Table Of ContentCs seal ie
| | Number 127 October 1992
Be Teadership cad: : 94
ot: ial Participation for Health : a
INTRODUCTION health professionals resortto frag mented, quick-
fix, vertical interventions, with limited sustain-
Reading the numerous publications attempting ability and impact.
to assess the progress that has been made
A quick-fix intervention may be easier than
towards the goal of Health For All (HFA) by the
tackling the root cause of a problem, yet Health
Year 2000, one feels a general despair over
for All involves going to the root causes of ill
inequities in health status and access to health
health. Again we find ourselves back to the
services. Efforts since that goal was set over
essentials of equity and justice in health care.
15 years ago in Alma-Ata have yielded some
Health for All involves appropriate values as
success, but much more remains to be done.
much as appropriate technology. The leader-
As the countdown towards the year 2000 con- ship required forits realization at any level must
tinues, there is distress and frustration over the be provided by people with a moral commit-
little progress made in implementation of pri- ment to those values—people willing to stand
mary health care (PHC) as outlined in the in solidarity with the poor in their struggle to
Alma-Ata declaration. Health professionals change their situation; people willing to lead by
arotuhen wdorl d appear confused as to whether developing and fostering norms, values, prin-
the PHC approach was ever truly possible. ciples, and strategies consistent with the goal:
There is ample evidence that the basic prin- people who set an example through their per-
ciples of PHC were neither understood nor sonal conviction and practice.
internalized by the heads of state and health
Only leaders such as these can generate the
professionals who signed the declaration. This
critical mass of persons necessaryto ignite and
explains the endless time and energy con-
sustain the realization of Health for All. Such
sumed in debates on the subject, which divert
leaders cultivate skills and attitudes: among
attention from the real issues central to PHC:
strategically placed individuals, who in turn
equity, social justice, and empowerment.
mobilize others. This is the process of gener-
Yet these issues must be addressed if the
ating the social conscience that will make the
health of communities, particularly the poor, is
ideals of PHC the norm, which will then lead to
to be substantially improved.
the correction of social injustices through a
In our experience, the greatest bottleneck pre- collective force operating in all communities, at
venting this improvement is the lack of knowl- all levels.
edgeable, experienced, and committed lead-
This Contact issue is the first in a two-part
ers at all levels—community, district, national,
series to focus on leadership and community
and international—leaders who are convinced
participation as the two most important ele-
that PHC is the only way to achieve HFA and
ments in the realization of Health for All. Here
are willingt o invest resourcesto see it succeed,
we examine aspects of leadership through
leaders with unwavering commitment to advo-
experiences in Kenya and Burkina Faso, and
cate for the disadvantaged and vulnerable.
also through interviews with David Werner,
The crisis in leadership manifests itself in vari-
author of Where There is No Doctorand Pierre
Ous Ways: poor design and implementation of Pradervand, author of Listening to Africa. We
programmes, lack of community participation, contribute this material to the discussions of
lack of resources, and lack of appropriate poli- leadership that we know are taking place within
cies to guide and support the implementation
village groups, NGOs, and other organizations
process. Instead of confronting and dealing with whom we are in touch around the world.
with the fundamental issue of lack of appropri- We knowthat these discussions are urgent and
ate and effective leadership, however, many that others share our fear that without the
necessary leadership and a return to the val-
ues embodied in PHC, the year 2000 will come
and go with little noticeable improvementin the
COVER health of the majority.
Drawing and design by Edwin Hassink, WCC. Dan Kaseje
LEADERSHIP FOR HEALTH FOR ALL—
THE PAINFUL LEARNING EXPERIENCE OF THE
SARADIDI RURAL HEALTH PROGRAMME (KENYA)
By Dan Kaseje, founder director of the Saradidi Rural Health Programme (SRHP)
and current chairman of the SRHP management board
The Saradidi Rural Health Project was first presented to Contact readers in
December 1985 (Contact No. 88) as one of the community-based initiatives of
the Diocese of Maseno South. Articles on SRHP have subsequently appeared
in numerous publications, mainly in illustration of the success of the commu-
nity-based approach to health care, as outlined at Alma-Ata in 1978. More
recently, however, mismanagement within the programme led it to the verge
of bankruptcy, until the community itself rose up to intervene. This is the story
of the lessons learned as the result of that bitter experience.
