03 April 2006
This paper assesses the role of management practices in improving the competency of community health volunteers in diagnosing and treating acute respiratory infections among children. Data were collected by a group of research physicians who observed the performance of a sample of 120 health volunteers in 10 sub-districts in Bangladesh.
Excerpts from the paper:
"The ARI (acute respiratory infections) control programme launched by BRAC (the Bangladesh Rural Advancement Committee) in 1992 focused on the community-based education, detection, and control of such infections. The aim was to reduce mortality and severity of complications from ARIs among children aged <5 years. It was assumed that educating caregivers in how to identify the signs of such infections would be possible even in societies where modern medical beliefs and practices were largely absent. We found that if only fast breathing and chest in-drawing were identified in a timely way, most deaths from ARIs could be averted where appropriate services were available.
"BRAC used community health volunteers as the frontline workforce at the grass roots level. The health volunteers were expected to detect cases and treat ARIs, but to refer severe and complicated cases to nearby health clinics. The community health volunteers were selected from among the local area: most had only 5 years of schooling. After BRAC began its community-based ARI control programme as a pilot project in ten sub-districts in the northern and central regions of Bangladesh, which covered a population of 2.4 million. This study covered all sub-districts in which BRAC had such a control programme. According to the official statistics, nearly 2500 community health volunteers— all of whom were women — were involved in BRAC’s ARI programme at the time of study. It was considered appropriate, therefore, to conduct this study in areas in which a BRAC programme was running. Each sub-district consisted of several unions (lowest administrative unit in the rural area) and municipalities. All rural unions were included in the study, but urban areas in the sub-districts were excluded. One community health volunteer from each (rural) union was selected at random. In total, a sample of 120 community health volunteers was selected as being adequate to assess volunteers’ performance. Five research physicians who had knowledge and skills in standard case management of ARIs using WHO guidelines were recruited and trained in case management of such infections in a specialized child hospital for one week. The training comprised exercises, role play, and field practice. The research physicians conducted several field practices with health volunteers in non-sampled villages as part of their training. Standardized reliability tests, in which a group of potentially sick children was examined independently by each physician, were conducted during field practice."