The Selection and Training of Primary Health Care Workers in Ecuador: Issues and Alternatives for Public Policy

Abstract

This article employs quantitative analysis to evaluate the effectiveness of the community health worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study first assesses CHW knowledge in the areas of prevention, maternal-child health, first aid, and treatment of common illnesses. The analysis reveals that CHWs retained less than 50 percent of what they learned one year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The second phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. These results yield some important implications for public health policy in Ecuador.

Delayed Fertility Transition Among Indigenous Women In the Ecuadorian Amazon

“…Their ability to disseminate accurate information on modern family planning technologies is often limited by low education, traditional values supporting large family size and the fact that they may have completed their reproductive lives prior to the introduction of modern contraceptives to their community. 27,35 In the case of Ecuador, we found that roughly half of community health workers in Amazonian indigenous communities are men. Thus, in their role as information distributors and facilitators of family planning use, male and older women community health workers are likely to have less knowledge than others of modern contraceptives—their use, effectiveness and potential side effects—and are not likely to be strong advocates for smaller families.…”

“…35 The promotoras in Guatemala are similar to those of rural Ecuador in that they are trained to inform community members about women’s health issues, including contraception; however, promoting modern contraceptives is not a primary charge in either context. 27 Furthermore, they are selected on the basis of their status as older, respected members of their communities. Their ability to disseminate accurate information on modern family planning technologies is often limited by low education, traditional values supporting large family size and the fact that they may have completed their reproductive lives prior to the introduction of modern contraceptives to their community.…”

“…11 Community health workers (promotoras or promotors ) provide other public health services to rural Ecuadorian communities. These individuals—who must meet minimal literacy, age and residency requirements—are chosen (primarily by community leaders) to participate in two months of health training administered by the Ministry of Health, 27 after which their primary charges include health education, detection of pregnancy complications, promotion of immunizations and hygiene, and treatment of common illnesses. In addition, community health workers act as a bridge to the formal health care system.…”

“…In addition, community health workers act as a bridge to the formal health care system. 27 Despite such attempts to improve access to health services for Ecuadorian Amazonian indigenous groups, fertility and family planning access may still be lagging behind other areas, such as in employment and education.…”

The decentralization of health care in developing countries: organizational options

“…This may not be forthcoming if ministry of®cials do not feel committed to a scheme that is not under their direct control. Primary health care involving community health workers, community volunteers, traditional birth attendants and the like has suffered from a lack of supervision by professionals as the cases of the Gambia, Ecuador and Nicaragua have shown (Walker and Cham, 1981;Heiby, 1982;Mangelsdorf et al, 1988). When provincial and district teams have been motivated to provide support, performance has improved, as in the case of Zambia (Inambao et al, 1987).…”