The village health worker programme in primary health care in the Maseru health service area: a case study

English: Health in Lesotho is similar to many developing countries, where health care facilities are poor. The delivery of health care services is especially poor in the rural villages. The aim of this study was to find out whether the implementation of the Village Health Worker Programme has improved the provision of health care services and the health status in the Maseru Health Service Area. The Village Health Workers' support in the villages and the problems, which may have resulted in poor delivery of services, were also investigated. In the empirical phase a qualitative survey was undertaken using Focus Group Discussions for three categories of respondents, namely the trainers, Village Health Workers (VHWs) and villagers. The interviews in the villages were arranged with the consent of the chiefs in Ha Foso and Ha Thamae. The interviews with the respondents were conducted in English and Sesotho. The reason was that the respondents in the villages could only communicate in Sesotho, while the VHW staff was proficient in English. The following factors can be highlighted regarding the Village Health Worker Programme in the Maseru Health Service Area: + Firstly, the greater percentage of Lesotho's population resides in the rural villages. The findings of this study reveal that many people in these villages are old, poor and unemployed. This situation results in poor health status in the villages. + Secondly, the delivery of health care services in the villages is poor. The researcher found that where the Programme was implemented properly, it was accepted and supported by the communities involved for example Ha Foso. Here the Programme also managed to improve the delivery of health care services, which resulted in a good health status within the community. On the other hand, the opposite was found in the villages that did not support the Programme, for example in Ha Thamae. Thirdly, the problems in the VHW Programme have affected its implementation in the villages. The respondents asserted that if the aim of the Government is to improve health in the villages, incentives to the VHWs must be a priority. In the light of the data obtained from the .literature study and from the respondents, one may conclude that unless the structure and policies of the VHW Programme are changed to suit the interests of all the people involved, it has no future in the Maseru HSA.