AEGIS ECAS 2007 - View abstract

Panel	54. Guinea-Bissau: there must be a solution - djitu ten ke ten
Paper ID	461
Author(s)	Gunnlaugsson, Geir
Paper	No paper submitted
Abstract	The health authorities of independent Guinea-Bissau moved quickly towards a primary health care policy influenced by ideas officially laid out in the Alma Ata Declaration in 1978. Of special interest is the expansion of health service delivery by community health workers and cost-sharing through the so-called abota system. With the support of international donors, this policy has been implemented in all the regions and thousands of matronas (traditional birth attendants - TBAs) and community health workers (ASBs) have been trained. The study aims to identify factors that distinguish villages with well functioning community health work from those who perform less satisfactorily in the Oio Region. At the time of study in 1997-98, 100 villages were involved in the program, initiated in 1982. Six village health posts were chosen by judgement sample by the regional supervisory team, three well-functioning and three badly run. In a household study, interviews in the villages were conducted with 30 adult men or their senior wife in case of the absence of the husband. A questionnaires with open-ended questions was used for interviews of mothers of young children (n=39), and for interviews with five nurses responsible at for the village health posts. Mothers of young children and adult men appreciate the community health posts when they function satisfactorily. Highlighted positive aspects were short distance to care, good treatment and its low cost. Confidence in the knowledge of ASBs and matronas in using drugs is high, and illiteracy is normally not seen as an impeding factor for achievements. Lack of drugs is the most serious problem identified, even in communities with a good functioning community health post. Contribution to preventive medicine through health education is appreciated but to a lesser extent than access to drugs. For the nurses, collection of abota was quite difficult in villages with badly functioning village health posts and those interviewed stated lack of trust as a reason for reluctance of participation. Further, nurses lacked vehicles for proper supervision and claimed the voluntaries had difficulties to understand the training material because of illiteracy. Villagers’ trust in the voluntary health workers is fundamental for a good functioning health post. Trust is a precondition for willingness to contribute to the abota system and active participation in the village health work. A prerequisite for good supervision and continuous education of the voluntaries is proper support of those responsible at the health centre and regional level.

Alma Ata in action: community health care in Guinea-Bissau