HST Update #5

Has the process of developing human resource's been geared towards making Primary Health Care a priority?" This is a question to which the previous edition of HST Update drew attention. We continue the debate by focusing on a cadre of health workers operating at the community level of health care.

The dominant issue is where community-based health care workers will finally be located in our new health system. Opinions vary between two extreme views. On the one hand, protagonists of Community-based Health Programmes (CBHPs) regard these health workers as the pillars of Cif not synonymous with) PHC and as such should be accorded state employee status. These workers, they argue, have proven their capabilities by providing in some instances, the only health care services available in far-flung and neglected rural South Africa. On the other hand, a less audible view rejects these health workers whose services are dismissed as primitive, ineffective and sometimes outright dangerous. The latter group argues that in most instances, communities are often ready to by-pass these workers in pursuit of more mainstream medical care offered by doctors and nurses. Somewhere on the continuum between these extremes is a view that welcomes the involvement of community-based health workers in health service provision while cautioning against expanding an already over-loaded civil service at a potentially exorbitant cost to the country.

We consider these disparate views through the eyes of a health worker from a programme managed by a socio-medical NGO which has been in existence for the past fifteen years. Also, the perceptions of health workers of twO small-scale and one state supported CBHPs are presented. Importantly, a description of typical activities of a Community Health Worker (CHW) and perceptions on the future of these CBHPs are provided through an interview with a CI-lW from one of the oldest state-supported CHW programme in this country. The debate obviously does not end here. We will continue to monitor developments on the future of health workers working at this level and will keep you the reader informed .