Community-based delivery of childhood health interventions in conflict zones: A case study from Eastern Burma

Multiple interventions with proven efficacy to improve child survival exist, but strategies for their effective delivery in areas of active conflict are lacking. In Eastern Burma, armed conflict has displaced more than 500 000 people, and one in four children dies before the age of five. 80% of these deaths are attributable to malaria, diarrhea, or acute respiratory tract infections.

Baseline evaluations confirmed that only a small percentage of caretakers follow high-impact practices such as handwashing or oral rehydration therapy, and access to zinc, antibiotics, and antimalarials is limited. The Burmese government operates no child health programs in areas of active displacement, and restrictive policies have constrained the humanitarian space available to international organizations. Many villagers must walk several days to reach a clinic, many are subject to repeated relocations, and few will access a hospital.

The Karen Department of Health and Welfare (KDHW) Village Health Worker Program is a task-shifting effort to support experienced community health workers (CHWs) in the training of lay villagers in basic child survival interventions. Through early 2010 the program has trained 15 CHW supervisors and more than 200 VHWs who coordinate health campaigns and deliver basic child survival interventions, following adapted IMCI guidelines. The program uses a village-based leadership structure, performance-based promotions, and a skill-based compensation scale. These elements allow KDHW to reach a highly mobile population and maintain quality of care, and the program provides an instructive case study on child survival programs in areas of active conflict.