A case study of the clinical competency of community health workers employed in the Eastern Highlands Province of Papua New Guinea was conducted in March 1993. Of the 79 who graduated from the Onamuga Community Health Worker Training School between 1989 and 1992, only 24 were currently employed in the province. Current knowledge and clinical competency were compared with results on completion of basic community health worker training. Results showed that 22 of the 24 maintained their knowledge competency, and 15 maintained clinical competency. It was found that those community health workers (CHWs) employed at a health subcentre use 40% to 50% of their skills, whilst those at a district health centre or provincial hospital use only 20% to 30% of their skills. Only 8% of the CHWs studied used all the skills obtained in their basic training. This study indicates that the CHW is being viewed by some health managers as a replacement for the nurse aide. If CHWs' skills are to be maintained, certainly good supervision, inservice training and adequate logistic support are needed, but so also is a change in management thinking. The CHW has been trained specifically to improve the access to essential primary health care services of people living in rural areas, especially in preventive and maternal and child health care. If in practice the CHW is not given the opportunity to practise and hence maintain these skills, the whole logic of the CHW training scheme will need to be reexamined.
PIP: The clinical competence of all 24 community health workers (CHWs) employed in Papua New Guinea's Eastern Highlands Province was assessed through interviews and observations conducted in 1993. The 24 CHWs were part of a broader group of 79 who were graduated from the Onamuga CHW Training School in 1989-92. A written test indicated that 22 (92%) maintained the knowledge they had upon completion of the CHW training; the mean knowledge score was 85.9% at program end and 82.1% at the time of the study. Only 15 (63%) maintained their clinical competencies; the mean competence score dropped from 87.9% at the end of training to 71.1% in 1993. The greatest deficiencies were observed in the areas of inadequate history taking regarding past health conditions, thoroughness of the physical examination, diagnosis, counseling, and communication skills. CHWs employed at a health subcenter were observed to use 40-50% of their skills, while those working at a district health center or provincial hospital used only 20-30%. In practice, CHWs were being utilized as nurse aides. CHW training was established to improve access to essential primary health care services, especially preventive maternal-child health care, in rural areas. These findings suggest that CHWs are not being fully utilized or being given the opportunity to practice their clinical skills. Recommended to remedy this situation are systematic provision of on-site clinical supervision of CHWs and semiannual in-service training sessions.