Working in pairs: male-female village health volunteers supporting maternal health and community engagement in remote and ethnic communities of Lao PDR-a qualitative study.

BACKGROUND: Community health workers (CHWs) are vital for improving maternal and child health (MCH) in underserved settings; however, gender norms often influence their functioning. In the Lao PDR, Village Health Volunteers (VHVs) serve as frontline CHWs in rural areas. Xepon District is a remote border area with Vietnam, characterized by underserved conditions, limited health access, and predominantly ethnic minority populations. The VHV workforce in this district is largely male, which restricts culturally acceptable outreach to women and underscores the need to test a paired male-female model. To address this gender-related limitation, a provincial pilot program introduced male-female VHV/VHW pairs to strengthen MCH outreach. OBJECTIVES: This study aims to explore how the male-female paired VHV model functions in remote ethnic minority communities and its contributions to maternal health promotion. METHODS: A qualitative descriptive study was conducted in 19 pilot villages in Xepon District, Savannakhet Province, from June to October 2024. Semi-structured interviews were held with 42 participants, including mothers, their partners, VHVs, village leaders, health center staff, and district/provincial health officials. Interviews were transcribed, translated, and analyzed using inductive thematic analysis based on Braun and Clarke's six-phase framework. RESULTS: Four key themes emerged: (1) building trust and comfort through gender-matched interactions; (2) gender-specific responsibilities and task sharing between paired VHVs; (3) strengthening family support and health system linkages through female VHV/VHWs engagement; and (4) challenges and support needs for strengthening the VHV Program. Female VHV/VHWs played a crucial role in culturally sensitive maternal outreach, whereas male VHVs facilitated engagement with male household members and community leaders. Paired implementation enhanced service utilization and helped shift household norms. However, challenges persisted, including gender selection barriers, literacy gaps, and limited institutional support for paired training and supervision. CONCLUSION: The male-female VHV/VHWs model may enhance access to MCH services by engaging men and women in complementary roles tailored to local contexts. To maximize its potential, institutional commitment is needed to formalize pair-based training, address gender barriers in recruitment, and strengthen community- and policy-level support systems for CHWs. Given the 2023 PHC policy, embedding gender-sensitive and context-specific approaches into guidelines and training manuals may be critical for aligning service delivery with sociocultural realities and ensuring responsiveness to the unique needs of remote communities.