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A common argument against preparing health workers adequately in curative care
is that “It would be dangerous! There is just too much material to cover in a short
course.”
This is true if training focuses on making the students memorize a lot of
detailed facts and information. But if training helps them learn basic skills through
role playing and actual practice, it is amazing how quickly they can become
effective in a wide range of curative skills. To develop reliable curative ability,
training needs to focus on 4 areas of learning:
1. Step-by-stop problem solving (scientific method).
2. History taking and physical examination of a sick person.
3. Practice in using a handbook to diagnose, treat, and advise people about
common problems.
4. Learning to recognize one’s own limits, and to judge which problems to refer
to more highly trained workers.
In our experience in Latin America, village health workers can, in 2 months of
practical training, learn to effectively attend 80 to 90% of the sick people they
see. In time, as they gain experience and receive good follow-up training, they can
effectively attend up to 95%. The best health workers learn to work as capably as
most doctors, with less misuse of medicines and more preventive education.
WHAT MAKES EFFECTIVE HEALTH WORKERS?
Whether or not health workers develop the skills and understanding to
help people meet their needs, on their own terms, depends on many factors
• They must be carefully selected, preferably by the community.
• Their instructors must be friendly, identify with the poor and with their
students, and have a good understanding of human nature.
• Training must be carefully and flexibly planned—according to the
needs of the students and their communities.
• Teaching must be appropriate and effective—built around problem
solving and practice.
• Follow-up after the training course must be supportive and reliable.
In Chapters 2 and 3, we have looked at the first three factors on the list
above. In the next chapters, we will look at others.
But first, it is important to get off to a good start.