****** Forwarded Message Follows *******
>To: Bart Vander Plaetse <[log in to unmask]>
>From: Lynne Kennedy <[log in to unmask]>
>Date: Wed, 18 Oct 2000 14:58:29 +0100 (GMT Daylight Time)
>Dear Mike,
>
>
>You may wish to look at the work developed in the North
>West of England, Bolton and Liverpool. A joint research
>project involving Bolton Food and
>Health Advisors (Community Dietitians) and myself and
>Researchers at the Department of Public Health, The
>University of Liverpool.
>
>The research looks at the feasibility of developing
>a service where Community Dietitians are complimented
>by Lay people recruited and trained to work as Community
>Nutrition Assistants (CNA's).
>
>The Food and health advisors at Bolton project are happy to
>describe the scheme ( 01204 360094/5) or for research
>aspects e-mail myself ([log in to unmask]) and see:
>
>Kennedy LA, El Hassan S, Sephton J, Price A, Ubido J.
>(1999). Dietetic Helpers in the Community: the Bolton
>Community Nutrition Assistants Project Journal of Human
>Nutrition and Dietetics 1999, 12, 501-512.
>
>
>Kennedy LA. 1998 Community Nutrition Assistants: Will they
>change the nature of community dietetics in the UK in the
>future? In: Public Health & Nutrition: Proceedings of
>International conference on nutrition and public health,
>Berlin, October 1997. Kohler BM; Feichtinger E; Barlosius,
>Dowler E (eds). Edition Sigma, Berlin, 1998.
>
>The Bolton scheme was recently awarded Beacon Status by the
>Department of Health. Thus there will be information
>available from their website.
>
>
>I am currently writing up my PhD on the subject of using
>Lay people as 'community (health promoters) nutrition
>assitants'. Obviously there is a great deal of literature
>available looking at the potential feasibility of using lay
>people as health advisors. You (and others here) raise the
>matter of 'overcoming barriers between clients and health
>professionals'. The evidence from America and developing
>countries suggests that lay people, who are indigenous to
>the communities / people  they 'serve', can be trained to
>act as community health workers. Their success as community
>health workers is based on the notion that "community
>residents are trusted and know how to interact with members
>of their community in a culturally competent way". The
>research suggests that generally, lay people tend to posess
>more credibility amongst their peers; are more likely to
>foster feelings of local ownership, increased control,
>empowerment and encourage commitment towards local health
>projects/schemes. This they achieve through a unique
>ability to forge links with the community, especially with
>'difficult to reach' disadvantaged or socially excluded
>groups, and their ability to translate complex health
>concepts into terms understandable by their peers.
>
>
>My own research suggests that there is indeed a continuum
>- professional - and Lay person and there is a tension, as
>others contributing to this discussion have put forward,
>between the different roles. It is particularly interesting
>to look at this interface in relation to policy and
>practice in the UK.
>
>
>I feel that your proposal for a scheme in dudley is very
>interesting and I hope you can obtain the necessary
>support to implement it. Should you have any specific
>queries I would be happy to help,
>
>regards,
>Lynne
>
>
>
>
>
>
>On Thu, 12 Oct 2000 21:58:52
>+0200 Bart Vander Plaetse <[log in to unmask]>
>wrote:
>
>> RE: Community health promotersDear Mike,
>> Dear Zafar,
>> Dear Claudio (I know you from very interesting
>communication on the > afronets, so I thought of sending
>you this one as well) > Dear all,
>> > I would like to react from the viewpoint of the
>situation in LMIC's, since > it was suggested that such
>community health promotor was "essentially > modelled on
>the village health worker concept from developing
>countries". > The suggestion given by Dr Zafar Fatmi seems
>a logic one to me, but a sign > that the community worker
>is not al that "community" as was hoped. Let me > explain.
