Training folk practitioners as PHWs in rural India.

4 pilot programs for training folk practitioners to provide specific types of primary health care (PHC) services in villages in the Varanasi area of India were described and evaluated. The programs were developed by staff members of Benaras Hindu University and by members of several other universities. The training programs included 1) 2 courses on the prevention and cure of diarrhea including oral rehydration therapy; 2) a course providing birth attendants with training in delivery technics including the use of delivery packs; and 3) a course in the diagnosis and treatment of 11 skin diseases. All programs were developed and taught by physicians except for 1 of the diarrhea prevention courses which was developed and taught by a social anthropologist. The courses were conducted over a 3-5 day period. Methodology not course content was the focus of the discussion. An effort was made to make the practitioners feel accepted by the formal medical system. Courses were conducted in places and at times convenient to the trainees. The general mode of presentation was to give a short formal talk about a specific topic followed by a discussion period and then a review session. Each program was evaluated separately in regard to 1) the degree to which specific health messages were translated into behavioral changes and 2) the amount of staff time which was required to motivate participation and to prepare and teach the course. In regard to the diarrhea prevention course taught by the physician 14 practitioners were trained and of the 8 health messages conveyed in the course 3 were being followed by the practitioners 0-4 weeks following the course. The diffusion rate was therefore 38%. Time inputs were 130 hours of medical staff time including 45 hours of direct teaching time and 80 hours of nonmedical staff time. The message diffusion rate for the other diarrhea prevention course was 20% at 8 weeks following course presentation. 14 practitioners were trained. Staff time amounted to only 21 hours of nonmedical staff time including 3 hours of direct teaching time. For the skin disease course diffusion rate was 69% for drug related messages and 18% for health education messages at 0-4 weeks following the course. The course took 114 hours of physician time including 45 hours of direct teaching time and 55 hours of nonmedical staff time. 20 practitioners were trained in the course. In reference to the birth attendant course of the 37 births which occurred in the area during the year following the course 7 births were delivered with technique taught in the course. The diffusion rate was therefore 22%. A total of 19 birth attendants were trained. Time inputs were 46 hours of medical staff time and 88 hours of nonmedical staff time. Recommendations were that some of the approaches and technique developed in the pilot projects would be useful in developing a large scale training program in the Gangetic plain and that simplified courses should be taught by paramedical personnel rather than by physician. However a physician should be present on the opening day of the course to demonstrate that the formal medical system appreciates and welcomes the assistance of the traditional practitioners. The characteristics of folk practitioners the impact of the training on the status and income of the practitioner and program acceptability by the villagers and by the practitioners were also discussed.