It is a misty morning in a small village nestled in the mountains and surrounded by lush rice fields in Xieng Khouang Province, in Lao People’s Democratic Republic. Outside a primary school, a game of “get the pen in the bottle” is taking place – the players are not schoolchildren, but a group of villagers and health centre staff. The game ends with everyone falling on the ground laughing. The participants are then asked to stand in a circle and reflect on what this experience showed them. One woman steps forward.
“To me, it means that if we work together and turn our faces towards each other we can achieve our goals. But if we turn our backs to each other or just one person works alone, it will be difficult to do anything,” she says.
Workshop participants play the “pen in bottle” game to practise good teamwork. ©WHO/Thidalat Phanthavong
COVID-19 poses significant challenges for families in this community, as in many across the country – both in maintaining their health and negotiating the socio-economic hardships caused by lockdown restrictions and quarantine. Poor relationships between villagers and health services, and lack of local ownership over decision-making can mean both communities and local authorities struggle to take action.
“COVID-19 has highlighted the need for sectors to work together with local authorities and community to tackle health crises,” says Dr Jun Gao, World Health Organization Officer-in-Charge to Lao PDR.
To address these issues, the CONNECT initiative (Community Network Engagement for Essential Healthcare and COVID-19 Responses through Trust) was created by a coalition of government partners, with the support of WHO, to empower local ownership of health through a sequence of participatory workshops which target different levels of governance beyond the health sector.
Dr Shogo Kubota, technical lead of the reproductive, maternal and child health unit at WHO Lao PDR, explains that the CONNECT initiative aims to build relationships and trust between the community and health providers by creating a safe space for mutual understanding and learning. This becomes the basis for collaborative efforts to sustainably improve community health through better healthcare quality and increased service uptake, and for collective COVID-19 responses at community level.
Participants and facilitators give the workshop the thumbs-up. ©WHO/Elizabeth Elliott
Key to the CONNECT initiative is a two or three-day community engagement workshop with exercises which encourage people to develop teamwork skills and understand what links them together. Importantly, the games create a positive atmosphere which helps participants to reflect on the existing strengths of the community and find new ways to relate to each other.
Workshop participants collaborate to build a “tower of good health”. ©WHO/Thidalat Phanthavong
Community members and health centre staff draw maps of the village’s needs and capacities. ©WHO/Elizabeth Elliott
One method used to bring out the community’s needs and capacities is community mapping, which encourages lively participation and debate about how and why people use healthcare. A village health volunteer, known as Mrs Siamphone, also assists women to give birth. When walking around the village with the health centre staff, she shares her knowledge of the challenges pregnant women experience in the area in accessing essential healthcare and delivering in safe conditions.
A health volunteer and birth attendant shows the houses of pregnant women while walking through the village. ©WHO/Elizabeth Elliott
During the pandemic, community cooperation is especially important.
Dr Kubota explains that trust in the health system is important for surveillance and reporting, and a sense of unity must be developed in order to provide psycho-social support and prevent infections in the community.
Role plays and action scenarios help participants to understand the dilemmas people face and to realistically make plans.
“Grandfather Nor”, a village representative, says: “In a scenario with a suspected COVID-19 case, we thought about how we should help him. In order not to spread the virus, he should isolate at home. The village committee have to work as a team to support him and his family.”
Exercises help community members to reflect on their motivations and barriers to using essential health services and responding to COVID-19. ©WHO/Elizabeth Elliott
At the end of the workshop, the community and health centre produce a joint action plan in the form of an “orange tree” which is presented to the district and then displayed on the walls of community spaces together with maps and information. The whole village is asked to give input, especially those most in need of essential healthcare such as women who are pregnant or have young children.
Joint action plans in the form of an “orange tree” and community maps are pinned to a wall. ©WHO/Elizabeth Elliott
Pregnant women and mothers of young children review the action plan and share their ideas. ©WHO/Elizabeth Elliott
The impacts of this community planning are immediately felt after the workshop.
One farmer who had taken part in the workshop describes his family’s experience of home quarantine after coming into contact with a COVID-19 case.
“We are overwhelmed by offers of support from the village and local authorities – we have received food, water and other household essentials. Actually, we have enough rice already but they keep bringing more! I feel that this is really a good test of what we have learned from the workshop.”
In another village, health centre staff excitedly share photos of two babies born on the same day. Previously their mothers had given birth at home rather than the health centre – a change that may have been brought on by stronger relationships with the community.
So far, 12 communities in three provinces have taken part in this workshop, which has been financed by the Korea Foundation for International Healthcare (KOFIH) for development and implementation. Next, Lao PDR Ministries of Health and Home Affairs intend to rollout the CONNECT initiative across the country, including modules on local governance and health centre capacity building.
As Dr Gao suggests, if communities across the country can use this simple, empowering and sustainable solution, the benefits of strengthened health ownership may be felt long beyond the pandemic.
The workshop aims to support people most in need of healthcare to receive good services, for a healthier future for young and old ©WHO/Elizabeth Elliott
To learn more, you can watch the video below:
Article by WHO consultant, Elizabeth Elliott.