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PubMed1993

Partnership for community health development.

A programme of community health development is reported from two villages in Haiti. It involves close cooperation between a district hospital, a local dispensary, and, most importantly, the inhabitants themselves. The programme is simple, financially realistic, adapted to local conditions, and linked to activities designed to meet basic requirements, such as those of food production and water supply.

Communicable Disease Control↗
PubMed1996

Qualitative assessment of community participation in health promotion activities.

Qualitative assessments of community participation were made at the beginning and end of a two-year project for improving children's health in an Indonesian village. The project directly addressed village health volunteers rather than the population in general, and this largely explained the marked improvements in indicators relating to organization, management and needs which were achieved.

Child↗
PubMed2005

[Dengue control as viewed by agents and the target population in São José do Rio Preto, São Paulo, Brazil].

The aim of this article was to identify daily situations experienced by dengue control agents in their relationship to local residents. A cross-sectional study applied questionnaires among vector control agents, community health workers, and a sample of local women. The answers by the dengue control agents and community health workers were grouped in the categories of work, private life, and community. The women were asked about the relationship with the vector control and community health workers. The difficulties cited in the private and work areas by the vector control agents were different from those reported by community health workers. At the community level they coincided and showed that neither group is adequately prepared to deal with these issues. Of the local women interviewed, 87.0% reported that they were well-informed or very well-informed about dengue, 84.0% stated that the work by the vector control agents and community health workers was always helpful, and 54.0% identified inappropriate visiting hours by vector control agents and community health workers as a difficulty. The study identified the need for a new job profile that would recognize and respect the specificities of the areas where their activities are conducted, integrating the community's socio-environmental issues.

Aedes↗
PubMed1987

Consumption of chloroquine phosphate provided for treatment of malaria by volunteer village health workers in Saradidi, Kenya.

A community-based malaria control programme in Saradidi, Kenya provided chloroquine treatment for malaria in each village beginning in May 1982. Malaria was holoendemic in Saradidi. Treatment was provided by volunteer community health workers chosen and supported by the village. Consumption of the drug and characteristics of persons treated were recorded. Between 1 September 1982 to 31 August 1983, 40,649 treatments with chloroquine were given to village residents. The treatment rate per person in the mid-year population was 1.24. However, at least 41.8% of the mid-year population of 32,650 did not receive a single treatment. Multiple treatments were given to 50.5% of persons treated at least once and 13.4% of 13,879 persons treated at least once received five or more treatments during the year. Consumption patterns were not random: they were higher in females, in persons above 30 years of age and in the area with greater community organization and community participation. There is need to ascertain the reasons why so large a proportion of the population never received a single treatment in this highly malarious area and why adults who should not have had a high frequency of clinical malaria were treated so often. Nonetheless, the results demonstrate that volunteer community health workers can effectively provide treatment for malaria.

Adolescent↗
PubMed1982

Primary health care in the Dominican Republic: a study of health worker effectiveness.

A comparison of the characteristics of the more effective community health workers with those of less effective community health workers in the Dominican Republic revealed no significant differences in mean age, martial status, or educational attainment. Male workers were more efficient in the provision of DPT vaccine than female health workers, but no sex differentials were apparent with regard to the effective provision of family planning services. A higher degree of job satisfaction was apparent on the part of the more effective health workers.

Attitude of Health Personnel↗
PubMed1996

Utilization of health care in an African urban area: results from a household survey in Ouagadougou, Burkina-Faso.

This study analysed the level of utilization of different kinds of health care providers, and its correlates, by people reporting an illness via a household health survey in a representative sample of 547 households (3667 persons) in the city of Ouagadougou, Burkina-Faso in 1989. More than one-fourth of the sample reported suffering from a health care problem in the 2-week period preceding the interview. Self care was the most frequently reported type of care received (55.6%). Bivariate analysis and logistic regression revealed that the principal determinants of the utilization of modern care givers were age, socio-economic level, illness characteristics (type, length, severity), and cost of care and transportation. In particular, we found that: (1) Even though the family remained the main provider of care in case of minor (mild and short) illnesses, it did not prevent modern health facilities from playing their curative role in case of serious illnesses. (2) Residential zone (central versus peripheral zone) was not significantly associated with health care choice, which was contrary to expectation. (3) On the other hand, socio-economic status strongly affected health-seeking behavior. (4) The travel pattern of the ill persons favored health carde facilities in the central zone. Taken together, the results of this study question the role of community health workers in the urban program of community health care which was in the process of being implemented at the time of the study. They suggest that the family, instead of the community health workers, should be seen as the provider of curative care for minor illnesses. Community health workers may have a more effective role in health education than in curative tasks.

Adolescent↗
PubMed2001

Community-directed health (CDH) workers enhance the performance and sustainability of CDH programmes: experience from ivermectin distribution in Uganda.

