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 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.