BACKGROUND nearest health facility was a small Roman
Catholic mission health centre 6.5 km from the
Saradidi is aruralareain western Kenya, 13km
project centre and agovernment dispensary 13
from Lake Victoria and approximately 65 km
km away. The closest government hospital
from the town of Kisumu (see map). The
was 30 km away. Only between 15-25% ofthe
climate is hot and humid, with two rainy sea-
population had any access to health services
sons per year. Rainfall totals about 150 mm
whatsoever. The 1979 Government of Kenya
annually, but is highly unreliable. The average
census showed the infant mortality rate in the
population density is 250 per km? (among the
Siaya district, in which Saradidi is located, to be
highest in Kenya). Almost 99% of the people
147 per 1000 live births.
belong to the Luo tribe; more than 90% are
Christian; and most are subsistence farmers.
Soil erosion, overgrazing, overplanting, and
damaging agricultural techniques have de-
creased land productivity in the Saradidi area. »
The land is now so poor that many people are
unable to produce enough food for their con-
sumption between harvests. A 1979 survey ETHIOPIA
showed that less than 10% of adults had any
regular income, and many men are forced to
leave their families in search of work. During
the rainy seasons, some villagesinthe areaare UGANDA
inaccessible by road. Water supply is mainly SOMALIA
from surface, unprotected sources. During the SARADIDI
e
dry seasons, many households are more than KISUMU
LAKE
3 km from available water. VICTORIA
@ NAIROBI
Significant health problems in the area include
schistosomiasis, malaria, diarrhoeal diseases,
worms, measles, and malnutrition-related TANZANIA iNGIAN
diseases. Before the SRHP was begun, the OCEAN |
The beginning of the SRHP committee was chosen to take responsibility for
day-to-day programme management, while
The Saradidi Rural Health Programme was
initiated in 1979 as part of the Integrated Rural reporting to the larger programme develop-
ment committee.
Development Project ofthe Diocese of Maseno
South of the Anglican Church of the Province of The executive committee drafted the pro-
Kenya, begun several years earlier. (Later, in gramme constitution and outlined specific roles
1985, it came under the sponsorship of the and responsibilities. These documents were
Diocese of Maseno West.) The main aim ofthe written by the programme director and other
programme was to improve the quality of life of community leaders, and then discussed in
the population by undertaking activities to re- meetings and modified accordingly. An Annual
duce disease and increase income. The Inte- General Meeting, open to the entire commu-
grated Rural Development Project was origi- nity, was first heldin 1981, when the community
nally intended to reach the poorest farmers in voted onandapprovedthe constitution. There-
the area. The orientation of the Saradidi Rural after, election of members of the executive
Health Programme was similar, but with a spe- committee and the filling of other leadership
cific focus on health. posts was carried out at the annual meeting.
From the beginning, the community was to be
LEADERSHIP IN THE SRHP
responsible for initiating and implementing pro-
The SRHP programme required different types
gramme activities. Initially, an interim commit-
of leaders: advisers, facilitators, extension
tee, elected by popular vote from the congrega-
workers, government. representatives, hired
tion of St Matthew’s Church Saradidi, raised
Staff, professionals, and community-based
awareness of the programme and mobilized
leaders and resource persons. In addition to
the community in its support. Three months
community-based leaders, there were people
later, community members, local government
and groups involved in leadership who were
administrators, members of the interim com-
outsiders, without a stake inthe programme yet
mittee and St Matthew's church, and other local
deeply committed to its vision and objectives
leaders met for a seminar to define the objec-
and how these would be achieved. Such people
tives of the programme. These were
introduced an element of objectivity in the
1. to establish a programme centre to pro- management process and were able to maintain
vide referral services and logistic and impartiality in conflicts and disputes. They
administrative back-up for village-based were not competing for the same, scarce
activities and to offer curative, promotive, resources as the rest of the community and
and preventive health services; were thus considered by the community to be
2. to train two community health workers trustworthy.
from each village;
Another category of leader, the local elite, was
3. to begin income-generating activities at generally not committed to social justice. They
the project centre and in each village; manoeuvred to become involved in the
leadership of the SRHP for their own benefit.
4. to construct a well in each village, with
Their hidden agenda did not include improving
each village contributing money, materi-
the welfare of the community, particularly the
als, and manpower;
poor and underserved. These leaders quickly
5. to evaluate the impact of the programme
adopted the correct language, however, and
on the basis of indicators suggested by
insisted on "community participation," meaning
the community.
participation of themselves, their friends, and
Village health committees were elected byt heir relatives. Some ofthese local leaders expected
communities. The interim committee that had to be trusted not because of what they did but
organized the seminar was then replaced by a because of what they were: teachers, church
programme development committee composed leaders, or government workers. The project
of representatives of village health commit- treasurer, who was aschool headmaster anda
tees. This group was so large that an executive leader atthe local church, for example, expected
2
comprised 11% of the
population, yet they occupied
more than 30% of the SRHP
leadership positions. Nearly
half of local government
Officials were members of
village health committees.
