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

Abstract

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.

Afrikaans: Gesondheid in Lesotho is in ooreenstemming met dié van talle ander ontwikkelende lande met swak gesondheidsdienste. Gesondheidsdienslewering is by uitstek swak in die landelike gebiede. Die doel van hierdie studie was om vas te stelof die implementering van die Village Health Worker-Program die voorsiening van respondente, naamlik die opleidingsbeamptes, die Village Health Workers (VHWs) en die inwoners van die dorpies. Dié onderhoude is gereël met die toestemming van die stamhoofde in Ha Foso en Ha Thamae. Die onderhoude met die respondente is in beide Engels en Sesotho gevoer, omdat die respondente in die dorpies slegs in Sesotho kon kommunikeer, terwyl die VHW-personeel net Engels magtig is. Die volgende faktore rakende die Village Health Worker-Program in die Maseru Gesondheidsdiensarea kan uitgelig word: • Eerstens, die grootste persentasie van Lesotho se bevolking woon in die landelike dorpies. Die bevindinge van dié studie toon dat talle inwoners van die dorpies oud, arm en werkloos is. Hierdie situasie gee aanleiding tot swak gesondheidstatus in die dorpies. • Tweedens, die gesondheidsorgdienslewering in die dorpies is swak. Die navorser het bevind dat waar die Program behoorlik geïmplementeer is, dit deur die betrokke gemeenskappe aanvaar en ondersteun is. Dit was die geval in Ha Foso. Hier het die Program daarin geslaag om die lewering van gesondheidsorgdienste te verbeter, wat ook 'n positiewe invloed op die gesondheidstatus in die gemeenskap gehad het. Hierteenoor is die teenoorgestelde bevind in die dorpies wat die Program nie ondersteun het nie, byvoorbeeld in Ha Thamae. • Derdens, die probleme in die VHW-Program het die implementering daarvan in die dorpies belemmer. Die respondente het aangevoer dat indien dit 'n doelstelling van die Regering is om gesondheid in die dorpies te verbeter, moet die voordele van die VHWs prioriteit geniet. gesondheidsdienste en die gesondheidstatus In die Maseru Gesondheidsdiensarea verbeter het. Ondersoek is ook ingestel na die ondersteuning van die VHWs en die probleme wat tot swak gesondheidsdienslewering aanleiding kon gee. In die empiriese fase van die studie is In kwalitatiewe ondersoek uitgevoer met behulp van fokusgroepbesprekings met drie kategorieë van In die lig van die data bekom uit die literatuur en van die respondente, kom die navorser tot die gevolgtrekking dat die struktuur en beleid van die VHW- Program gewysig moet word om die belange van al die betrokkenes te dien, anders het dit geen toekoms in die Maseru Gesondheidsdiensarea nie.