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Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991.  p. (USAID Contract No. DPE-5969-Z-00-7064-00)Representatives from several nongovernmental organizations visited Uganda in February-March 1991 to help the Control of Diarrheal Disease (CCD) program bolster its ability to advance case management, training, and supervision of health care professionals. Specifically, the team focussed its activities on determining a strategy to create a national level diarrhea training unit (DTU) centered around case management for medical officers, interns and residents, medical students, and nurses. Similarly, it participated in developing a strategy for training traditional healers in diarrhea case management and for inservice training for health inspectors (preventive health workers). The team presented a generic model for a training/support system to the DTU faculty and CDD program manager. The model centered on what needs to be done to ensure that the local clinic health worker manages diarrhea cases properly and instructs mothers effectively to manage diarrhea. Further, in addition to comprehensive case management, content included interpersonal communication at all levels supplemented by supervision and training skills. It encouraged a participatory approach for training. In addition, it strongly encouraged the DTU faculty and CDD program staff to follow up on training activities such as supporting trainees and reinforcing skills learned in the training course. The team met with relevant government, university, and donor representatives to learn more about existing or proposed CDD activities. Further, the CDD program asked team members to assist informally in the surveyor training session for the WHO/CDD Health Facilities Survey. The team also spoke to WHO/CDD staff about its plans and future activities. WHO/CDD was concerned that training in interpersonal skills not weaken the quality of training in diarrhea case management.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.