Trained Village Health Workers Research Articles

Risk factors for infant mortality in a rural community in Nigeria.

In this prospective community based study, information on births and deaths was collected for five consecutive years (1993-1997) by trained village health workers (VHW) and traditional birth attendants (TBA). The main objective was to identify factors which are associated with infant deaths in a typical rural community in southwestern Nigeria with a current mid-year population of 3,308. Infant mortality rate was found to be 68.2 per 1,000 live births and is lower than the national rate but higher than the regional rate. Neonatal deaths, with a rate of 37.6 per 1,000 live births, accounted for 55.1% of all infant deaths while postneonatal deaths accounted for 44.9% of the deaths. Twelve (44.4%) of all neonatal deaths (27) occurred within 24 h of delivery while 20 (74.1%) of all neonatal deaths occurred in the first week of life and were perinatal deaths. These high perinatal rates indicate that more efficient obstetric and public health services are needed in the community. First birth order and older mothers (> 34 years) at time of death of infant were associated with significantly higher risk for mortality in this village (p = 0.004). Females were twice as likely as males to die in infancy (p = 0.011), a finding which is contrary to what is generally found; there is a need for further studies to exclude gender discrimination in this village. Significantly more neonatal deaths occurred during the rainy season than in the dry season (p = 0.018) suggesting that environmental factors play a role in neonatal deaths. In the neonatal period, the commonest cause of death was due to complications of low birth weight while in the postneonatal period it was due to infection. VHWs and TBAs are good resource persons for obtaining accurate numerical data at the grass-roots level, and the potential of using their services to collect vital but non-existent statistics should be explored. These workers also need to be trained to recognise factors that put infants at risk. Reassessment of preventive strategies already implemented for reducing infant mortality may be required in order to further reduce the infant mortality rate in this community.

Should community-managed drug stores be phased out?

The existence of community-managed drug stores (CDS), operated by trained village health workers under the supervision of health officials, is under threat in the Philippines. This is to determine if there is an association between households' access to medicines and three types of CDS, namely, Botika Binhi (BB), Family Health Management By and For Urban Poor Settlers Pharmacy (FAMUSCY) and Botika ng Barangay (BnB) in selected urban and rural communities in a province where all three types operate. The study design was case-control using structured interviews and observations. A total of 1,710 households or 90% of the total were interviewed, and the medicines at home were inspected. Indicators for the five dimensions of access are affordability, availability, A1 quality, acceptability and appropriateness. The village with the longest-running CDS for each type was selected. There is an association between the presence of any of the three CDS and villagers' perception of affordability of medicines, between FAMUSCY or BnB and availability of unbranded medicines at home as well as perception of counselling provided by prescribers and dispensers to be more than expected. On the contrary, there is an inverse association between the presence of FAMUSCY and availability of herbal plants at home, between BnB and percent of correct uses of medicines at home, and between either FAMUSCY or BnB and perceptions of availability of medicines and quality of services by dispensers at patronized drug outlets. Phasing out CDS should be weighed against the benefit of making medicines affordable at the village level, promoting the use of unbranded medicines and herbal plants with recognised therapeutic value, and keeping the clients informed through drug counselling provided by prescribers and dispensers.

Integrated health programmes.

Over a period of 10 years, a hospital in rural Africa slowly built an integrated primary and secondary health care program to the point where it has more than 40 elements. In its initial stage (1982-84), hospital staff and community participants were trained, the number of mobile clinics was increased, community participation was sought, and health education was emphasized. During 1985-86, 92 village health committees were organized with 70 trained Village Health Workers (VHWs). This led to a rapid increase in vaccination rates, the use of oral rehydration therapy, and training of traditional birth attendants. In 1987-88, 14 VHW were trained to use basic medical kits and distribute medicines. By 1990, 18,000 of the 72,000 outpatient treatments were administered by VHWs. In 1987, the hospital made a community diagnosis and increased the size of its advisory board (which became 60% female). Because the community identified food, water, and poverty as its priorities, the hospital took steps to improve the food supply, the water supply, and the financial position of the women. In 1989-90, the primary health care (PHC) project added the components of family planning, a weaning food production unit, food coupons, food for work, grain banks, a trust fund, literacy classes, health stamps, a mobile malnutrition clinic, subsidized fertilizer and seed, low-cost care for victims of AIDS, new malaria treatment schedules, and a housing association. The PHC program has resulted in a reduction in under-five deaths from the national average of 330/1000 to 145/1000 (other areas have reduced deaths to 270-300/1000. The program is also becoming increasingly cost-effective, costing about 6 pounds per capita over 10 years for a population of 50,000. Country-wide implementation of the PHC program would require only 30% of the present health budget.

