Paper short abstract:

Community engagement in Lao PDR effectively utilises participatory and anthropology-based methods to empower locally-driven planning for COVID-19 responses and essential healthcare. Shifting the national public health approach from unidirectional to inclusivity involves challenges and negotiations.

Paper long abstract:

Worldwide, the COVID-19 pandemic has placed public health high on national agendas whilst highlighting that this sector alone cannot be responsible for ‘health’. This is particularly apparent in Lao PDR, where an under-resourced, inconsistent and aid-dependent state healthcare and governance system serving a diverse and dispersed population creates challenges for sustainable and locally-driven action. However, Lao implementors are aware that the key to mitigating impacts of COVID-19 lies not in top-down directives but the active engagement of communities in decision-making through increased trust. Shifting away from these habitual patterns therefore requires a change in approach.

A community engagement initiative (CONNECT) designed by WHO and the Lao PDR Ministry of Health combines ethnographic and participatory methods to explore community perspectives and capacities, leading to concrete plans for COVID-19 responses and essential healthcare. Activities such as “Orange Tree” have practical and symbolic value in building and representing agency and relationships. This paper dissects the impacts, reactions and shifts in perspective among community members, health staff and local authorities, arguing this approach is effective in empowering context-specific actions requiring minimal resources and breaking the user-service provider dichotomy.

However, for sustainability, this approach must become institutionalised and requires collaboration across sectors and disciplines. From an anthropological perspective, this also poses dilemmas and necessitates compromise and negotiations. Can a non-homogenous ‘community’ be inclusively represented and their real priorities reflected in a plan which also answers specific public health outcomes? Are government staff able to step outside their hierarchy and re-position themselves as facilitators and listeners?