Front Line Workers
Item
- Title
- Front Line Workers
- Creator
- medico friend circle
- Date
- January 1980
- Description
- Front Line Workers and a few questions which come to our minds. Signed by Luis Barreto. Includes questions to be considered before Jamkhed visit.
- extracted text
-
MEDIC 0
FRIEND
CIRCLE
POs GOPURI, DISTT.WAU)HA(M.S.)
Ref, No.
Date:
January’ 1980
Dear Friend,
We are glad to note you are attending the Medico-Friend
Circle Meet in Jamkhed from the 2Uth to 26th January!1980.
Attached kindly find a little information about the Front
Line Workers and a few questions which come to our minds.
Kindly go through the paper and think over the questions
and possible answers based on your experiences^*© would perhaps
find answers to some of these questions,when we .see Jamkhed.
This little spadework would help to make discussions
more likely and the sharing more useful.
( LUIS BARRETO )
Medic--' Friend Circle
FRONT
LINE
WORKERS
INTRCEUCT ION:
The Health status of hundreds of millions people in the
world is far from satisfactory and in fact unacceptable. More
than half the population does not have the benefit of adequate
health care. There is wide gap between the developed and the deve
loping countries in the level of health and in the resources they
are devoting to the improvement of health, Moreover within indi
vidual countries whatever their levels of development,wide dispari
ties exist between health facilities and health conditions of diff
erent groups of population.
The present medical manpower produced both in the developed
and in the developing countries has been inadequate and more important still,incapable of delivering health care to the people who
need it and in places where it is needed the most.
2.
The World Health Assembly has in its 31st Meeting in 1976
decided that the main social target of governments and W.H. 0 in the
coming decades should be”the at ainment by all citizens of the world,
by the year 2000 of a level of health that will permit them to
lead a socially and economically productive life.'
3-
k.
The Alma-Ata declaration stressed the need to the provide
Primary Health Care. This was to be the key to attaining the
target of health for all bythe year- 2000.
J.
The main people for delivery of primary health care would
be the Front L-jne Workers. It is to be noted however that neither
primary health care nor front line worker, are a new concept. M
best one could say it is a new jargon. But new jargon is not a
bad thing,for it evokes renewed interest. But it is bad,if it
does not take into consideration onr past experiences. It is
based on the sharing of experiences of various countries on utili
sation of front line workers in delivery of primary health care
that this concept has come to be envisaged as one of the main
pillqrs of the National Health Care Delivery System. One must also
note that in India projects like Jamkhed in particular and others
like Mandwa,R.A.H.A.etc. have been utilising front line workers
even before the -Alma-Ata Conference.
6.
The Government of India launched the C.H.W.'s Scheme on
Oct. 2,1977 in an attempt to strengthen the health services at
the grass, roots* and solve the two main problems our countries’
health services has been facing namely:
a) Outreach
b) Active community participation.
7.
Projects in various countries like Bangladesh,Burma,
Thailand,Indonesia,Nepal,Ceylon and India and in some Latin America
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countries have since lo-ng been trying to deliver primary health
care through front line workers known as either village health
workers,community health workers,village health communicators
village health volunteers, village health promoters etc. These
workers are either part-time or full time,paid or unpaid,literate
or illiterate or both, male or female or both etc.
8.
In our country the former government launched the C.H.W.’s
scheme on Oct. 2nd, 1977.. This new rural health policy incidentally
is supposed to reflect the ideological concept and rural bias in the
field of health. By September,1979, it was estimated that 180,000
C.H.W had been trained. The scheme had been extended to 981 PHCs.
The scheme covers all states in India^ Except Kerala,T.N. & Jammu
and Kashmir,Karnataka agreed to the implementation of the scheme
only since April, 1979.
A
that in
"
It is to be noted before we proceed/ 123 blocks(out of 892 blocks
in the tribal areas) PHCs. have yet to be set up.