Similarly, the better educated,
who were also better informed,
were at an advantage in the.
election process. Age was
also considered a qualification
for leadership, and the older
the individual the more likely
he or she would be elected to
Community health workers Flora Ong'aro, Rose Oindo, Felistas Oigo, voting during a position of leadership.
a local election, held outside the Saradidi Community Clinic.
Leadership within the SRHP
to be trusted and did not see the need to follow programme, as within the community, was male-
the project constitution nort o keep meticulous dominated.
records. He could always produce instant Thus leaders were most often elected by the
financial reports, presumably from memory. community as a direct or indirect reward for
This led to confusion, rumours of theft, and goods and services received from them. The
eventually to the discontinuation of some SRHP election process tended to be emotion-
external funding. ally and politically charged, which further lim-
Election of leaders within the SRHP ited the opportunity for a rational selectioonf
leaders. The elite were at an advantage and
Electiono f leaders within the programme was
could be elected without having the slightest
by ballot and was hence based on popularity.
commitmenttothe objectives of the programme.
In Saradidi, people can be popular fora number
of reasons, including economic power; power Leadership changes over the past 13 years
of educational exposure and information; power The first group of SRHP leaders, in place up to
of position in the village, clan, local govern- 1989, tended to be predominantly committed
ment, or church; power of age; and power of
Christians, who were able to maintain Christian
gender. values and activities (e.g. worship services,
Community members with a regular income— prayer meetings, Bible studies, retreats, and
businessmen, school teachers, government regular conventions). They were not prone to
extension workers, church workers, and some fight publicly and tried to sort out their problems
local politicians—tend to be vocal, prominent through consultation and discussion in the many
and known in the area. Their positions and meetings creatfoer dth is purpose. They tended
income allowthem opportunitiest od emonstrate to be humble and could admit shortcomings
their goodness to the population. Thus they and limitations. Certain managers who were
command a following and enjoy support, limited in skills delegated responsibility to other
regardless oftheir personal leadership qualities. team members with the required knowledge
Such people are already in positions of power and skills. The group appeared united and
in the community, and their favours in terms of gave the image of being comparatively clean,
- goods and services are often sought by ordinary upright, and not greedy. They managed to
villagers in their frequent times of need and maintain free communication at all levels, pro-
difficulty. The average community member's viding feedback and supervision. Thus the
dependency on such people is a reality that system was kept “oiled and functioning” and
limits their freedom of choice at election time. did not involve the community in controversies
Community members with a regular income and quarrels among the leaders.
These leaders were also trusted and respected implemented. They had no commitment to the
because of their commitment and dedication. needy. To protect their positions, they politi-
The community's confidence in them had been cized the system to consolidate power. They
established before external funding started flow- co-opted and collaborated with government
ing into the project in the early 1980s. There Officials and local donor agency representa-
was mutual respect at all levels, and skills and tives, to the frustration of the people for whom
contributions from community members were the resources were meant.
not only recognized but also encouraged.
Number one on their agenda was to avail
themselves of project funds. In addition, they
Nonetheless, over time the situation deterio-
created space for staff to steal money and
rated. The leaders, including the manager,
supplies such as tools and drugs by eliminating
were not adequately equipped for alltheir mana-
all mechanisms for feedback, supervision, and
gerial functions, particularly financial. They
accountability. They concentrated onthe project
refused to allow leadership change, as was
centre and on getting the most out of it. They
required every two to four years by the project
expected preferential treatment at the clinic
constitution. They demanded payment for their
without standing in line, for example, and they
time because project staff were paid. This
expected “soft” loans from the programme and
demand quickly erodedtheir credibility as cham-
access to the programme vehicle for personal
pions of the needy. They insisted on preferen-
use. They interfered in executive matters and
tial service at the clinic and demanded the use
paralyzed the accounting system to maximize
of project vehicles unnecessarily, They did not
_ their monetary gain.
