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This book presents the current place and future role of the community health worker. The majority of the world's population continues to suffer levels of ill-health and death that are only a distant memory in prosperous countries. Approaches to alleviating this burden are well-known, and range from specific medical interventions to broader development policies. Since the Chinese experience of mobilising 'barefoot doctors' became known, the approach of training villagers to offer local services has received strong support from international agencies and governments. More recently reports of the quality of the services offered by these workers has indicated that a large gulf may have existed between the rhetoric and the reality. Some have questioned the basic premise that such workers can make a valuable contribution. However, the debate has been informed only by a limited number of often dated accounts. This book analyses programmes in a limited number of countries whose experience is particularly relevant to understanding the role of these workers. The picture that emerges demonstrates the potential value of community health workers as individuals, but highlights the widespread failure of the programmes required to support them. Through case studies and an analytical overview, this book sets out the preconditions for effective community health worker programmes.
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