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Some American Indian health workers in Arizona found it so hard to win the trust
of people in their own villages that they traded jobs with health workers in distant
villages. They found that as ‘outsiders’ they could command more immediate
authority. People were quicker to follow their advice without question.
Similar ‘swaps’ have been made by health workers in several countries. And
some of the larger health programs make it a point not to send health workers to
work in their own communities.
We feel this is a mistake. A stranger to a community, no matter how well he
works, perpetuates dependency on outside help. Only when a health worker is
from the community can his example show “what we people in this village
can do for ourselves.”
WHO SELECTS HEALTH WORKERS AND HOW?
Many programs feel that health workers should not only be from the community
where they work, but that they should also be selected by the community. These
are the reasons:
• If everyone takes part in the selection, chances are greater that the health worker
will be well accepted.
• Participation in the selection process is a step toward greater responsibility and
control by people over factors that affect their health.
• A health worker chosen by the community is more likely to feel that his or her first
responsibility is to the community.
Problems with selection by the community
Problem: In many
villages, the local
headman, mayor, or a
powerful landowner insists
that one of his children or
family members be chosen
as health worker. Even
if a public vote is taken,
the poorer people may be
afraid to suggest or vote
for someone else. As a
result, the health workers
selected may represent
the interests of those with
land and power rather than
those with greatest need.
This is a problem reported
from many countries.