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APPENDIX A 1 "(Y Y-V/,4 /, .gJL-
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PROGRAM DEVELOPMENT AND SUPPORT (POPULATION)
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I. Objective
SCOPE OF W)RK
PIO/T No. 520-0000. 5-3-80234
'Tb provide USAID/Guatemala with a "state-of-the-art" assessme-ant
of community-based health workers (CBHI) and in particular, the
traditional birth attendant (TBA), and their potential use in health
care delivery programs.
II. Background
Guatemala has a remarkably rich experience with CBI's
including the program of Rural Health Tec1hnicians (T6cnicos de Salud
Rural) which is unique to Guatemala, rural health promoters,
volunteers of various descriptions, traditional birth attendants,
traditional healers, patent medicine salesmen and the paid auxiliary
nurse who works at the lvest level of the official health system,
the Health Post. There have been several operational research
efforts to test the usefulness of various approaches to health care
delivery using this level of worker, notably SINAPS,
PRI2ZPS and the
"Patulul Project." Some very interesting studies and evaluations
have been carried out of isolated dimensions of the work of some of
the CBIF 's, including a recent look at the effectiveness of patent
medicine salesmen (PKS) in communicating child survival and family
planning messages to the semi-literate, traditional rural population
of Guatemala.
As an AID "Child Survival Emphasis Country", Guatemala will
continue to receive financing for assistance in improving health
status in general, and of children under five years of age in
particular. t'tst recently,
USAID approved a three-year extension to
the family planning program.which included tentative earmarking of
funds for developing activities in the Ministry of Health which
revolve around reducing risks involved in the birth process. A key
figure in this program is expected to be the traditional birth
attendant (TBA).