Open Access Research article

Village health volunteers’ social capital related to their performance in Lao People’s Democratic Republic: a cross-sectional study

Yu Sato110, Tiengkham Pongvongsa2, Daisuke Nonaka7, Sengchanh Kounnavong3, Phetsomphone Nansounthavong5, Kazuhiko Moji16, Panom Phongmany4, Yasuhiko Kamiya1, Miho Sato1 and Jun Kobayashi89*

Author Affiliations

1 Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan

2 Savannakhet Provincial Malaria Station, Savannakhet, Lao People’s Democratic Republic

3 National Institute of Public Health, Vientiane, Lao People’s Democratic Republic

4 Savannakhet Provincial Health Department, Savannakhet, Lao People’s Democratic Republic

5 Sepon District Health Office, Savannakhet, Lao People’s Democratic Republic

6 Research Institute for Humanity and Nature, Kyoto, Japan

7 Department of Parasitology and International Health, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

8 Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan

9 Bureau of International Cooperation, National Center for Global Health and Medicine, Tokyo, Japan

10 Department of Nursing, Faculty of Health and Welfare, Seinan Jo Gakuin University, Fukuoka, Japan

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BMC Health Services Research 2014, 14:123  doi:10.1186/1472-6963-14-123

Published: 12 March 2014



Improving the performance of community health workers (CHWs) is a global issue. The relationship between CHWs and their community may impact their performance. In Lao People’s Democratic Republic (Lao PDR), CHW are called village health volunteers (VHV). Lao PDR has a problem with VHV inactivity, especially in rural areas. This study focused on which aspects of social capital are related to VHV performance.


This research represents a cross-sectional study with a quantitative survey based primarily on interviews using a semi-structured questionnaire. Interviews were conducted with 149 VHVs living and working in the Sepon District. VHV performance evaluation was measured with scores on a 5-point scale, and the cutoff point for designating performance as good or poor was set at the median score. This evaluation of VHV performance was conducted as a self-evaluation by VHVs and by health center staff who were supervisors of the VHVs. Measurement of social capital was accomplished using the short version of the Adapted Social Capital Assessment Tool (SASCAT). For statistical analyses, logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).


The results of multiple logistic regression adjusted by moderator variables showed that citizenship activities in the structural social capital component of SASCAT were significantly related to performance in self-evaluation by VHVs (adjusted OR: 2.10, 95% CI: 1.19-3.71) and the evaluations by health center staff (adjusted OR: 1.67, 95% CI: 1.01-2.77). Support from groups (adjusted OR: 1.87, 95% CI: 1.27-2.76) and cognitive social capital (adjusted OR: 7.48, 95% CI: 2.14-26.10) were found to be significantly associated but only for VHV self-evaluation.


The results suggest that individuals who interact with important figures in the community and who cooperate with other villagers whenever problems arise, i.e., have social capital, exhibit good performance as VHVs. These findings suggest that increasing citizenship activities could increase the retention rate of CHWs and help improve their performance. Citizenship activities could also be used as a predictive indicator when selecting new CHWs.

Community health worker; Social capital; Performance; Lao PDR