9 - Front Line Workers in India:
The front line workers in different projects in India are :
a) Village Health Workers in Jamkhed & Mandwa.
b) The village health promoters in Raigarh(RAHA),
c) The Anganwadi workers in the 100 Integrated Child Develop
ment Services Scheme in the various tribal,rural and urban
blocks in different parts of the country.
d) Link workers in the Tea and Coffee Plantation in the South.
§) The Community Health workers in different parts of the
country in our villages, etc.
J
i 0. What is the role of the front line workers in delivery of
primary health care? Different projects have assigned different
roles varying from mainly a role of an informant and an educator,
as in the plantatit v .> to treatment of minor ailments and collection
of data and treatment of malaria,sanitation and health education
as in the case of village health promoters,C.H.W*s etc. In projects
like Jamkhed the VHW's have besides delivery of primary health care,
also been involved in total socio-economic development and in social
change in the community.
a) What according to you should be the role of these front
line workers,taking into consideration in particular the
C.H.W.’s Scheme?
b) Should they involve in activities besides health?
and
11. Criteria^"process of selection:
In Jamkhed the community
is informed about the type of worker required byihe doctor,and *
the social workers and BNMs. and the community select the worker.
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Ip the plantation, the selection is made by the supervisor and
the manager of the tea garden in consultation with the medical officer
and the community.
In the Integrated Child Development Service Scheme,the Block
Development Officer and Child Development Project Officer are the
main selecting authorities. In Raigarh Ambikapur Health Association
the church authorities in collaboration with their social worker
and community select the worker- The CHW’s should ideally be selected
bythe Gram Sabha- but this seldom happens and it is largely the
Panchayat workers and the Medical Officers and other political workers
who eventually select their protegees.
p
a) Which system according to you is better?
Why?
b) Do you have any suggestion as to how the workers could be
selected?
c) Considering C.HoW.’s scheme in particular -how could one en
sure that the right people get selected?
d) What should the sex/caste/economic class/education of the
worker be?
12. TRAINING:
The mode of training differs from place to place.
In lamkhed an initial training in the headquarters for a week
is followed by in service training in the field in their respective
villages and coupled with refresher session they work for a whole
day, where working come to the headquarter every Friday stay and eat
together(this gives them an opportunity to share their problems
and occasionally find solution from each other experiences). This
is followed by another day(8aturday) of review of the weeks1 work,
collection of data and checking of records (done by M.O. and A.N.M,
Social orker),teaching of a new lesson and solving their problems
or rather helping them to find solutions.
Link workers from different gardens come in batches to the
headquarters in Coonoor or to their respective garden hospitals for
weekly training mainly in data collection,sanitation and are also
thought the methods of production and transmission of disease and
treatment of the same by the Medical Advisor or the Medical Officers.
In R.-.H.A. -training is given by social workers and Nurse-Mid
wives in one of the villages for 15 days and followed up with
refresher session for 15 days every 6 months.
The Knganwadi Workers are trained in different institutions
selected for the purpose by the Project staff. They are trained by
doctors, social workers etc. for 3 months. .. Some of them receive in
service training.
...A/-
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The CHW’s are trained by the M.O. ard M.H.W. with occasional
guest lectures at the P.H.C. and some field training.
Most of the projects utilise nudio-visual aids, but much stress
is laid in Jamkhed and plantations and R.k.HA. and some of the PHCs.
Jamkhed utilised locally relevant audio-visual aids.
The methods of training vary from mainly didactic lectures
with not much stress on in service and field training to much stress
on field training and purposeful,problem,solving meetings as in
Jamkhed and Plantations.
a) Who should actually give the training?
b) Are the doctors in our PHC capable of imparting training
to CHW’s.
c) Should these doctors receive a training^themselves?
d) If so, where shou1d they be trained? Bor how long?
e) What type of training should they be given?
