to its geographical context; slowly yet faithfully village health volunteers are precariously weaving the web. Their efforts ought to be rewarded and supported through a multi-pronged approach from communes, health centers, and villages backed up with appropriate policy and legal frameworks.

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