The Role of Community Health Workers in the Management of Essential Drugs

Abstract

The ability to provide essential drugs not only fulfills part of the primary health care (PHC) duties of the community health worker (CHW), but also helps legitimize the role of the CHW in the community. Essential drugs are often routed through relatively inefficient government structures before reaching the CHW, thus creating problems of regular supplies and timely distribution. Few examples are said to exist where CHWs take charge of essential drug programs to the fullest: planning, purchasing, and maintaining their own stocks. An association of CHWs in Idere Nigeria has been doing just that since 1986-87. Self-assessment of this scheme was stimulated by several factors including rising wholesale prices and subsequent community member reluctance to pay for medicines. In addition, the local government had begun its own CHW training in line with national PHC guidelines and priorities. It became possible to examine the two systems side by side. The main variable used to determine system functioning was whether CHWs had replenished their village drug box stocks in the previous year. Among five factors tested, group (Idere CHW association member or local government trainee) sex, age, residence (town or hamlet), and perceived willingness to pay by villagers, only group was shown to be significantly associated with stock replenishment purchases. Most (63%) of the independent Idere group had replenished their stocks compared to 35 percent of local government CHWs. Cultural factors such as elders' predisposition to provide free service to those in need were also identified. The Idere association used this information to suggest ways of improving supervision, support, and purchasing so as to strengthen their service to the community.