Primary health care workers: the rural health aide program in El Salvador.

20 of the 100 households served by each Rural Health Aide (RHA) in 26 of the 103 cantons of El Salvador where RHAs had been working for 1 year and 16 of 32 where they had worked for 2 years were randomly selected and interviewed to assess the effectiveness of the RHA program. The questionnaire was intended to determine the frequency of contacts degree of health center utilization for perinatal and infant care patterns of contraceptive use and incidence of diarrheal disease among infants. Path analysis was used to determine the effect of the duration of RHA work on RHA and respondent activity and multiple classification analysis was used to examine selected indicators of maternal and child health care in terms of the duration of RHA work. Both analyses were controlled for the distance from the canton to the nearest health center and the relative size of the cantons. The findings show that survey subjects in cantons served by RHAs for 2 years were more likely to be visited by the RHA more likely to visit their RHA more likely to visit their health centers after referral by their RHA more likely to receive prenatal and postpartum care and more likely to have their children immunized. The data also suggest that larger cantons need more than 1 RHA that there is a greater need for RHAs in remote cantons and that a relatively longer duration of RHA work tends to counter the negative relationship between maternal and child health indicators and the distance between the canton centers and their nearest health centers. Despite study limitations of unsatisfactory control group and use of indicators of contact with the health care system rather than direct indicators of health the findings suggested that RHAs can effectively promote contact between rural communities and the health care system.