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[afro-nets] Lay or community health workers can improve the health of children (7)
- From: "Claudio Schuftan" <email@example.com>
- Date: Sun, 11 Apr 2010 14:01:46 +0700
Thanks for your reactions to my provocation* *on 'no
sustainability' of LHW. The few examples of the contrary that I have received are not convincing . Yet the main question is: are the communities supporting the LHWs, in a durable way? and more: is the LHW a human resource that has been wanted and therefore 'employed' by the community?....or is it instead an 'invention' of the experts (we) to make a bridge between the formal health system and the community itself? I have my answer.... Communities have had their autochthonous health practitioners for ever ?the local healers: they are wanted, they are paid for their service, they are fully sustainable.
Let's listen to the people, in rural or urban areas. What they do feel important for their health, for the improvement of their health is not 'somebody that will teach them to wash their hands after defecation'.....but a dispensary, a health center, a hospital where they can get a service, a satisfactory if not a good service. Free from payment when it must be so, free from corruption, constantly stocked with drugs and essential items. A service offered all day long, a delivery carried out at night by a nurse that is motivated enough to receive a pregnant woman with a smile..... This kind of service that people expect (1) from an institution created by the Government (2) to improve their health (3) is weak, too weak --let's be sincere. The flourishing of a private system is there to confirm it. Therefore, the answer is not to form new cadres of health workers, but to improve the performances of those that are already in place.
A nurse, an MCH aid, a midwife, a doctor herself working in the periphery are expected to interact deeply with the community. Ideally, it should be so: there should be hours spent in prescribing drugs *and* hours spent in talking to the leaders about issues of health or sanitation, visiting selected families, conducting campaigns, providing health/nutrition education. If people receive a good service, especially a curative one that they regard as essential, they will be ready and certainly more willing to accept also words of prevention and/or of behavioural change. No need of 'new' LHWs.....the formal, white dressed workers of the dispensary/health center/hospital are the best and most respected LHWs.
The issue is: how to make these employed workers perform better? how to motivate them? By emphasizing on LHWs and not on them......one day the fashion will change and their time will be over.