Volunteers who work: the community health care project in burma

The Community Health Care Project in Burma stimulates villager involvement in health issues and, simultaneously, extends the coverage of the government health services beyond existing subcenters, down to the village level. The Project, which began in 1977, is based on two voluntary part-time workers-a Community Health Worker (CHW) and an Auxiliary Midwife (AMW). CHWs have substantial curative as well as preventive and promotive responsibilities. AMWs are expected to perform deliveries as well as give pre-natal and post-natal advice. Village People's Councils select the CHWs and AMWs, develop drug resupply schemes, hold and spend funds, and participate in motivational campaigns. The majority of the volunteers in this national-scale program continue to perform their tasks several years after their initial training.Many similar programs, following an initial period of enthusiasm, have failed-or have succeeded only if their scale is kept small. Why is this program continuing to operate? Buddhism and other aspects of Burmese culture, the strong political support for voluntarism, the substantial quantity and power of community involvement vis-a-vis the voluntary workers, the large amount of supervision and an emphasis on drugs and deliveries appear to be the major reasons.