The performance and 'drop-out' rates of ivermectin (Mectizan) distributors in the Ugandan programme for community-directed treatment with ivermectin (CDTI) were investigated and related to the manner in which the distributors were recruited. Distributors, from randomly selected communities endemic for onchocerciasis in seven of the 10 affected districts, were interviewed. Questionnaires were initially completed for 296 communities (in which ivermectin had been distributed in 1998 but not in 1999) and then extended to another 310 communities (in which ivermectin had been distributed in both study years). Discussions were also held with some other community members, in participatory evaluation meetings (PEM) in 14 communities from four districts. Despite the CDTI being labelled as 'community-directed', the first round of interviews and questionnaires revealed that there were in fact three categories of distributors: 322 (69.4%) of those questioned had been selected by community members and were therefore truly community-directed health workers (CDHW) but 101 (22%) were community-based health workers appointed by the leaders of the local council (CBHW-LC) and 41 (9%) were self-appointed volunteers (CBHW-SA). During 1999, only the CDHW received good community support; they still helped to mobilise and educate their community members and advocate CDTI, and 98% of them agreed that they would distribute ivermectin during the following year. In contrast, many of the CBHW-LC were neither supported nor appreciated by the community members. Presumably in consequence, many of the CBHW-LC did not help to mobilise or educate their community members in 1999, nor did they advocate CDTI. Almost all (95%) of the CBHW-LC said that they would not be available to distribute in the following year, and were therefore regarded as total 'drop-outs' from the CDTI. The CBHW-SA were better supported by community members than were the CBHW-LC, they did more to advocate the CDTI, and 93% reported that they would distribute ivermectin during the following year. The 'drop-out' rates for 1999 were < 2% for the CDHW, 7% for the CBHW-SA, and 95% for the CBHW-LC. The results also indicated that the CBHW-SA were not as reliable as the CDHW. Similar results were obtained from the second round of questionnaires, in which 224 (73%) of the interviewees were CDHW, 57 (18%) were CBHW-LC and 28 (9%) were CBHW-SA. The results of the PEM showed that the CDHW, who mainly came from the same kinship groups as the people who selected them, were likely to achieve higher ivermectin coverage within a week than the other categories of distributors. It is clear that, for the optimum performance and sustainability of the CDTI, the distributors used should be CDHW selected by their own community members.

Adolescent↗
PubMed1985

Decision making and job satisfaction among youth workers in community-based agencies.

Sixty-four counselors and 32 alternative school teachers in 13 grass-roots agencies reported on levels of participation, influence, and competence in making clinical and administrative decisions. The data supported predictions that (a) professionals would report greater decision-making opportunities and abilities than nonprofessionals, and (b) that workers in general would report higher levels of participation, influence, and competence in clinical than in administrative domains, and higher levels of competence than influence in both domains. However, regression analyses testing the effects of the decision-making variables on different aspects of job satisfaction did not support predicted interactions among participation, influence, and competence. Rather, decision-making involvements had positive effects and decision-making abilities had negative effects on worker morale. The discussion high-lights the need for further research to identify the underlying processes involved in the observed relationships.

Adult↗
PubMed1994

[Intervention with community health agents in immunization programs in the gypsy population].

OBJECTIVE: To measure how the vaccination coverage of the Gypsy child population in the Cartuja and Almanjayar quarters evolved throughout a Health Education Intervention using Community Health workers belonging to the Gypsy community. DESIGN: A descriptive study, pre-test/post-test, with no control group. SETTING: Community level. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the Gypsy child population under 14, consisting of 1,073 children, and four Community Health workers. INTERVENTIONS: Health Education for mothers and carers, by means of home visits carried out by four Health workers, previously trained and contracted for this purpose for a year by the Andalusian School of Public Health. MEASUREMENTS AND MAIN RESULTS: We measured the Vaccination Coverage in September 1988 (42.2%) in order to establish the situation both at the start of the intervention in March 1990 (46.2%) and at its end in March 1991 (68.2%). We measured Vaccination Coverage of the different vaccine doses through frequency allocations. CONCLUSIONS: The Health Centre increased Vaccination Coverage by 4% in 18 months. The intervention increased it by 22.2% in 12 months. This demonstrates the intervention's effectiveness and underlines the importance of carrying out this kind of intervention when working with at-risk population groups.

Adolescent↗
PubMed1992

General principles in delegation of maternity functions to community-based health workers.

Following a review of the general principles in delegation of responsibility, the functions to be delegated are presented together with minimal criteria for training to acquire required skills. Problems arising from delegation are reviewed as well as possible solutions which include modification of some standard procedures. It is concluded, drawing from case summaries, that effective delegation needs strong leadership of maternal health teams buttressed with national political, professional, and community support.

Community Health Services↗
PubMed2001

Nutrition education training of health workers and other field staff to support chronically deprived communities.

This paper focuses on the provision of adequate training in nutrition education to health and other community development workers for their improved performance and achievement. The difficulties encountered and special care needed when dealing with low-income, chronically deprived communities are raised. A brief analysis of past and present trends in nutrition education is presented to show the progress made from restricted, authoritative and not very successful proposals to more comprehensive and participatory approaches. The need to train and update regional and field-level personnel on the new approaches, theories and models offered by nutrition education is highlighted, but the scant availability of resources for training activities may be a great limitation for this undertaking. The contribution of educational, social, psychological and communication sciences, as well as marketing, in improving and broadening the performance of health and nutrition education is recognised. Some successful nutrition education projects, implemented in different regions, using various approaches, have managed to improve the nutrition situation of low-income groups and could be used as good examples to be followed. Recommendations for implementing nutrition education projects or activities need to consider some prerequisites, such as good knowledge and analysis of the nutrition situation, careful selection of the strategies and methods, careful planning and implementation, and clear definition of the procedures and instruments for follow-up and evaluation.

Adult↗
PubMed1987

The training process in community-based health care in Saradidi, Kenya.

Community health workers from a community-based health development programme in Saradidi, Kenya, were trained beginning in 1980, using participatory training. Training was considered high priority by the community. The process of training was geared to local problems, perceptions, situations and resources. The content of training was based on perceived health problems in the community and on responsibilities agreed upon by the health workers. Training was done in or near the villages where the participants were living and working. Concrete actions that could be taken to solve local problems were emphasized. The trainers were people who understood local problems, lived in Saradidi and were known to the trainees. Community leaders and members participated in the training as did some community health workers after completing their training. Evaluation indicated significant changes in the trainees' knowledge practices and behaviour.

Community Health Services↗