Overview
Community health programmes work best when they co-operate, rather than compete with other branches of the health service.
They need to learn to co-operate with government in a well-defined partnership, with each recognising the strengths and roles of the other.
They should be open for alliances with the private sector, providing there are strict safeguards. Community health programmes will use and relate to doctors in a variety of ways. They should consider carefully how to work in co-operation with any private practitioners or traditional health practitioners in the project area.
Finally CHPs should integrate with other levels of the health service, including referral hospitals, so that each tier carries out the jobs for which it was designed. This causes increased job satisfaction to health workers, provides more effective services for patients and greatly reduces costs.
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Excerpt from setting up community Health programmes by Ted Lankester
Patients requiring referral to hospital will include: emergencies; those needing surgery, Caesarean section or assisted delivery; any needing investigations (either as out-patients or in-patients).
In acting as a referral centre the hospital will have three important tasks:
1. It will receive patients, trying where possible to admit any patient referred, especially if from a long distance.
2. It will care for patients in the ward, where staff will need to be taught to show kindness and special care for the poorest, the most uninformed and the most sick. Often in practice staff respect the rich and push the poor aside.
3. It will discharge patients back to the community, if possible, first contacting the primary health centre team to arrange a suitable time, and means of transport. A doctor or nurse should write a discharge summary.
Often there is no effective referral system at all.
This is partly because of poor quality health services where many people try to bypass the primary levels of the health service and go to the secondary or tertiary levels for their minor health problems. In particular, the wealthy and powerful like seeing smart doctors in smart hospitals even for their headaches and itchy bottoms.
This has unfortunate results:
1. The rich get overtreated, demanding more expensive drugs and treatments, so setting up an inappropriate pattern which others start to follow.
2. The poor get undertreated or not treated at all as there is little time left for serious problems referred from the level below. The supply of essential drugs runs out.
3. Health workers are unfulfilled: doctors spend time seeing patients with minor problems, and so get bored, Community Health Workers and middle level workers get bypassed except by the very poor, and so get discouraged.
4. The referral system breaks down.
5. Costs increase as more hospitals get built.
6. Almost anyone is prepared to see a private practitioner if suficiently desperate and unable to face the often frightening and unfriendly world of hospitals
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