in Majuro under Alec Keju.
This program is presently shut down due to
lack of funds either for training new health assistants or continuing
education.
Many
health
assistants
in
the
field
have
not
had
a
continuing education session for as long as ten years.
h.
An attempt was made sometime in the past to have health assistants
deliver
services
through
well-baby, pre-natal, etc.
regularly scheduled
special
clinics
i.e.
This generally broke down due to the smal]
numbers of patients seen and inefficient use of the health assistant's
time.
Most health assistants have fallen back to going to the patient
when called for by a family member
scheduled times.
instead
of holding
clinics
at
It appears that the community generally knows where to
find him if he is needed.
2)
General Recommendations
a.
Expanded role of worker:
In the section on “public health" (see section B} an outline of the
various service needs in the areas of preventive, promotive, and curative
health was presented i.e. health education, maternal and child health, social
C
problems, etc. It was recommended there that separate specialized supporting
technical
staff be provided at the central
planning and managing these services i.e.
level to be responsible for
a “health educator" to plan and
direct health education activities, a “sanitarian" in environmental health,
“public health nurse“ in maternal and child health and immunizations, etc.
Yet at the implementation level in the outer island clinics the emphasis
will be on having the main primary care worker assume the “integrated” role
of delivering all types of services - health promotion and prevention as well
as curative services.
Furthermore,
it
is
felt
that
specific kinds
of
services (be they curative or preventive} should not be delivered by means of
specialized clinics at limited times and days i.e. "well baby clinics" on one
day and “family planning“ on another day.
In summary, the health worker at
the primary care level is to serve an “integrated/expanded" role ~- he is to
be the implementor of all health activities at the local level, and the
patient will be able to receive a full-range of services at any particular
time the clinic is utilized during its regular hours.
In practice this will mean the primary care worker will spend his time
in the following manner:
A certain specified number of hours each week will
be spent at the clinic during which time an individual patient may come and
receive
general
health
services
including:
QQ
of
both
preventive
and
curative
types