>> There are al sorts of people in the community doing tasks
>for the community, > and they do so without having a
>salary. This however does not mean they do > not get a
>reward. Social recognition is one of those rewards, and
>perhaps > the most important one. In Mike Griffiths
>message, it was nicely stated that > 'a barrier' needed to
>be overcome since the health workers were perceived as >
>outsiders. To overcome that barrier (for health education,
>but I've seen > socalled volunteers being used for all
>sorts of things) we then come up with > a community based
>worker, community health promotors, village volunteers >
>etc. Very soon, these volunteers and the village they come
>from change: the > volunteers find themselves doing a job
>that formerly the salaried staff was > doing, and would not
>mind being paid, and in the end becoming staff him or >
>herself. The community does not recognise the volunteer
>anymore as 'one of > their own' but now as 'one of them
>-the health staff'. So we are back to > square one. > The
>barrier -let me use Mike Griffiths word- cannot be tackled
>by an > initiative coming from one direction. If you want
>to remove barriers between > health workers and the
>population they cover, you need to give power in the >
>hands of this population, give them control, true social
>control. And I do > not mean putting up a health committee,
>appointing some people in it, and > then have meetings all
>the time. I mean real social control. I would like to >
>refer to a nice article written not so long ago: Public
>Health in developing > countries by Macfarlane, Racelis and
>Muli-Musiime in the Lancet, vol 356: > 841-46. Here, it is
>nicely described that we need "a restatement of the >
>centrality of people in public health and its practice". >
>The way how to do so is definitely something else than all
>the pseudo > community participation we have been dealing
>with. We are miles away from > such a social control on
>micro level in our developed world -while at the > macro
>level there is considerable social control. Large scale
>projects have > proven that in developing countries
>settings such social control can happen: > In Mali, people
>have taken over the management of their facility, and the >
>staff is now accountable to their population instead to
>someone in an > obscure heirarchy. ( Maiga, Z., Nafo TF., &
>el Abassi, A. 1999, La réforme > du secteur santé au Mali
>1989-1996. ITG Press, Antwerpen. and > Nafo TF., el Abassi,
>A., & Maiga, Z. 1999, "Health care reform: the > experience
>in Mali.," in Innover dans les systémes de santé, J. >
>Brunet-Jailly & S. Nittayaramphong, eds., Karthala, Paris.)
>> Only such approaches remove barriers, not only barriers
>to spreading health > promotion, but barriers to equity and
>development. > > Regards, > > > Bart > >
>> Bart Vander Plaetse > > [log in to unmask] > >
>> -----Original Message----- > From:
>[log in to unmask] >
>[mailto:[log in to unmask]]On
>Behalf Of > [log in to unmask] > Sent: Thursday, October
>12, 2000 05:38 > To:
>[log in to unmask]; >
>[log in to unmask] > Subject: RE:
>Community health promoters > > > Dear Mike, > > This is one
>of the fundamental barrier to provision of primary health
>care > in a developing country or in a similar setting, I
>presume. There is > question that how long a volunteer can
>work without being paid? One cannot > expect a volunteer to
>work for life and if they get paid from any temporary >
>source (which could be local, national or international)
>then he/she is no > more a volunteer at one hand and the
>other aspect is that how will you > sustain that support
>and funding when the programmatic activities stops. > > I
>have first hand knowledge of training and establishment of
>referral chain > through Community Health Workers (CHW) in
>two rural areas of the province of > Sindh Pakistan. You
>could motivate and involve volunteers once in a while, >
>and you could get over the barrier of directing or giving
>advice and also > not being perceived as outsiders, which
>you have mentioned. It is not usual > that they are being
>perceived as outsiders but they are felt as "different >
>i.e. getting paid and all the support and on the other hand
>CHW are not > being paid and lacking all the support". The
>lesson I learned through > training them is that they stop
>working after a while when the motivation > and enthusiasm
>goes down, and if they don't find continuous support and >
>supervision. The only hope is that if you try to INTEGRATE
>them in the > mainstream health system and make them
>EFFECTIVE and OFFICIAL part of the > health system. They
>should be recognized, given continuous supervision, >
>respect and support. I also think that they should be paid
>as well according > to their capacity. This is hard task in
>itself at one hand and also > difficult to implement
>politically in a developing country. But if you would >
>look for outside of the existing mainstream system for
>training and support > it may not be sustainable. > > Hope
>I am making sense here. > > Regards, > Zafar Fatmi > > Dr
>Syed Zafar Ahmed Fatmi > Research Fellow > Department of
>Community Health Sciences > The Aga Khan University >
>Stadium Road > Karachi > Tel: 92-21-4859-4868 > Email:
>[log in to unmask] > > > > Official: Yes >
>>   -----Original Message----- >   From:   Griffiths
>Michael (QEC) >
>[SMTP:[log in to unmask]] >   Sent:
>Thursday, October 12, 2000 1:51 PM >   To:
>[log in to unmask] >   Subject:
>Community health promoters > >   Is there a place for
>giving community volunteers a little training, > education,
>support and funding to act as health promoters in their >
>community, thus overcoming the barrier sometimes
>encountered by health > professionals trying to give advice
>but being perceived as outsiders? Does > anybody have any
>experience or knowledge of such a programme, essentially >
>modelled on the village health worker concept from
>developing countries? > Does this have a place in our inner
>city populations, to promote healthy > living, childhood
>vaccinations etc? > >   Mike Griffiths > > >
>
>----------------------
>[log in to unmask] Lynne Kennedy Lecturer Public Health
>Nutrition The Department of Public Health
>Whelan Building Liverpool
>L69 3GB
>
>telephone: 0151-794-5277  or
>           01829-271586
>
>
>
>
>
>