Training of Village Health Workers in Tanzania; a Comparison of Two Approaches

The paper compares the costs of training for two groups of Village Health Workers (VHWs) in Tanzania, where the policy of developing a system based on Primary Health Care principles will require the training of more than 16,000 VHWs during the next decade. In the Kilombero District, one group of VHWs was trained according to the guidelines of the National Programme of the Ministry of Health, and another group followed the training programme of the Kilombero Project, based on the Swiss Tropical Institute Field Laboratory. The training scheme of the Kilombero project cost almost 80% less for one VHW, largely because it depended on on-the-spot training by local staff. The results of a first investigation of the efficacy of the training were encouraging; a long-term evaluation is in progress. The curricula for the two programmes also differed; the Kilombero programme had shorter blocks of theory, interspersed with supervised practical work, and introduced curative medicine earlier in the course. The advantage and disadvantages of the two programmes are discussed, not only in terms of cost but also in terms of their efficacy in training VHWs who will be motivated, efficient and accepted by the community.

Primary health: handle with care.

The concept of primary health care is inherently vulnerable. It seems ironic that the very needs that necessitate the proposal of PHC solutions may also inhibit the effective implementation of those solutions. The reasons are numerous. Such villages may have poor cash economies, supervision and supply are more difficult, and workers are more difficult to find. The expectation had been that relative isolation would imply a greater need for health services, and that once offered, acceptance of village health posts would be highest in areas most dependent on them. This would not appear to be so. Community involvement is arguably the most difficult part of PHC to put into effect. Since 1974, the Lardin Gabas Rural Health Program of the Church of the Brethren Mission has been training village health workers from 119 villages in northeastern Nigeria. From 1976, the scheme was introduced, with few modifications, to the central plateau region by the Church of Christ in Nigeria Rural Health Program, in a further 33 villages. The ingenious teaching techniques--using parables and local stories, drama, songs and riddles to convey health messages--have received considerable international exposure in the literature, but little attention has been given to the pratical difficulties experienced in actually establishing and maintaining the program. The purpose of this paper is not to detract from the worth of village health schemes; the teaching methods are both sound and appropriate, the aims are worth pursuing, the need for such services great. However, it is necessary to point out that the primary health care approach, by its very nature, needs to be sensitive to the individual social and cultural situation in which it is to be implemented.

Selecting Alternative Strategies for Community Health Education in Guineaworm Control

Community health education strategies in guineaworm control can be applied at several intervention levels. Community development mobilizes local resources to provide safe water supplies such as wells. Mass education in schools and communities can teach personal protection measures such as filtering water. Training of volunteer community health workers produces front line staff, who by being culturally in tune with the community can demonstrate and promote the use of appropriate prevention and treatment measures. Advocacy assists community members to express their needs to government and ministry decision makers. All of these strategies have been applied in a community health education/primary health care program in Idere, Ibarapa District, Oyo State. Community development for well construction was found to be a long-term strategy that first must overcome problems of village organization and resource location. Mass education, to be effective, must have a simple and acceptable technology to promote. Trained village health workers must overcome traditional beliefs that inhibit use of preventive and treatment measures. Advocacy requires basic political education of community leaders. A variety of health education strategies is needed to address short- and long-term priorities as well as to overcome the different barriers to guineaworm control.

A Health Education Approach to Training Village Health Workers in Nigeria

Health education plays an important role in the primary health care process, particularly in the training of village health workers. Three educational concepts, training based on community felt needs, trainee involvement and social and cultural realism, are essential in designing these programs. These concepts were applied over a three year period in the training of village health caretakers in Idere town of Oyo State, Nigeria. Volunteer village health workers from ten villages were able to bring about changes in knowledge, behaviour and health status of their fellow villagers indicating that the health education approach fostered skill transfer to the communities.