The purpose of this document is to describe the Village Health Volunteers (VHV) system in Thailand in general and also to provide specifics on the system’s role in early warning, surveillance, and rapid response for avian/pandemic influenza. Evaluation information on the added value of VHVs to avian flu (AI) surveillance and response using existing data is included. The document is intended for those who may be interested in involving community/village health volunteers in such initiatives.

VHVs are community members who work in community settings and serve voluntarily as connectors between the community and the health care providers to promote health. In Thailand, the VHVs scheme has been in place for over 30 years and, as stated in the document, serves as the backbone of community-based public health in the country. As of 2007, every village in Thailand had at least one VHV, a total of approximately 750,000 volunteers, each responsible for 5 to 15 households. Groups of VHVs function as a team at village level, often headed by a senior VHV. Since 2004, VHVs have been involved in the early warning system for AI and, as stated here, are playing a key role in the nationwide surveillance for AI. The surveillance, called “X-rays”, assesses the avian influenza situation in the country as a cross-section in time by surveying human and animal health in every single household across the country.

The VHV operating costs are mainly financed by the local government authorities at the provincial and district levels. This includes all VHV expenditures (per diem, transportation, training courses, and educational materials). Other government ministries may also fund training on AI and provide protective equipment, communication materials, and funds for transportation. VHVs, who work voluntarily, are exempt from the annual universal health coverage fee and also have full and free access to health services at the district hospital. Additional incentives depend on the specific district processes and resources available. These may include special quotas for VHV families to apply to government nursing colleges as well as grants for young VHVs to study and return as public health officers. VHVs receive public recognition from the community as well as the formal health sector. VHVs are treated as part of the formal health system, and the district health services use them in the out-patient department at health centres, when there is a surge of work or a personnel shortage. The concept of non-monetary social incentives that are rooted in the socio-cultural values inherent in the community appear to work best, according to the document, in rural settings where the volunteer structure aligns with local tradition.


The document describes VHV recruitment and training, including training for AI detection and prevention. Meetings for training allow those trained at district and sub-district levels to train their local groups. A Ministry of Public Health survey in 2005 indicated that 78.7% of the VHVs were trained in the area of poultry survey, 47.7% on specimen collection, and 69% on patient transfer. The same survey indicated that after the training, most VHVs (85.7%) were active in educating villagers about avian flu, while only 45.9% were involved in specimen collection.

The surveillance system includes over 1,000 Surveillance and Rapid Response Teams (SRRTs), laboratory networking (12 Regional plus one Central), case management and hospital infection control, and risk communications. In addition to the "X-ray" survey of every household, including specimen collection from sick animals, VHVs educate their village families about government standards and policies of compensation and registration for poultry and report through a paper-based form to a primary health officer twice monthly. In case of an emergency, the VHVs use phones or the wireless radio located in every health centre to report to responsible officials. The role of VHVs in the response to AI operations is to assist the operation of SRRTs. When an outbreak occurs, while awaiting the arrival of the SRRTs, the main role of VHVs involves risk communication, i.e., to warn villagers not to touch the infected poultry, to promote hand-washing with soap whenever handling poultry products, and advise/refer them to a hospital if they feel unwell. Once SRRTs arrive, VHVs help to bury the dead poultry and to disinfect the affected areas under the supervision of SRRTs, with appropriate personal protective equipment. VHVs are not directly involved in taking any laboratory samples, nor are they responsible for transferring sick villagers to health facilities.


The document presents an evaluation showing the decreased magnitude of AI cases between the 2003 outbreak and the 2004 outbreak. Three measures were used to attempt to evaluate the impact of VHVs:

1) Number of notifications of influenza-like illness (ILI) or severe pneumonia in humans to health authorities by month of notification over time;

2) Time from onset of ILI or severe pneumonia in humans to notification; and

3) Time from onset to admission to hospital.

These measures show reductions associated with VHV involvement, media alerts, and increased VHV training.

The document concludes that "there are two major factors contributing to success. First, as in any successful health programme, there is a high level of government commitment to and investment in the VHV system that includes continuous capacity building, recognition, membership in a network, and two-way communication. Second, there is good collaboration between the Ministry of Public Health and the Ministry of Agriculture to coordinate surveillance activities in both humans and animals at all levels down to the village level."

Australian Government Department of Agriculture Fisheries & Forestry (DAFF) website.