2-3
Another problem: Sometimes villagers select a person who is very young,
inexperienced, or irresponsible. This may be because people feel that “study is for
the young.” Also, older persons frequently have too many other responsibilities.
Part of the reason for poor choice of health workers, however, is that often
the selection is made in a hurry, without enough critical discussion. Somebody
suggests a friend, or someone he likes. Someone else suggests another friend, and
a vote is taken. More often than not, the winner is the person for whom the first
show of hands is called.
Still another problem: Many programs find that health workers with more than
a primary school education are likely to leave their villages for better-paying jobs in
the cities.
To avoid these and other problems, some community-based programs in the
Philippines do not accept the following persons for health worker training:
• close relatives of village leaders or officials
• young people and those likely to marry soon
• those with more than a primary school education
• those with many other responsibilities or official positions
In a similar way, a health program in Iran decided to exclude from health worker
selection, family members of any village authority or large landholder. After this
decision was made, villagers chose health workers who were more representative
of the poor and more concerned with their needs.
Ways to help communities select wisely
Rather than deciding for the community what kinds of persons it should or should
not select, it is often better to help the community decide wisely for itself. But this
takes time and care.
For example, instructors from the villager-run health program in Ajoya, Mexico
ride on muleback to mountain villages, spending a few days in each. Often they will
make several visits, getting to
know the people better. Then an
all-village meeting is held. Women
and children are encouraged to
attend (instead of only men, as
is customary). The instructors try
to get an active discussion going:
What are our health needs?
Do we need our own health
worker? What qualities should
this person have? As the people
make suggestions, these are
written on large sheets of paper or a
blackboard, and discussed further.