In terms of improving the quality of services delivered by lay health
workers, Nomtuse Mbere of South Africa discusses using technologies
such as mobile phones and telemedicine. In this region doctors and
midwives are in short supply and lay care workers are heavily relied
upon for education and prevention.
In Nepal they employ Female Community Health Volunteers (FCHV) in the
role of lay health workers. Roshani Laxmi Tuitui includes the following
in their role: counseling to mothers, vaccination education,
distribution of Vitamin A, temporary FP methods and counseling on
HIV/AIDS.
Daniel Wibowo of Indonesia adds that in addition to all of the roles of
the lay health workers already discussed in this forum, these workers
are role models for healthy living for others in their communities.
Health cadres in Indonesia do not do interventions, they are used for
education and risk identification.
Kenya, notes Jane Otai, has a pilot project involving training CHWs to
administer Depo Provera. These CHWs are trained in counseling, storage,
injection administration, and disposal of used needles. This pilot
project is using self-nominated community volunteers who are usually
semi-literate but have a high desire to serve their communities.
Chandrakant Lahariya shares some of the history of lay health workers
in India. In the 1970s there was a huge increase in community healthy
workers. This role all but disappeared in the 80’s. Under the National
Rural Health Mission in India a new cadre of lay workers was born.
These workers are called ASHA or Accredited Social Health Activist.
There are now over 700,000 ASHAs working in rural and remote parts of
the country.
Kamlesh Jain of India discusses the use of Rural Medical Assistants.
Kamlesh recommends changing their title to not include the word “rural”
as it belittles their profession and subtly indicates that they are not
good enough for the urban populace. Kamlesh also encourages regular
promotions, salary hikes and continuing education for this cadre.
Jaafar Heikel of Morocco shares a unique examples of using lay persons
in the role of health workers. First, IMAMS – religious individuals who
conduct prayer within the Mosque – were asked to educate the public on
condoms and sexually transmitted infections. This is a place where
discussion of this nature would usually be considered taboo, but due to
the respect for this individual this was a very successful programme.
In Haiti, Adrienne Allison of USA adds that for more than 20 years they
have been successfully using community health workers to deliver
vaccinations and injectable contraception.
Chris Morgan of Australia shares his experiences with lay health
workers in rural Nepal and Tibet. This role is voluntary in these
settings and therefore to be successful this population needs other
motivation such as increase in self worth, increasing their standing in
the community and greater integration into the local health system.