PHM-Exch> Lay or community health workers can improve the health of children (5)

[Claudio Schuftan]

From: massimo serventi ser20 at hotmail.it


Dear All, 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 autoctonous 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 peope 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 emphasing on LHWs and not on them......one day the fashion
will change and their time will be over.


Massimo Serventi
Pediatrician
Khartoum
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