9-20
FOLLOW-UP EVALUATION
The final measure of a training course is how
effectively the health workers serve their communities.
In an article called “Evaluation—A Tool or a Burden?”*
Mary Annel discusses this issue. Mary works with the
Huehuetenango Health Promoter Program, which has
trained over 400 village health workers in Guatemala.
Mary points out that most of the volunteer workers
have limited reading skill, and many find long evaluation
questionnaires terrifying. They complain, “We weretrained in health care,
not statistics.” Evaluation is far more practical if it “fits into the daily running of
the program and makes sense to people in the village.” Instead of trying to gather
mountains of facts, Mary suggests that an easier way to evaluate is to observe “the
change in the way people act.”
“For example ... families used to bring undernourished children into the health center when
the children had been ill for a month or more. The children were dying, and the center was
considered the last resort. In areas covered by health promoters, families now bring children
to the promoter much earlier, long before hospitalization is necessary. We use such criteria to
measure the success of our program.”
To evaluate their program, they try to answer these questions:
THE COMMUNITY
• Does the community work with the
promoter in common projects? For example,
does the community build its own health clinic, or
help pay for the promoter’s expenses for training
courses? All of the promoters may have been
elected by their communities; but voluntary labor
and/or monetary contributions imply a strong
commitment to the health proflram.
• Do neighboring villages without promoters
ask for their own health workers? In the last
five years, over 225 villages have requested promoters
and our program has more than doubled in size.
• Do the sick follow the health promoter’s
advice? Do they complete a prescribed series of
injections, or do they stop after the first or second
of the series? (The Indians see illness as caused by
God’s will and they accept illness fatalistically. If
members of the community follow the promoter’s
advice, they are more actively controlling their
own health and lives.)
• Do sick people referred to medical centers
actually show up at the centers?
• Do the mothers of the village bring their
children to be weighed in the undtfr-fives
clinic each month? Preventive medicine is
always one of the most difficult concepts to
communicate. If the health promoter can convince
the mother that a relatively healthy-looking baby
is showing early signs of malnutrition when the
baby’s weight gain falls off, great strides have
been made toward eliminating malnutrition in the
village.
THE PROMOTERS (village health workers)
• Do the promoters come UP with new ideas
and initiate projects? Or do they simply accept
what they learn in training sessions?
• Do the promoters have more responsibility
for administration, supervision, and continuing
education within the program than they did six
months or a year ago?
• Do health promoters want to learn more? Do
they regularly attend continuing education courses?
Do they spend free time during the training sessions
doing optional reading? Do they stay after class to
ask questions? Do they being patients to the course
for advice on difficult cases? Do they bring lists of
patients with their symptoms for consultation?
To be used by other programs, the questions asked
will need to be different. But the advantages of this
approach to evaluation are clear:
• It can be used in a community-based program
administered by health workers who have had little
schooling.
• It considers changes in ways people act in a
community rather than charts and graphics based on
often inaccurate statistics.
• It makes evaluation a tool, not a burden. The findings
can be understood and used by those involved in the
program.
• It is inexpensive. In fact, in many programs the
information is already available or can be put
together easily from existing records.
*From Sa/ubritas, American Public Health Association, July, 1980.