*
f) Shoul the PHC-MO’s train their MHW'S to teach the CHW?
g; ) Could Medical colleges involve themselves in training of
the M. 0. + M.H.VPs.
h) What according to you would be the best way of training
the C.H.W.1s.
i) Contents of training,skills imparted to VHW’s and the
level to which they should be trained, Should the training be uniform?
j) What educational methods and principles should be utilised
in training the VHWs.
k) Main training emphasis on professional (health work) skills
or on how to conscicntise people about socio-economic
problems and actions? or Both?
13. a) Should workers he part time/full time?
b) Should they be honorary or paid?
c) If paid, how much? 'W&JJ/Kind?
d) Who should contribute the money and through whom should
the payment be done? O^e who dor payment will effectively
control V.H.W.
1U.
Reactions of community to CHWs. : In projects like Jamkhed,
R.A.H.A.,Mandwa and Plantation majority of people are happy to
have some body to give, them basic health care.
However there is large amount of dissatisfaction with the
government in various parts of the country also in some of the
projects. Some of the reason are:
i) Not a dedicated worker
ii) Not enough knowledge
iii ) Does not give injection iv) Not accepted by the community
v) Helps only the rich and affulent.
What according to yo-u are the main reasons for this?
c
1$.
a) What should he the sex/age of the worker?
b) Could religion/educational status/sex/age affect performance?
c) should socio-economic conditions be a criteria for selection?
Evaluation:
What should be the methods of evaluation of
performance of front line workers?
16.
a) Decrease in morbidity and mortality in the community/vul
nerable groups.
b) Immunisation status of the community
c) Nutritional status of children?
d) ^ocio-economic changes
e) Changes in Knowledge Attitude Practices in the community.
f) Acceptance by the community.
g) On going evaluation/terminal evaluation(for projects)?
h) Decrease B.R..improvement of M.C.H. services?
i) Any other.
j) Who should evaluate? How can the community participate
in evaluation of CHW and in supervision and control of
their workers.
17. BEMUltgUJION:
Workers are most often part-time and are expected
to devote 3-U hours a day per month.
In the I.C.D.8.8. the workers are full-time drawing about
Rs.100/- to Rs. 1^0/- per month.
In most other projects workers are paid Rs.30/- to Rs. 50/per month. The Govt, CHW get Rs. 200/- per month (full time during
their initial training) and Rs. 50/- per month later on after their
initial training.
In R.A.H.A. and Plantations the workers are honorary,
Eva-
luation fif workers in most projects and PHCs, shows that the
workers/higher honorarium.
- want
17. i)What population should each worker cover?
ii) How many villages should he/she cover?
18. Supervision:
a) Should the CHW he responsible to the village?
MHW’s and PHC- M. 0?
Or. the
b) Should village health committees be formed?
c) Should Block Development Officer supervise?
19. a) Should CHW’s shheme be part of the PHC- set up?
b) Should it be independent?
c) What should be the interphase between the District Health
authorities and other development authorities and CHW’s.?
d) What should be the interphase between the C.H.W. and the
community?
- 6 20.
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a) should thc^be refresher training for the workers? How
frequently? For how long?
b) Should avenues for promotion and increment in wages be
worked out for CHW’s? If so how.?
a) How could medical colleges with the new schemes for take
over of 3 PHCs. - take responsibility for the scheme?
b) Could they involve in the training of the workers and :
evaluation of the scheme?
Primary health care envisages the involvement of health
department with various departments like agriculture,social welfare
etc. in development of the community.
22a
a) How could front line workers do this?
b) Are the doctors capable of functioning in unison?with
other development agencies.
^hese are only a few facts about front line workers and a few^
questions to stimulate discussions in view of what we have observed
in Jamkhed which perhaps is one of the best projects today. We
must attempt however to project how some of the things done here,
could be implemented in other pockets and parts of India.
Primary Health Care it has been said, marks the changing
point which a future historian would perhaps call the beginning
of health revolution.
Let us all hope the future historian gets an opportunity
to do this!
Ib/ks.
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