Field worker needs assessment

Vaccinators were given training in social mobilization and flip charts and flash cards were created to support their discussion with beneficiaries. This kind of communication is crucial in getting people to return to complete the full course of vaccination. However, a national, qualitative Needs Assessment Study carried out in 1991 revealed that training was much too general in nature. On-site observations revealed that not more than a quarter of workers actually counseled mothers about side-effects or told them when to return. It was also found that at 40 percent of urban sites and 9 percent of rural sites observed, workers gave incorrect information on programmatic matters such as the tetanus toxoid schedule, appropriate age for vaccinations and the number of visits needed. At these sites, less than 10 percent were observed to use flip charts and flash card in their talks with caretakers. Less than 19 percent of those who counselled mothers ensured that the mother had understood the massages given.
During household visits there was little rapport-building with mothers and vaccinators almost never examined the vaccination sears. Few gave information on the need for immunization, when they would return or what the mother should do if there were problems following vaccination. There were also differences in how workers dealt with poorer mother, acting rushed ot rude not giving information unless asked and often not answering questions at all. Workers were also noted to break the serial sequence of mothers waiting at vaccination sites so they could serve friends and richer clients.
Focus group research and in-dEpih interviews with mothers of unvaccinated children also revealed that lack of information was the main reason for their failure to participate. In addition, some people were turned away for reasons which should not have prevented vaccination such as mild illness of the child, missing vaccination cards, switching outreach sites, the percEpiion that children were too old to vaccinate or the fact that the vaccinator had filled his/her quota and refused to do more. This indicates that some of the workers are not clear about a number of technical aspects of the programme and refresher training is needed.
One key finding was that Epi is not yet reaching a large percentage of poorer families. Of the mothers coming to Epi sites, a disproportionate number had only one or two children. Whereas approximately 40 percent of currently married woman have one or two children, during the study period 64 percent of clients attending urban center and 54 percent attending rural sites had one to two children. This indicates that a good deal of motivational works is needed to bring in these left-outs, a large percentage of whom are form the poorest sector, with larger numbers of children.
The exhaustive 1991 Needs Assessment Study is now being fed in to programme planning for management, monitoring, and surveillance, logistics, training and communication for the remainder of the 1990s. A massive retraining programme is required, with emphasis on motivating caretakers through interpersonal communication and counseling. Without such as strategy it is difficult to see how other health services can be effectively added to the health workers agenda at Epi outreach sites.
In spite of these constraints, the Needs Assessment Study revealed that health and family planning workers had been motivated by their participation in the programme. They feel upon. In some countries this is called “Epi-Plus”, a goal-oriented approach to achieving integrated health care.

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