RESUMO
Primary Health Care programs should not stop with the training of PHWs. Not only do these village-based workers need regular supervision; they also need continual access to the resources required for them to carry out their duties. Formal health agencies have had difficulties in meeting these demands for supervision and management on the scale required to bring health to all in even the remotest hamlet. There is consequently a need to look for ways that a community can manage its own PHC program. Efforts to develop a PHW Association in Idere, Nigeria, have shown that self-management is a realistic goal. They have also shown the need for health educators to focus on organizational and leadership development as part of their contribution to primary health care.
RESUMO
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.
RESUMO
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.
RESUMO
Health education has been advocated as a major foundation for primary health care. However, the value of this approach is yet to be fully proven. An experimental PHC programme in ten Nigerian farm hamlets using methods such as community organization, participatory training and village meetings, put health education to the test. Significant short term improvements in community health knowledge resulted after training of a village health worker from each hamlet. Positive intermediate results in water sanitation behaviours were later observed. Three years after initial intervention, long term health outcomes included the reduction in prevalence of guinea worm, a locally endemic water borne disease. The programme also encountered certain organizational and technological issues. For example, integration with existing health care systems and local well construction capabilities surfaced as problems. Consequently efforts are currently underway to expand research into these areas.
