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
5 affiliations
- 1Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, United States of America
- 2Department of Emergency Medicine, University of California, Los Angeles, California, United States of America
- 3Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- 4ASEAN Institute for Health Development, Mahidol University, Bangkok, Thailand
- 5Department of Health, Karen Department of Health and Welfare, Karen State, Myanmar
Abstract
Cardiovascular disease (CVD) is the leading cause of death in Myanmar, but care models are lacking to deliver evidence-based treatments to reduce CVD risks in areas of armed conflict. Village health workers (VHWs) play a key role in bridging communities and clinics, but their role in CVD prevention and management in conflict-affected settings has not been clearly defined. This study aimed to describe the system for CVD care and to elicit perspectives on how VHWs might contribute to a village-based care model to overcome structural and behavioral barriers to CVD risk factor control in remote rural areas experiencing active armed conflict in Karen State, Myanmar. We conducted 33 semi-structured key informant interviews with patients, VHWs, clinic staff, ethnic health organization leaders, donors, and non-government organization health experts. Content analysis of participant responses suggested many people were unaware of CVD and its risks, and there were persistent gaps in CVD screening, medication adherence, and referral systems. Transportation costs and hazards, medicine shortages, and security risks made it difficult for patients to visit clinics or achieve continuity of care. 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. Respondents reported that expanding VHW roles could make CVD care more accessible, particularly where travel to clinics was unsafe or unaffordable. Respondents perceived that VHWs have the potential to address CVD care gaps, and that 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.
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BibTeX
@article{htoo2026development,
title = {{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}},
author = {Eindra Htoo and Parveen Parmar and Adam Richards and Tara Russell and Catherine Lee and Saw Sha Kler Law and Saw Kyaw Myint and Zay Yar Phyo Aung and Tom Traill},
journal = {PLOS Global Public Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pgph.0005610},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005610},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Eindra Htoo
AU - Parveen Parmar
AU - Adam Richards
AU - Tara Russell
AU - Catherine Lee
AU - Saw Sha Kler Law
AU - Saw Kyaw Myint
AU - Zay Yar Phyo Aung
AU - Tom Traill
PY - 2026
DA - 2026/11/06
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005610
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005610
AB - Cardiovascular disease (CVD) is the leading cause of death in Myanmar, but care models are lacking to deliver evidence-based treatments to reduce CVD risks in areas of armed conflict. Village health workers (VHWs) play a key role in bridging communities and clinics, but their role in CVD prevention and management in conflict-affected settings has not been clearly defined. This study aimed to describe the system for CVD care and to elicit perspectives on how VHWs might contribute to a village-based care model to overcome structural and behavioral barriers to CVD risk factor control in remote rural areas experiencing active armed conflict in Karen State, Myanmar. We conducted 33 semi-structured key informant interviews with patients, VHWs, clinic staff, ethnic health organization leaders, donors, and non-government organization health experts. Content analysis of participant responses suggested many people were unaware of CVD and its risks, and there were persistent gaps in CVD screening, medication adherence, and referral systems. Transportation costs and hazards, medicine shortages, and security risks made it difficult for patients to visit clinics or achieve continuity of care. 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. Respondents reported that expanding VHW roles could make CVD care more accessible, particularly where travel to clinics was unsafe or unaffordable. Respondents perceived that VHWs have the potential to address CVD care gaps, and that 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.
SN - 2767-3375
ER -