vasudeo health providing healthcare

In any community, people become ill and require access to health care facilities and treatment. The problem may be physical, such as diarrhoea, fever or injury, or mental, e.g. psychosis, epilepsy or a learning difficulty. Women have special needs related to pregnancy and childbirth, and children require immunization against common diseases. Regardless of the nature of the health issue, the health outcomes depend to a large degree on individuals’ ability to access health care services. Unfortunately, health services are often planned without consulting the community members who use and pay for such services, particularly in rural areas. To counter this, and to meet community demands for accessible, affordable services, community members should be actively involved in their planning. Health centres should attract the community (see Figure 10.1). The way in which people deal with illness is also an important factor in health care. Most people initially treat ill-health within the home and seek outside help only when the problem continues or becomes severe. Such help may not necessarily come from qualified medical personnel; it can also come from local pharmacists or medicine sellers, traditional healers, religious leaders and friends. Often, seeking medical advice from qualified personnel is the last resort. This can happen for many reasons, such as that an individual does not consider the problem to be severe or “medical” in nature, or that the value of medical advice is not appreciated. Sometimes, there is simply mistrust of the medical profession. Consequently, when planning health care interventions, it is important first to understand current health practices, as well as community needs: which health care services are available, what type of service the community wants and where health facilities should be located. This can be achieved through community discussions using participatory learning techniques with different community groups—defined by age, gender, wealth and ethnic/religious affiliation. The purpose is to generate a reliable picture of community needs and ensure that the services provided will be equitable, accessible and affordable. Providing health care services • Health care facilities (rural clinics, health centres) should be within easy walking distance of the community, particularly for women and children. • Outreach or primary health care workers, such as health visitors and promoters, can be valuable front-line community health workers if they are provided with adequate training and support, particularly if they come from the community itself. • Other health service providers (pharmacists, medicine sellers, traditional healers) can provide additional health advice and care if they are given adequate training and support, and are supervised by medical staff. • Referral systems between different levels of health care (primary, secondary and tertiary) should be clear and comprehensible to both users and providers. The reasons for referrals are often unclear to the users, which can provoke anxiety and lead to non-attendance. In addition, many primary- and secondary-level health care workers may not understand how to refer a patient to higher levels of service, or may not recognize symptoms of more severe illness, which leads to dangerous delays in referral. Establishing community health care programmes When community health care services are established, it is essential that the primary health care be effective and efficient. Community members can lobby local service providers to put primary health care workers in the community, as well as identify community members who could be trained to provide health advice. Other people who can provide health advice to the community, such as pharmacists or medicine sellers, birth attendants and traditional healers, should also be identified. Local service providers can be lobbied to provide additional training and support for these people if necessary. To be effective, health care workers should be acceptable to different community groups and have unrestricted access to the population. Women, for example, may not consider male health care workers to be acceptable for certain issues, and vice versa. Primary health care workers should also have sufficient knowledge and support to recognize illnesses that are beyond their ability to treat, and be able to refer patients to higher-level health care facilities for expert advice and treatment.