Bhutan: Community Action Groups – Building local participation for improvement in public health

Participants at the Asia Pacific Malaria Elimination Network’s Community Engagement for Malaria Elimination Workshop shared their country experiences on community participation.  Below is a summary of experiences shared by participants from Bhutan, which shows how we can integrate malaria activities into broader community development efforts.

dscn5601-sm2.jpgBhutan is a small country of 39,000 km2 with a population of 634,982. It is bordered by large countries – China to the north and India to the south. The northern reaches of the country are in the Himalayas and have high elevation and cooler climates thus there is no malaria transmission in this region (4 districts). The middle section of the country is considered at risk for seasonal transmission (9 districts) and the southern zone bordering India is considered endemic (7 districts).

One of the main community participation methods in public health, including malaria control and elimination, is the formation of Community Action Groups (CAGs). In the rural communities, these groups have been formed at the village level in four southern districts in Bhutan from 2009 to 2011. The CAG initiative aims to create community ownership of health activities, stimulate decentralization of health work to the grassroots level, and to motivate and build capacity for local leadership. CAG members receive a three-day training which covers sanitation, community motivation, nutrition and child care. The training, meeting costs and monitoring of the CAGs are funded by Global Fund.

Members of the CAG are elected by the community:

  • Chairperson (Tshogpa): this representative is paid by the Government for a five year term
  • Secretary: this is a Village Health Worker, who provides the message delivery on preventive and curative services and are involved in LLIN distribution. These workers attend training on communication methods and receive refresher training.
  • Allied sector representative
  • Water caretaker: this person has strong community ties
  • Female representative
  • Religious group member: this is typically a monk

The CAGs discuss priorities and develop a community action plan. The groups meet quarterly with monitoring every six months and reports are sent to block level with feedback going up to the national level.

One CAG has been successful in achieving sanitation improvements. CAGs are also seen as a platform for multi-sector involvement. A challenge of this strategy is the high turnover of village health workers because they are no incentives. In the future, Bhutan hopes to increase the number of districts with CAG groups, but the source of funding is not yet available.

[Thanks to Yeshi Nidup, Tshewang Phuntsho and Cara Smith-Gueye for the presentation and this summary.]

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