PLANS FOR A STUDY IN THE METHODOLOGY
OF RURAL HEALTH CARE

 

 

 

Reasons for undertaking the study:

During the last ten years, in piloting a modest primary care program
in the mountains of western Mexico, we have become increasingly convinced
of the importance of a "grass-roots" approach to rural health care. Our
experience in Mexico concurs with recent conclusions of many other
pioneers in rural Health care, that the key to rural health care in
developing countries lies in helping the local people learn to cope -
more effectively with their own health needs. We have found that villagers
with as little as two or three years of primary education can be trained,
in a matter of months, to provide appropriate preventive measures and/or
effective treatment for many of the important health problems. Through
distribution of the villagers* medical handbook, Donde No Hay Doctor
(Where There Is No Doctor }-_now used as a training manual for village
health workers (VHWs) and as a model for similar handbooks in Asia and
Africa--we have been communicating with pioneers of rural health care
programs in many parts of the world. Thus, we have become increasingly
aware of the tremendous need for further study into appropriate methods
of providing villagers with the basic knowledoe and incentive needed
to better their own health. It is to help meet this need that the present
‘study is proposed.

 

 

 

 

 

 

 

Scope of study:

Our intention is to gain first-hand knowledge, in a representative
selection of developing countries, of approaches and methods presently
being used to help members of rural communities--including mothers,
school children, midwives, traditional healers, and VHWs--cope more
effectively with their own health needs. Included will be countries,
areas, Or programs in whichs

1) local, modestly trained health workers play a substantial role
in the health care of their own communities;

2) traditional healers make--or are helped to make--significant
use of Western medical concepts and/or pharmaceuticals;

3) lay members of given communities; are actively involved--or
encouraged to become involved--in curative and/or preventive aspeets
of their health care.

Efforts will be made to observe, gather data upon, and evaluates

1) methods of selecting, training, supervising, providing follow-up
and evaluating the work of village health workers;

2) the range of ability, capacity for primary. decision making,
concern for patients, attention given to preventive and gromotive
aspects of health care, outreach and other factors which influence
the effectiveness of VHWs;

3) the appropriateness and actual use of existing teaching aids,
study guides and work manuals by VHWs and other members of the rural
cammunity3

4) appropriate vs. inappropriate use of Western pharmaceuticals and

medical concepts by 2) VHus, Bb) traditional healers and midwives,
c) the lay public, and d) the local medical profession;
5) the ways in which traditional beliefs, customs and attitudes

toward illness and healing influence the VHii's canception and use

of Western medicine and "scientific method"; and the need to take these
Factors into account both in training and in the development of
teaching materials and work manuals;

6) economic factors, especially: a) earnings of health workers at all
levels, 6) if and how villagers pay for services and medications,

and c) the extent to which the local health program is-~or could
be--economically self-sustaining;

7} ways in which beneficial aspects of traditional and Western-
type medicine are being~-or could be effectively integrated.

Approach to the study:

 

Phase I. Preliminaziess

 

A. So as to build upon rather than duplicate relevant study already
completed, a preliminary survey will be made, through review of
published material and through communication with leading authorities
on rural health care. _

8. Contact will be made with leaders of village-based health
programs in different countries, in order to determine which
programs we might profitably visit and where we would be welcome.

Phase II. Fieldwork:

 

Fieldwork will be low-key and, where possible, data will be gathered
through interviewing and observing the health workers and villagers
themselves. Whereas “hard data" as to the effectiveness of different
health workers on the snecific health problems will be difficult to
obtain in the time allowed, a scheme of guidelines for estimating
effectiveness. is being worked out. Major emphasis in the field study
will be on observation of training methods and materials in actual
use, and an gathering data for the development of more effective
teaching and work manuals. .

Phase IIT. Follow-up: (Uses of the study)

We intend to use. data and insight gained through the fieldwork in the
Following ways:
A. to revise Donde No Hay Doctor, adapting both language and
content for better comprehension and use by villagers in other
countries; .

B. to prepare additional training and work manuals [in Spanish and
English.) Plans includes a handbook for rural mothers on child care,
a health primer for village children, and a villagers’ manual of
simple dentistry;

C. to write a provocative, well-documented account--directed at
medical and lay readers alike--of the role and ocotential of the

village health worker and other members of a rural community in

improving the health of their own peaple;

DO. ta promote an ongoing, productive interchange of ideas, methods
and tools among the pioneers in rural health.