Kakaire A. Kirunda
4 June 2008
A community-based health service using lay health workers with some basic training can supplement services offered by health clinics by offering a number of basic services within their localities and giving referrals for what they cannot provide.
This is according to findings from a project being implemented by the NGO Family Health International (Uganda) in the districts of Luweero and Nakaseke. The project, which set out to explore the role of lay community health workers, was first piloted in 2004 in Nakasongola District by Save the Children (Canada).
It has now been scaled up to two other districts and is being supported by the Ministry of Health and the United States Agency for International Development (Usaid).
A statement from FHI shows that the project is a model that has been shown to work in family planning services, where community-based distributors (CBDs) have been a common feature, and have been found to offer efficient services and information on contraception.
"Research has shown that, with training, CBD workers can give accurate information about how to use pills and can identify conditions that rule out using pills in some clients. Because they live in the same areas as their clients, they can monitor their clients to ensure compliance," the statement further reveals.
Among other findings from the project is that CBD workers can also demonstrate and dispense condoms and give HIV prevention information. Similarly, "CBDs are also highly acceptable in the communities, as they share the same culture and values. By reaching out into rural communities and isolated neighbourhoods, CBDs can serve to reduce unmet needs for contraception."
However, is the public safe from lay health workers? According to FHI, community-based workers are trained in counselling skills, health screening for injectable users and techniques for safe injections (in the case of family planning clients), and proper waste disposal.
"During the training, they also spend two weeks observing and practicing giving Depo injections in supervised medical settings, after which they begin providing injections on their own. They are also given job aids to assist them in client screening and counseling," say FHI's Dr Angela Akol and Monica Wanjiru in a co authored article on the project.
The duo says the CBDs concept should be replicated on a wide scale as a way of achieving some of the calls made during recent first global forum on human resources for health that was held in Kampala. The forum that ended with the Kampala declaration recommended the promotion of community health workers in national health programs, to alleviate inadequacies caused by staff shortages in the health sector.
Wanjiru adds that with the Uganda project showing that CBD workers can safely and effectively deliver injection-based contraceptives, further strengthens the case for promoting CBD services.
This project is beginning to attract attention from other countries in East Africa seeking to learn how to implement similar activities. Information indicates that in the last one year, two country-delegations (Kenya and Rwanda) have visited Uganda to learn more about the CBD model.
FHI believes that with the right policies and guidelines, appropriately trained community health workers can play a key role in supplementing clinic-based extending some basic health services to areas affected by staff shortage.
RESEARCH FROM UGANDA'S ORGANISATIONS
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