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3. Using too many medicines. Unfortunately, some programs tempt health
workers to overuse medicines by permitting them to make a small profit on the
medicines they sell. This is often the only money the health workers earn for their
services. The temptation to overprescribe can be reduced by allowing health workers
to charge a small fee for services. Medicines can then be sold at cost— with prices
posted. For more discussion on the overuse of medicines, see Chapter 18.
4. Spending too much time on curative medicine. Many Training programs
seek a balance between prevention and treatment. But it often happens that
community health workers spend much more of their time on curative services than
on prevention.
Before protesting this too loudly, we should remember that to be accepted by
the community, health workers must respond to people’s felt needs. And most
people feel a greater need for curative than preventive measures. Only through a
gradual process of education and growing awareness will a community choose
to place as much emphasis on prevention as on cure. The adviser should respect
the community’s wish for curative care. But at the same time he must be ready
to encourage and support increasing emphasis on preventive activities, as people
become aware of the need.
The temptation to put most of their energy into curative medicine will be
stronger if health workers earn money only for their curative work. Ideally, of
course, health should be more rewarding than sickness. Look for ways to have
the health worker’s pay reflect this. For example, in ancient Japan each family
would pay the doctor every month as one as everyone was healthy. But when
someone became ill, his family would stop paying until the doctor healed him.
This kind of arrangement would encourage health workers to work hard on
prevention.
The adviser can help the health worker and
health committee to make specific plans for
carrying out various preventive projects.
Agreeing on goals and careful planning will
help make things happen.
5. Feelings of frustration and need of
support. Feelings of discouragement are
sometimes overwhelming for community
health workers. It is easy for one person to
dream of what is needed to make a community
healthier. But real changes are part of a slow
process that involves all of us.
In addition, village health workers are
usually closer to the people they work with
than are most medical professionals. They
tend to get more personally involved. When
something goes wrong or persons get angry
with them, they are less protected. So they
need plenty of support from their friends
and family, the health committee, and the
program leaders.
The community health worker is less
protected than most doctors, and
therefore needs more support.