Community health workers in national programmes : just another pair of hands?

Abstract

Community health worker programmes have be-. come a prominent feature of many primary health are schemes in developing countries. This paper, which is based on a larger collaborative study undertaken in 3 countries, focuses on the experiences with such workers in Botswana, and concludes that many of the key issues that were higl&hted in the Botswana study are similar to those in other countries. These can be summarized under four headings: unrealistic expectations, poor initial planning, prob-lems of sustainability, and the difKculty of maintain-ing quality of care. The future success of these workers will depend on their being integrated more systematically into local services, with concomitant strengthening of management support and supervi-sion.