Front line health workers (4)
-----------------------------
I would definitely support Helga's 'personal files' approach. The ob-
jective is that a majority of health workers in a country or coun-
tries would maintain their own personal files of clinically relevant
material. How might this be achieved and what are the potential pit-
falls?
One of the most important factors, as implied by Helga among her list
of reasons for under-use of information, is motivation on the part of
the health workers. It is easy to see how a file might 'disintegrate'
if there is a lack of incentive to maintain it or if new source mate-
rial is hard to come by (or, perhaps worse, a lot of 'information' is
available but of dubious quality or relevance, or similarly if it is
impossible for the health workers (HWs) to separate the good from the
not-so-good).
Motivation would of course require any major initiative to respond
directly to the demands of HWs and their trainers, and to involve
their input throughout the development of the scheme. The sources of
material for the files, and their relevance to the perceived purpose
(on-the-job vs. reference vs. CME reading), would need to be highly
selected to ensure quality and relevance. Motivation might need to be
directly encouraged by HW trainers to promote personal use of health
information, as implied by Helga and also indicated by AHRTAG's expe-
rience with resource centres for HWs in Tanzania. Perhaps maintenance
of personal health information files might be a requirement for HW
training certificates?
The physical quality, appearance, and durability of the files and
their contents might also be important factors in motivation and
pride in maintaining the files. In this regard, good presentation and
editing of text and graphics are perhaps almost as important as the
content - plain e-mail-style printouts may not be appropriate.
When it comes to the actual content of the files, there seems to be a
balance to find between flexibility/chaos on the one hand and rigid-
ity/structure on the other. The flexibility aspect is presumably im-
portant because different types of HW clearly will have different in-
formation needs, and there will also be differences across localities
and between countries. Perhaps, however, there are many reasons for
developing a central regional source of HW information (perhaps
starting with a 'pilot' scheme in a single country) to promote an un-
derlying structure to the files:
Firstly, as Helga says, there are insufficient local staff and re-
sources to package such information comprehensively (and any attempt
to stretch resources might impair the highly valued Medline 'digest'
services already in existence in Zimbabwe and several other countries
in sub-Saharan Africa).
Second, a central source would be more cost-effective, resulting in
high-quality publications packaged by a dedicated team of clinicians,
editors, and others.
Third, the principles of practice of medicine, whether at HW level or
tertiary level, are largely the same across nations - a structured
'central' format would readily be complemented by local guidelines on
specific diseases.
And fourth, the information that HWs need is already available cen-
trally - what is needed is for it to be packaged and disseminated ap-
propriately, to a target audience that is ready to use it to its full
potential.
A problem with the central approach is that the information needs of
HWs are clearly hugely different, and so no single package would suit
all. Perhaps one type of HW could be targeted in the first instance,
with a view to expansion of the audience (by introduction of a second
package) if successful.
The 'flexible' approach would presumably tap into a variety (?infin-
ity) of sources, resulting in very individual HW files. But I wonder
whether this would quickly lead to a large pile of disorganised mate-
rial that might be less useful than a more structured format (e.g.
series of guidelines originated from same source; periodicals or
newsletters).
It is important to look at the 'personal files' approach in the con-
text of what is (or is not) already available, and here there will be
large differences between localities and countries. This includes
central library resources; resource centres; availability of materi-
als from NGOs and other sources; current use of printed information
support for HW training and CME; ownership of textbooks and manuals
for HWs; etc.
The many issues involved underline the need for a better understand-
ing of information needs among health workers in developing countries
generally.
What is ultimately needed is greater co-ordination among interna-
tional health agencies, NGOs, and other sectors to tackle these is-
sues together, to define priorities and set objectives. Only then can
we hope to develop a coherent framework to meet the varied needs of
HWs in developing countries.
Neil
Dr Neil Pakenham-Walsh MD
Programme Manager, INASP-Health
International Network for the Availability of Scientific Publications
(INASP)
27 Park End Street
Oxford, OX1 1HU
UK
mailto:101374.3615@compuserve.com
[INASP-Health is a co-operative network of organisations and indi-
viduals concerned with the provision of information for doctors and
other health workers in resource-poor countries.]
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