The Health Guide scheme--the Mysore District, India: the community's perspective.

Abstract

In order to make health services more accessible at the village level the State of Karnataka began a Primary Health Care (PHC) Program involving Health Guides (HGs). These are local villagers who are trained in basic health services and who work in their own village. This research was conducted among village community members living in the Mysore District where HGs had been working for 1 year. A total of 240 household members were interviewed using pretested semi-structured survey instruments in 30 selected villages. Results indicate that 70% of the household members surveyed were aware of the HG scheme and 58% said the HG was always or often available to them. According to the official guidelines set down by the State of Karnataka the village community was requested to recommend 2 or 3 persons considered suitable by them to become HG candidates. However survey results indicate that 99.6% had not been involved in the selection process in any way. When asked what the 4 most important functions of the HGs were the household members responded overwhelmingly (98.3%) that the sole function was treating minor ailments. More of the household members surveyed went to the HGs to receive medical services than to any other persons. Of those who made HG contact 52.2% reported that they were very satisfied and 44.4% said they had been partially satisfied by the medical services they had received. The vast majority of the community reported that they felt very little work was being done in the area of prevention (soakage pits sanitary latrines water supply family planning and immunization). But these items were not perceived to be very important and seem to have little impact on the communitys acceptance of the HG scheme and on its further continuation and expansion. A large majority of those interviewed wanted the HGs to visit their homes more often for health-related services. 20% of the community household members said they would be in favor of financing the HG honorarium or the HG drug supply currently provided by the Government of India and the State of Karnataka. Finally 92.1% felt the HG scheme should be continued in their area and 91.7% felt it should be expanded to other areas of the State. Suggestions are offered regarding ways to improve the community participation in this pilot area. Examples include regular home vistis by the HGs to all households using complete up-to-date household surveys; pictorial signs aroung the village area to advertise HG services; spending more time during training sessions on preventive aspects of the HG job and the adequate explanation of the philosophy of the HG scheme with particular stress on the importance of preventive and promotive services. Such steps will ensure relevancy of the programs ensure success of immediate activities and pave the way for long-term changes in the communities themselves.