Over the last few years I have noticed some patterns in the health programs I work on.
1 – The users of health services need time to adopt new behaviors and try new services.
I’ve been in multiple communities where the main complaint is that by the time people go to receive services, the health center is no long providing them. On the health center side, they complain that they launch new programs but no one comes for several months so partners/government request the programs closure. There is a mismatch in the time horizon of the community and health program designers.
2 – Peer advocacy works.
I’ve helped implement and researched multiple short term and medium term health projects and having the community take ownership for it’s health awareness/sensitization works. In short, let the communicate educate itself, often in the process the re-evaluate hidden values and assumptions which keep them from changing their behaviors.
3 – There is a serious problem of management at the community health center level.
The complexity of the funding sources and the financial and administrative requirements to run a health center far outweigh the often times 6th grade education level of the valiant nurses who are asked to manage these centers. Performance targets and other incentives only mask the need for more sophisticated management skills at the health center and clinic level.