AN APPRAISAL OF THE COMMUNITY-BASED VOLUNTEER HEALTH WORKERS' PROGRAMME IN LAGELU LOCAL GOVERNMENT AREA, OYO STATE, NIGERIA

Abstract

The Volunteer Health Workers' (VHWs) Programme emanated from the World Health Organization (WHO) Alma-Ata Declaration (1978) Article Six that recognized the people's right and duty to participate individually and collectively in the planning and implementation of their health care. Nigeria embraced this Declaration through its National Health Policy in 1988. The Programme was launched in Lagelu Local Government Area (LGA) of Oyo State, Nigeria in 1992 but has so far not been appraised. The objective of the study is to appraise the implementation of the programme in Lagelu LGA. The study is descriptive in design and was carried out in Lagelu LGA with approximate population of 88,894. The respondents were all the 60 trained VHWs who had initially volunteered to distribute ivermectin under the Onchocerciasis Control Programme, 5 staff members of the Health Department involved in VHW programme and also two members of the Village Health Committee. Information was obtained through review of records at the LGA Health Department using the Federal Ministry of Health (FMOH) Checklist for Village Health Services, interview of the respondents, observation and review of minutes at the VHWs Association's Monthly Meetings. Of the 60 VHWs, 12(20%) were males while 48(80%) were females. Mean age was 48 years (SD±12). All the females were traders while 10(83%) of the males were farmers. None of the females had secondary education. Also, only 5(42%) of the males went beyond primary education. The 5 LGA staff consisted of a trained Nurse, a Community Health Extension worker (CHEW), the LGA Statistician, the Pharmacy Technician, and a Clerical Officer. The 2 Village Health Committee members were the Traditional Ruler and a Chief of Oyedeji Village. The study revealed that the National Health Guidance of the FMOH were not fully complied with by the VHWs. Hence, there were no records on activities relating to Water, Sanitation and Food Demonstrations. The VHWs were observed to be overworked as one VHW served 1,500 people instead of 500 recommended by the Guidelines. None of the VHWs participated in community mobilization for the activities. All the VHWs were asking for remuneration for their services although they came in as volunteers. Observation at the VHWs Meetings showed that the Drug Revolving Fund Scheme was in place and members restocked drugs from the LGA Pharmacy store, which had in stock all drugs in the List of Nigerian Essential Drugs for VHWs. However, the VHWs were unable to restock their drug kits during the LGA Worker’s Strike, as a result they were rendered inactive during the period. The Nurse and the CHEW regularly carried out monitoring and supervision fortnightly. One VHW was found to be using his position to legitimize an illegal clinic set up by him. Two of the VHWs reported that two of the VHWs were selling their allocated drugs to peddlers or patent medicine stores. It was also observed that the Village Health Communities was inactive in their scheduled activities such as keeping a drugs account as specified by the Guidelines. The Appraisal revealed that more VHWs needed to be trained so as to meet recommended ratio of 1:500. Materials for record keeping should be provided and VHWs trained to use them. Monitoring should be intensified to prevent pilfering of drugs and abuse of privilege to participate in health work by the VHW. Also, the Village Health Committee should be revitalized in their activities.