This study evaluated the effectiveness of four projects where traditional practitioners were being trained to provide various primary health care services to communities. The projects were based in Ghana, Mexico, and Bangladesh. The objectives were to evaluate the impact the projects had upon the communities they served, to determine which materials and training approaches were most effective, and to develop training guidelines to assist others in replicating similar projects.
A qualitative evaluation was performed of data collected from project documents and field interviews with 152 persons: 28 health agency staff (doctors, nurses, administrators, trainers), 61 traditional practitioners (herbalists, bonesetters, spiritualists, birth attendants and midwives), and 63 members of communities served by the projects.
Effectiveness of the projects was determined by criteria which included:
a) How the traditional practitioners utilized the primary health care (PHC) skills they were taught during their training.
b) How the attitudes of traditional practitioners changed after training.
c) How satisfied were community members with the services of traditional practitioners.
d) How collaboration improved between traditional practitioners and health agency staff.
e) How health behaviours of community members changed after traditional practitioners provided the new services.
f) How primary health conditions improved in the communities where trained traditional practitioners worked.
The data are reported as four case studies and the results are discussed according to various issues:
EFFECTIVENESS OF TRAINING - i.e. primary health care tasks performed by traditional practitioners, attitudes of traditional practitioners, satisfaction of community members, collaboration between traditional practitioners and health agency staff, and health behaviours of community members.
ADMINISTRATIVE ISSUES - i.e. policy issues, project planning and community involvement, training methods and materials, training of trainers, follow-up support, evaluation, costs of training, and difficulties encountered.
One general conclusion from the many specific findings indicated that trained traditional practitioners played an important role in promoting primary health care services in communities, in identifying critical cases early and referring them to clinics and hospitals, and in improving primary health conditions in communities.
The project in Ghana, the only one of the four where adequate statistical records were found, showed that during the two year period from 1990 to 1992 there was an annual decrease in the number of still births and in maternal and neonatal mortality rates in areas where trained birth attendants were working.
These records also indicated that during the 13 month period ending March, 1992, the normal nutritional status of children covered in five project communities increased from 46% to 62.3%, while the percentage of severely malnourished children decreased from 21.4% to 16.1%.
The evaluation report concludes with a section on Lessons Learned and Recommendations for Effective Planning and Implementation and Evaluation of Traditional Practitioner Training Programmes.
A summary of the Guidelines for Training Traditional Health Practitioners in Primary Health Care concludes the report with guidelines for planning the content of training, using effective methods and materials, training trainers, and evaluating training.