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- W2205254741 abstract "The Ministry of Public Health of Nicaragua began in 1976 a program to provide health services in the rural areas through the use of trained traditional birth attendants or empiricas. This program offers concrete examples of the problems that can be expected when implementing a primary health care system in a dispersed rural population. The selection of the health services to be provided by the partera reflected the constraints of a low cost program as well as an appraisal of major health problems. The short term objective was to establish a rural health care infrastructure that would be capable of a wider range of services in the future. The tasks that the pateras were trained to do are outlined. The program emphasized the interventions that required minimal training and allowed the parteras to sell whatever drugs were selected at a subsidized price retaining a commission as their only form of compensation. All training was conducted by a single team of nurses hired specifically for the program. The 5 day course was task oriented and focused on the appropriate use of the contents of the parteras health kit and a small number of health education concepts. It contains approximately 150 distinct skills and areas of knowledge ranging from how to remove oral contraceptive pills from the packet to instructing a mother about a weaning diet. 2 years after the beginning of the program a total of 768 parteras had been trained in 47 courses. During 1978 which was to become the programs final complete year only 497 parteras returned for resupply. The direct costs for the training for the first 2 years of the project came to $192 per partera including $50 for the health kit. Although incompletely documented the program provides potentially useful lessons. The most obvious limitation of the program was the failure to establish a meaningful level of field supervision by the clinical auxiliary nurse. The need for a mechanism to manage the supervision system was also evident. Observation of the training course suggests the need for experienced instructors. Even with substantially improved planning and organization the partera program would have left several questions unanswered. Increased supervision and longer training would have increased the effectiveness of the parteras but would have raised the programs cost." @default.
- W2205254741 created "2016-06-24" @default.
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- W2205254741 date "1982-01-01" @default.
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- W2205254741 title "Some lessons from Nicaragua." @default.
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