have full confidence in the project leader and
suspected that he had gains unknown to them
The community reacts
and hence they felt “used.” They did not. fully
share the vision of health for all. They were The community finally revolted against the mis-
certainly not committed to the ideals of social management of this group and, in November
change. A few of them helped themselves to 1991, through a community-supervised free
resources meant forthe programme. Although and fair election, they reinstated most of the
their stealing was not conspicuous and did not people who had been among the first group of
hurt the whole project, since there was plenty at leaders. These people had some credibility
that time, it was enough to cause the main because of their historical role in the project,
donor to withdraw support. . Theft increased their Christian commitment, and their deeper
during this period, but as legal proceedings. understanding of the project’s original vision
were not undertaken, its extent was unknown. and mission. By this time, however, the project's
resources had been depleted and all external
The-second leadership group, elected in 1989, funding withdrawn.
had neither the historical good will of the pio-
neer leaders nor the wisdom and sensitivity to Community members gathered in large num-
realize their disadvantage. They were dis- bers at very short notice at two community
united and showed it in public. They eliminated centres on 24 December 1991 and at the
fora for discussion and ignored Christian activi- project centre on 26 December 1991. At these
ties, to the dismay of the predominantly Chris- meetings, the community lamented their many
tian community, who were then set on the alert. failures. They felt that all of the resources, the
seeds, that they should have sown in order to
To the deep distress of the community, this ensure a harvest had been eatenup. They now -
group of leaders proceeded to display openly had neither the seeds nor the harvest. Itis a
their “ungodly” appetites and practices (e.g. sign of great weakness for any responsible
witchcraft and favouritism). Most of their deci- person to eat grain that has been set aside for
sions and actions were in pursuit of their own planting. It shows lack of foresight and wisdom
interests, and thus they were hardly involved and is always punished by hunger and want.
with the community. Decisions made in meet- The community saw themselves to be in this
ings that were not in their favour were not situation as punishment.
4
They also felt that they had realized their mis- with leadership within SRHP had been assign-
takes and would take corrective measures. To ment or assumption of tasks without the neces-
start with, they had elected new leaders, who sary skills to carry them out. The community
had been tried and found to be effective. They leaders had been responsible for managing the
recognized that, under the second group of support system, for example, and this task
leaders, the project centre had come to over- demanded management skills that they lacked.
shadow village activities, and they agreed to The situation had been further aggravated by
make a new commitment to community-based the fact that they did not know what skills were
activities. They recognized that they were required and so did not realize that they lacked
unable to manage the project-centre, person- these skills. In addition, because they were the
nel, and finances and agreed to hand these local elite, they found it hard to admit that there -
Fe over to the Diocese of Maseno West, so that were skills that they simply did not have.
they could be free to concentrate on the activi-
ties that they could handle effectively. SRHP leaders had been unwilling to allow the
competent hired staff to manage resources on
Accordingly, on 8 February 1991, a letter was their behalf and under their supervision. They
written to the Bishop of the Diocese of Maseno preferred to manage these resources them-
West on behalf of the community by leaders
selves, in spite of their lack of technical know-
and 11 members of St Matthew's Church Sara- how and supervision. This eventually led to
didi, which had initiated the SRHP. They gave gross mismanagement of resources and con-
examples of mismanagement by the SRHP sequent damage to the programme.
Management Committee and cited the conse-
quences of these. They also appealed to the The impact of external funding on
Diocese to assume the management of SRHP leadership
by means of a board, chaired by the Diocese.
The beginning of the downward spiral in lead-
THE COMMUNITY LOOKS AT ITS ership was largely due to the influx of donor
LEADERSHIP PROBLEMS money, which was put directly in the hands of
Early in 1992, a hasty independent assess- local leaders. All of the problems experienced
ment of the situation involving the SRHP was by the programme could be traced back to
carried out. Members of the community and money coming from outside the community,
SRHP staff were interviewed on their Bp iolons which began in 1980. Rose Oindo, current
~of SRHPl eadershifrpo m
inception of the project
in 1975 through 1991,
on where the leadership
went wrong, on how the
problems could be cor-
rected, onthe character-
istics and qualities that
they now sought in
SRHP leadership, and,
finally, on the achieve-
ments ofthe project over
the years, despite its
problems.
