Paradigm conflict: village health volunteers and public health in Thailand

Reformist doctors in Thailand have combined to create a primary health care system in rural areas in which village health volunteers play a major role. Consistent with the WHO whole-of-society approach, these doctors have envisaged a decentralised system that emphasises volunteers as community oriented, self-reliant agents of change. Our ethnographic research in Chiang Mai, Thailand, reveals that these ideals of village health volunteer empowerment have not been realised. Rather, village health volunteers have become entrapped in a hierarchical, top-down health bureaucracy that affords them limited deliberative agency. We argue that this predicament reveals a conflict of paradigms between, on the one hand, an idealised holistic, spiritual dimension of health with village health volunteers as dedicated, self-sacrificing agents of local communities and, on the other hand, the imperatives of state authoritarian interventions in the avian influenza and COVID-19 pandemics, including rigorous public health protocols and epidemiological methods.