Training health workers: what needs to be taught and who should teach it

The training of many health workers has been inadequate in producing workers who can function effectively in rural health services. This inadequacy is seen in two areas. While health workers are well drilled in technical procedures, operational strategies for applying these procedures in the conditions of rural health services are often lacking; and much of what they are taught is inappropriate in terms of the practicalities of working in rural areas. Two aspects of training are then discussed. What is taught and who teaches it. A distinction is made between teaching routine technical procedures and teaching cognitive strategies for problem-solving. These need to be distinguished and both considered when training health workers. The use of health workers themselves as trainers of other health workers is then considered. They often do not have the confidence necessary to teach in open participatory, discussion-centred ways. These ideas are then briefly considered in the light of a training scheme in Kenya, and how it has been used for training in Primary Eye Care.