Workshop curriculum.

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, control of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

Community Health Workers↗

PubMed2000

Taking public health to the streets: the 1998 Auckland Meningococcal Disease Awareness Program.

Since 1991, New Zealand has experienced a dramatic increase in cases of serogroup B meningococcal disease. Early in 1998, a program was initiated in Auckland to raise awareness among high-risk communities about the early clinical features of meningococcal disease and appropriate action to take. The campaign was conducted largely through door-to-door visiting by Maori and Pacific Islands lay educators, who visited more than 11,000 households and engaged more than 9,000 people in discussion. Significantly greater awareness was found in people visited by lay educators than those not visited. For the first time in 5 years, there were no meningococcal deaths among the target population for the 6 months from the start of the campaign. Home visiting by lay educators is an effective and highly acceptable means of communicating important health information to populations at high risk of meningococcal disease in New Zealand and should be considered for other public health campaigns.

Community Health Workers↗