CHWs trained in ARI management.

Regular supervision and refresher trainings were the key to the success of a CHW (community health worker) training program in rural Bolivia. Since 1988, with the support of PLAN International, volunteer CHWs have been trained in 115 villages in Sucre, a rural health area lacking adequate health centers. CHWs educate the community, diagnose and treat pneumonia and refer severe cases to health centers or hospitals. CHWs who were already working on diarrheal disease control were chosen for the acute respiratory infection (ARI) case management training. A 3-day training program was organized for individual CHWs in their own homes and communities. The course included practicing on real ARI cases under the trainer's supervision. Since the program started, community respect for CHWs has risen. In one remote village, community leaders reported a marked improvement in child survival. Factors which explain the positive effects of CHWs include: a limited number of clearly defined tasks, provision of one-on-one appropriate training, periodic refresher courses, and continuous supervision. The main problems have been a lack of constant supply of essential drugs and some CHWs over-diagnosing pneumonia. However, once diagnosis is made, CHWs are careful about giving the correct antibiotic doses and instructions to mothers. Refresher training and supervision have helped to correct these initial problems. PLAN International and the Ministry of Health have organized supervision and training meetings every 2 months. The CHWs bring to these meetings reports of children treated and referred. Case management is analyzed, resupply of essential medicines is arranged and those with special problems are scheduled for a supervisory visit.