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 identify the functions of VHWs that could improve access and quality of CVD care in conflict-affected areas of Karen State, Myanmar. We conducted 33 key informant interviews with patients, VHWs, clinic staff, ethnic health organization leaders, donors, and non-government organization health experts. A qualitative content analysis was carried out to explore barriers, facilitators, and potential leverage points for improving CVD care in conflict-affected settings. Participants reported that 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. Results showed expanding VHW roles could make CVD care more accessible, particularly where travel to clinics was unsafe or unaffordable. This study underscores the urgent need to develop and test community-based strategies to mitigate the growing burden of CVD in conflict-affected Eastern Myanmar. VHWs have the potential to address CVD care gaps. 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.