10-12
DEALING WITH PROBLEMS
Health workers are as human as any of us. All make honest mistakes, and some
make dishonest mistakes. Although we have emphasized the supportive role
of advisers (or supervisors), they do need to make sure that health workers are
working responsibly and effectively. (Health workers, for their part, need to make
sure that the advisers also meet their responsibilities.)
Many common problems in health work can be solved or avoided if the health
worker, his adviser, and the community plan and work together. When difficulties
arise, it is important to get criticism, suggestions, and cooperation from all parts of
the ‘support system’, including the villagers. Remember that the various parts of
the support system may have conflicting interests.
COMMON DIFFICULTIES AND WAYS TO AVOID THEM:
1. Charging too much for medicines or services. In many programs, at
least a few health workers will try to turn curative care into a profitable business by
charging high prices.
Some health workers are rightfully angry
about criticism on this subject from experts or
professionals. At a conference in Guatemala, one
health worker protested, “So we cheat 25 cents
here or there on a few medicines. Remember, we
are poor! What is 25 cents compared with the value
of the cars, homes, educations, and paid travel
enjoyed ‘honestly’ by those who criticize us?”
In this kind of situation, solutions must be
suggested, chosen, and upheld by all parts of
the support system, including the health workers
themselves- One helpful step is to nail an agreed-
upon price list to the door of the health post.
2. Failure of people to pay the health worker for medicines and services.
Sometimes people do not have money to pay for health care and medicines when
they are sick. In fact, it is the poorest and the hungriest who get sick most often. A
health worker will usually give these persons free medicine rather than see them
suffer, especially if they are relatives or friends. A village clinic among the Paya
Indians in Honduras had to close down because the health workers gave away all
the medicines and had no money to replace them.
Getting people to pay is a common problem in programs that try to be self-
sufficient. However, most persons can afford to pay something, or may be able to
later. The health committee and the program can help determine which people are
unable to pay, and perhaps make special arrangements for them. They can also
remind those who can afford to pay, but have forgotten. Perhaps persons who
are better off can be asked to pay higher rates. One program in Bangladesh uses
a simple insurance plan; each family pays a small amount each month. In Ajoya,
Mexico, the village health team raises vegetables, chickens, and bees to help cover
their expenses. Persons who cannot pay for services are asked to send a family
member to help with the work on these self-sufficiency projects.