Oral rehydration and immunization : the role of the rural health promoter [in] Guatemala

The evaluation covers the period through 12/88 and is based on case studies (including written tests administered to promoters) in eight participating rural communities in four health districts. Without exception, field investigators observed good relations between promoters and community members, though the same cannot generally be said for promoters" relations with midwives and district health personnel. Most residents are aware of the promoters" strict resource limitations and are supportive of their efforts. However, promoter training, the focus of the project, has been weak. Formal, full-scale training events were conducted during the past few years in only one of the four health districts evaluated. Promoters who have joined in the interim have only participated in short annual retraining courses, which are focused more on curative than on preventive care and consist primarily of lectures, with little time for hands-on demonstrations or practice. Promoter training manuals are often unavailable, obsolete, or difficult to understand for the majority of promoters, who are not native Spanish speakers and have limited schooling. These shortcomings are reflected by the low level of knowledge of ORT and EPI among promoters. In an ORT test, a sample of 90 promoters achieved a total mean score of 59.4%; only two scored above 80%. Nearly 15% of the promoters did not recognize that diarrhea can lead to dehydration, and a disturbingly high percentage had serious misconceptions of how to prepare packaged ORT mixture. Test scores on EPI were also low, with a total mean score of 67%. Almost half the promoters did not have any conception of vaccination coverage, and nearly one-quarter did not recognize the importance of training for those who participate in immunization activities. About 20% could not identify the six immuno-preventable diseases. The promoters are also constrained by low levels of technical and moral support and supervision from district personnel. Promoters reported that even the most basic equipment, supplies, and medicines would greatly facilitate the execution of their activities. A major recommendation is that, if promoters are to receive continued project support, a larger share of the budget should be allocated to promoter training, supply, and supervision.