The "Super VHV (Village Health Volunteer) Community Health Innovator" model may be a new hope for Thailand's healthcare system in remote areas, creating skilled health volunteers who can provide timely patient care, reduce costs, decrease inequality, and sustainably link communities with the healthcare system.

Given the remote location of Omkoi District in Chiang Mai Province, even minor illnesses can become serious issues for villagers who must walk for hours to reach a hospital. This is especially challenging during the rainy season when paths become muddy and difficult to traverse, preventing many from accessing timely medical care. Today, however, the situation is beginning to change as "Super VHVs" have taken on a significant role, becoming a new hope for helping patients in remote areas.

King Mongkut's University of Technology Thonburi (KMUTT), together with the Faculty of Nursing at Rangsit University, the Faculty of Education at Chulalongkorn University, and the Area-Based Development Fund Management Organization (ABDO), along with local public health agency partners, have jointly developed "Super VHV" or "Community Health Innovator" to strengthen the healthcare system in remote and inaccessible areas under the project "Study of Area-Based Mechanisms for Scaling Up Super VHV Development in Remote Areas."

This project aims to build a sustainable health system from the community base using the "Super VHV" concept. It doesn't just focus on enhancing medical skills for village health volunteers but aims to reduce inequality in healthcare access, particularly in remote areas. The project functions as a "bridge" connecting the public health system with communities by building local capacity with knowledge, understanding, and self-care skills to enable timely patient assistance and referral.

Bowornsakdi Phetranon, researcher at the Center for Promotion and Support of the Royal Project Foundation and Royal Initiative Projects at KMUTT and principal investigator, said: "In mountainous areas like Omkoi District, travel is a major barrier to healthcare access. Many patients cannot leave their villages even when seriously ill, while medical personnel cannot reach them. Although VHVs serve as health intermediaries between public health agencies and communities, it's still not enough. We need to empower local people to care for themselves. This is the heart of 'Super VHV.'"

The development began with in-depth analysis of real problems in the area by faculty teams from Rangsit University, who send nursing students for field training in remote villages every year. They discovered two urgent issues: "first aid for everyday accidents" and "maternal and child care," which are linked to local beliefs and culture.

"In the field, we see children with fever wrapped tightly in blankets because parents think they're cold, or pregnant mothers who don't dare eat nutritious food because they fear the baby will grow too large for delivery. These small misunderstandings become life-threatening problems. So we had to start by teaching VHVs to truly understand and be able to explain to villagers, through hands-on practice in the field, not just classroom lectures," Bowornsakdi shared about the project's initial work.

"Super VHV" doesn't use traditional training methods but creates a "learning ecosystem" where VHVs learn by doing. It starts with practical workshops using real equipment, extends to observation in hospital emergency rooms, with mentorship from health center staff supervising initially until they gain confidence and independence. There's ongoing monthly training, connected through LINE groups—simple yet powerful technology that allows Super VHVs to send patient photos for consultation with mentoring teams and researchers anytime. Learning occurs in every location, every time they work, and this speed helps keep community members safer.

In just seven months (October 2023 to April 2024), 30 Super VHVs successfully served as frontline health caregivers. The numbers clearly reflect their achievements: 1,268 treatment services provided, with nearly half addressing respiratory system issues. They also reduced the burden on sub-district health promoting hospitals by continuously monitoring blood pressure and blood sugar levels for 96 at-risk individuals and following up on several bedridden patients. Meanwhile, they helped reduce villagers' expenses by 400,000-900,000 baht by eliminating the need to travel outside for basic services.

Another remarkable aspect is that once Super VHVs gained knowledge and confidence, they didn't stop at helping individual patients but started their own "village health projects," such as a salt reduction program for the elderly using salt meters as communication tools, or teaching proper infant bathing methods to reduce high fever in babies, including physical therapy programs for bedridden elderly using pulley systems to help them walk again.

The project has become a clear example of "bottom-up" problem-solving that starts from understanding the real local context rather than waiting for orders or centralized programs that often don't align with reality. However, this success also reveals several significant challenges, particularly inflexible medical supply disbursement systems and central policies that don't understand local contexts, such as mandating reporting apps in areas without internet signal, along with compensation that doesn't match increased workloads.

"Super VHVs must visit and treat patients, but compensation remains the same as regular VHVs. I'm concerned that workers may burn out without additional motivation," Bowornsakdi said, proposing non-monetary support such as providing solar panels for homes without electricity or scholarships for children of outstanding performers.

Nevertheless, the research team believes this Super VHV model isn't just a solution for northern mountainous areas but can be scaled to remote areas nationwide, ensuring all Thais, especially grassroots communities, have equal opportunities for healthcare. "We believe this model can be scaled nationwide if the bureaucracy is willing to unlock and support grassroots work, because the health of all Thais will improve only when everyone has equal access to care. And the people in these areas are the true answer to a sustainable healthcare system," Bowornsakdi emphasized.