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  1. 1

    WHO guideline on health policy and system support to optimize community health worker programmes.

    World Health Organization [WHO]

    Geneva, Switzerland, World Health Organization [WHO], 2018. 116 p.

    The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities. The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs. Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.
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  2. 2

    Community participation in family planning: some suggestions for organisation development and management change.

    Askew I; Lenton C

    London, England, International Planned Parenthood Federation, 1987. [2], 36 p. (Occasional Series on Community Participation)

    Community participation in a family planning program implies a partnership between the people served and the family planning association (FPA). That partnership requires the people themselves to participate in identifying their needs as well as assuming responsibility for planning, managing and controlling the actions to meet those needs. The FPA is particularly well suited to manage a community participation program because the FPA is concerned with the problems of individuals, works routinely at the community level, and is organized to serve small communities. If an FPA is to manage a community participation program, it must itself be organized as a hybrid structure, somewhere between a centralized, hierarchical, "mechanistic" structure and a decentralized, flexible, "organic" structure. At the local level the structure is organic and must include a team from the community's organizational structure, a team from the FPA which includes the community Worker, and a team responsible for seeing that the needs assessed by the community team are met by the resources of the FPA. At the central level the FPA must retain a hierarchical, mechanistic structure, but it should be oriented toward serving the needs of the local units rather than determining how they operate. The local and central levels can be linked by a "linking-pin" arrangement, in which at every level, from the community organization, through the community development workers, the block supervisors, the field supervisors, and the project manager, there is 1 person from the next lower level. The management style appropriate to management of a community participation project may be described as "humanistic-democratic-participative" (HDP). Decisions are made by consensus; information flows evenly up and down; and staff activities are coordinated by teamwork. Overall responsibility for the project rests with the project manager, who must be a flexible, creative leader, willing to make mistakes and learn from them. In some cases, where the manager has been trained in standard hierarchical management technics, it is necessary to "convert" him to HDP-type philosophy by a process known as "organization development." In the HDP philosophy of management, supervision is achieved by the use of "socialized power," where the manager exchanges his trust in the staff for their acceptance of his authority. In addition to participatory supervision, the project manager must be able to think "synthetically," i.e., to improvise and innovate and be able to confront uncertainty and solve problems as they arise. The field staff, whatever else their duties may be, must function as an interface between the community and the FPA. They are an integral element in the support system provided by the FPA to the community in that they function as a supervisory system for coordinating the work of the community level teams, and as a supply system for providing resources and technical assistance. They must have the responsibility for making decisions, and their personality and attitude is at least as important as their technical skills. The community workers form the front line of primary health care. Their work includes service delivery, referral, education, community organization, resource procurement, record keeping and data collection, and demonstrating innovations. They may be full or part-time, paid or voluntary, although a joint payment from the community and the FPA would seem to be best in terms of community respect. The training of the community worker is one of the most tangible ways of empowering the community by giving it a participatory role in the program.
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  3. 3

    Report on the evaluation of UNFPA assistance to the civil registration demonstration project in Kenya: project KEN/79/P04.

    Kannisto V; Makannah TJ; Mehta DC; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. xi, 36 p.

    Kenya established a compulsory vital statistics and civil registration system in 1963 and it was extended nationwide in phases until it covered the whole country by 1971. Serious under-registration of births and deaths however, has persisted. In order to improve registration coverage, the government submitted a proposal to UNFPA to support experimentation with ways to promote registration in some model areas. The original project document included 4 immediate objectives: the strengthening of the civil registration system in the model areas including the creation of a new organizational structure, the training of project personnel and the decentralization of registration activities; the improvement of methods and procedures of registration through experimentation; the collection of reliable vital statistics in the model areas; and, the establishment of a public awareness program on the need for civil registration to ensure the continuation and extension of the new system. Of the 4 objectives of the project, 2 have been achieved--the strengthening of civil registration in the model areas and the improvement of methods and procedures of registration. The major deficiency during the project period was the lack of required staff in the field. The primary feature which distinguishes the project is that traditional birth attendants and village elders become key persons at the village level and act as registration informants after receiving training. The strong points of the project are the high quality of technical assistance provided by the executing agency, the close collaboration among various government departments, and the choice of project strategy and model area. Recommendations have been made to correct the problems of a lack of key personnel at the head office and in the field, and the expansion of registration to new areas before consolidation was completed in the old areas.
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  4. 4

    A midterm evaluation report of the rural health system project of the Ministry of Health, Guyana.

    Carlson D; Hamilton M

    [Unpublished] 1984. v, 37, [60] p.

    This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
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  5. 5

    Training of health personnel for implementation of ORT program.

    Pal SC

    [Unpublished] 1983. Presented at the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C. 3 p.

    Training of health services personnel at all levels and education of both mothers and community members should be an essential and integral part of the Diarrheal Diseases Control Program. Experience demonstrates that mere distribution of oral rehydration solution (ORS) in the community fails to bring about its proper utilization. The National Institute of Cholera and Enteric Diseases (NICED) in Calcutta monitors training of health personnel at all levels in connection with the National CDD Program of India. Since 1980, 37 2-day national seminars on OR therapy (ORT) were organized by NICED with assistance of the World Health Organization (WHO). Thus far 1754 medical personnel were trained, including 1196 clinicians, 174 public health doctors, 259 health administrators, and 125 of various other categories. The training program was evaluated by WHO in 1982. Wherever training was conducted, there was a significant increase in the proportion of diarrhea cases treated with ORS. Also observed was a downward mortality trend. It is proposed to organize about 400 district level training courses to train the primary health center (PHC) doctors during 1983-84. As a WHO-collaborating Center for Research and Training in Diarrheal Diseases, NICED has conducted 6 intercountry/interregional courses on the different aspects relating to the CDD Program. 92 scientists from 11 countries have been trained. A key question is who to train first if the resources are scarce. Since the community health worker will have to play the pivotal role in home delivery of ORT, they have to be trained by the doctors in charge of PHCs. Thus, the doctors at the different levels of the health care delivery system will have to be trained first. If the decision is made to implement salt/sugar mixture at the house level rather than packets of ORS, the training of the community health workers will have to be geared and designed in such a way that they will be in a position to educate the mothers to prepare the homemade mixture properly. Training should be an integral part of a broad PHC training program. Doctors will be the best trainers because of the clinical nature of the training involved. To improve the training components of the ORT program, the following steps need to be taken: motivation of the national CDD program managers to undertake the training program, preparation of curriculum and teaching aids for the trainers at different levels, establishment of clinical demonstration centers, and provision of adequate funds for training.
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