Understanding the primary healthcare context in rural South and Southeast Asia: a village profiling study

Abstract

The use of comprehensive village profiles is one way of characterising contextual factors important for the implementation of primary healthcare interventions and service planning in rural areas. However, there are few such data available at the village level in rural South and Southeast Asia. This study aimed to address this gap, as well as compare high-level data from representative under-served and understudied villages across seven sites in five countries (Thailand (n=3), Cambodia, Laos, Myanmar, and Bangladesh). A survey-based approach using key informants supplemented by other relevant information sources was used to collect data from 687 of 707 villages participating in the South and Southeast Asian Community-based Trials Network. Data on four key health and socio-economic indicators (literacy rate, percentage of attended deliveries, percentage of fully-immunised children, and percentage of latrine coverage) as well as access to health services, public utilities, and education were collected and analysed using descriptive statistics. There was considerable variation between sites in terms of health and socio-economic indicators given that the countries are at different stages of development, and also between the three sites in Thailand. Five of the seven sites were highly diverse ethno-culturally and linguistically, and all were reliant on primary health centres as well as village health workers/village malaria workers as the main providers of primary healthcare. These were generally bypassed by severely ill patients in favour of first-level referral hospitals and private sector facilities in towns. While >75% of villages at each site were near to a primary school, educational attainment was generally low. Over 70% of villages at each site had mobile phone coverage and availability of electricity was high (≥65% at all sites bar Myanmar). These results illustrate the wide diversity of villages in rural South and Southeast Asia that need to be considered in public health research and policymaking.