Lay workers in primary health care: victims in the process of social transformation

The training and utilization of non-professional Primary Health Care Workers (PHCW's) is currently a major strategy for meeting the minimal health needs of the four-fifths of the world's population without permanent access to care. Increasingly, however, in countries where the wealth is in the hands of the few, PHCW's are become victims of political violence. Because the implementation of the Primary Health Care Model in these Third World countries requires a major transformation of the existing socioeconomic structures, the PHCW may be knowingly or unknowingly placed in a vulnerable situation. This relates to the various functions--both latent and manifest--of the PHCW's role as well as to the way they have been trained and utilized. That PHCW's may be utilized as vehicles of a nation's overall political strategy is demonstrated by the role of the 'barefoot' doctors during the cultural revolution in China. In contradistinction, they may be trained and utilized as part of a government's strategy to 'take over' struggling liberation groups and to 'cool out' potentially explosive situations. In addition, they may be used as spies as may their foreign counterparts and trainers. PHCW's trained in programs which encourage health workers to participate with the community in a critical analysis of the root causes of their ill health may be subject to reprisals if, in fact, they actually participate with the community in the development and implementation of strategies designed to combat the underlying social causes of their problems.(ABSTRACT TRUNCATED AT 250 WORDS)