Systems analysis of the village health worker program

The systems analysis focused on five principal activities: diarrhea and malaria treatment; maternal health; nutrition; and water and sanitation. Researchers also studied training, supervision, and drug supply. To complete its analysis, the research team interviewed male and female village health workers (secouristes and matrones), mothers, community key informants, supervisors, and heads of medical centers; they observed diarrhea and malaria treatment, pre- and postnatal consultation, group education sessions, training courses, and supervision encounters. Data were collected in three of Niger"s seven provinces. Ministry of Public Health documents indicate that secouristes are to: advise fellow community residents on nutrition, well maintenance, and water treatment and conservation; provide other health education; treat common illnesses and trauma; manage drugs and supplies; and act as liaison between the village and public health facilities. Matrones are to: educate the public on hygiene, nutrition, and other health matters; detect and monitor pregnancies; assist in normal deliveries and refer abnormal ones; give postnatal care; and provide information on family planning options and fertility problems. However, interviews with knowledgeable observers as well as our own findings indicate that secouristes emphasize curative care, and matrones immediate post-childbirth assistance. Little activity is apparent in prenatal consultation, nutrition, or water and sanitation. The emphases given during training to preventive and educational activities does not evidently correspond with reality. Also, while village health teams officially include two secouristes and two matrones, fewer than half of those observed were fully staffed, and absences were common. In summary, the most important problems with VHW activities are: the high rate of VHW absence or abandonment; low activity levels on the part of many workers; and the long list of assigned tasks, many not adequately performed. (Author abstract)