# Effectiveness of Village Health Volunteers/Workers Working as Male-Female Pairs on Women’s Use of Postnatal Care Services in Sepone District in Lao People’s Democratic Republic: A Protocol for a Quasi-experimental Cluster Study

## TL;DR

This study will test if pairing male and female health workers improves women's use of postnatal care in rural Laos.

## Contribution

The study introduces a novel approach of using male-female health worker pairs to address gender norms and improve postnatal care uptake.

## Key findings

- A 10% increase in postnatal care visits is expected in intervention villages.
- Improved trust and husband support are anticipated outcomes of the pairing strategy.

## Abstract

Background: Despite substantial improvements in antenatal care and skilled birth attendance coverage, postpartum service uptake lags in the Lao People's Democratic Republic (Lao PDR). The 2019 Lao Primary Health Care Policy emphasizes the importance of village health volunteers/workers (VHVs/VHWs) working as groups or pairs to promote primary care services, including obstetric care. However, little is known about whether or how the pairing of male and female VHVs/VHWs may encourage better uptake of postpartum care in communities with solid gender norms.

Objective: Therefore, the study aims to assess the effectiveness of male-female VHVs/VHWs working in pairs on women's uptake of facility-based follow-up PNC visits in rural Sepone, Lao PDR.

Methods: A quasi-experimental cluster study will be conducted between July 2024 and October 2026 in 37 selected sites from two districts in the southern Lao PDR. In 19 selected intervention villages in the Sepone district, trained female-male VHVs/VHWs pairs will promote postpartum services, whereas in 18 similar control villages in the Vilabuly district, VHVs/VHWs will implement standard activities for obstetric care promotion. The study obtained ethical approvals from the University of the Ryukyus and the Lao Tropical and Public Health Institute.

Data analysis: Difference-in-difference analyses will be conducted to estimate service coverage pre-post intervention changes in study sites. Then, using mixed-effect binary logistic regressions, we will assess the association between pairing VHVW/s and facility-based follow-up PNC use, which will be adjusted for other covariates and time effects. Finally, we will analyze the context of pairing VHVs/VHWs implementation using coded transcripts of interviews and focus group discussions.

Results: At the end of the study period, we anticipate at least a 10% increase in follow-up PNC visits at intervention sites compared to control sites. The improvement is expected to result from improved mothers' trust and satisfaction with VHVs/VHWs, and enhanced husband support.

Conclusion: The findings of this study will guide the Lao government's strategy to involve both male and female VHVs/VHWs in primary healthcare according to the 2019 Primary Health Care Policy.