Lack of leadership
skills led to
mismanagement
Villagers behind sacks of grain they contributed to the SRHP. Some of the grain would
be used to feed participants in SRHP meetings and training sessions. An unfortunate
The interviews indicated
effect of outside funding to the SRHP was the reduction in community contributions to
that the main problem the programme. After 1985, these contributions ceased altogether.
manager of SRHP andi its longest serving staff leadership in 1989 rapidly exhausted the
member, said categorically, “The problem financial resources that remained and then
started when funds started coming in.” Things went on to incur debts and also to use the
literally got out of hand when the community project for personal fundraising. It was this
leaders had direct contact with external do- rapid downward spiral towards bankruptcy that
nors. This happened not when the leadership led the community to rise up and try to put a
changed but when external money began flow- stop to it in order to save the project.
ing into the programme.
It was because of money that the leaders
monopolized power. It was because of money
that they discontinued regular meetingst o avoid
questions in regard to their mismanagement
and to keep people uninformed. It was because
of money that the elite in the community
struggled to getinto SRHP leadership positions,
evenifit meant canvassing for votes and rigging
elections. Government officials in the area
(including the district officer) went so far as to
impose leadership on the community, so that
SRHP leaders would also give them access to
funds.
It was because of money that the local elite,
once in leadership positions, refused to follow
the SRHP constitutional guidelines, thus re-
moving all mechanisms of control, checks and
balances, and accountability. They deliber-
ately kept inadequate or faulty records and
pleaded ignorance at auditing.
It was because of money that the most powerful
leaders left their assigned responsibilities and
Role play at an SRHP training workshop for community health
took over functions that gave them access to
workers. Participatory learning methods were part of the pro-
funds. It was because of money that undue | gramme from its inception, to help equip the community to speak
out against injustice.
emphasis was given to the health centre and
health centre-based activities, instead of em- LESSONS LEARNED
phasizing activities in the villages.
Lack of a shared vision and passion for the
The wrong leaders were attracted into the poor; lack of shared objectives and strategies
project by. money, and good leaders were in favour of the most disadvantaged; lack of
destroyed by money. The competition that shared Christian principles, values, and prac-
developed because of money led to the first tices all became rich soil in which greed and
replacement of the leadership committee in corruption took root to develop the SRHP into
1989. Guided more by the desire to access an unjust structure. Under the pretext of pro-
external funds rather than to realize the project viding community-based health care, SRHP in
objectives, they moved rapidly to create official its later years was actually increasing the plight
means of tapping project funds: per diems and of the poor!
sitting. allowances, for example. They also The painful lessons learned from the SRHP
began to interfere with the financial experience could be summarized as follows:
management system.
1. Thereisaneed to clearly define the roles
“Donor fatigue” had already set in by this time. of the various partners involved in a pro-
Several donors had withdrawn. The new gramme to ensure transparency-and account-
6
ability to the community through commonly goals, contributed to the deterioration in
developed, known, andrespected mechanisms. SRHP leadership. Assessment helps to pro-
The partners that are vital to programme man- vide feedbackt o the community and allows the
agement are the community (including com- community to reflect on the effectiveness of its
munity resource persons), the leadership, and leaders.
the service providers from the support system.
6. Leadership tasks must be assigned or
2. There is a need for regular and fair elec- undertaken according to competence. Most
tions, conducted according to established and of the mismanagement of the SRHP that the
agreed rules, without politicized campaigns. community was ultimately blamed for was mis-
Campaigning should be replaced by a process management by the support system. Certain
of educating the community as to their rights aspects of programme management should
and responsibilities as voters and how they can not have been in the hands of the community in
exercise these rights. The community should the first place.
also know what is expected of them and what
External resources and the support system
they should expect of their leaders.
should be managed by an institution at an
Quantitative elections do not always result in adequate distance from the community, to en-
good leaders. Some ofthe reasons for this are: sure fair play in the use of facilities and re-
sources and also managerial competence.
¢ Election campaigns in many community
settings interfere with traditional ways of It is clear that the roles of partners in commu-
selecting leaders. The results of elections nity-based health care must be clearly defined.
tend to reflect the ability of certain individu- The community, for example, should not be
als to campaign and to manipulate the elec- expected to manage the support system. Part-
tion process, rather than their qualifications ners should manage only those resources for
for leadership. Popularity can be deter- which they are responsible and accountable.
mined by many, often negative factors.
In the final analysis, it was not surprising that
¢ The community may lack awareness of the Saradidi community could not run the SRHP
theirown rights and responsibilities and what support system nor managtehe external funds,
they should expect of leaders. even though they had created the support
system themselves. The community finally
¢ There may be lack of interest, ability, or
realized this and surrendered the management
mechanisms to ensure good leadership
of the support system and the health centre to
through accountability, transparency, fair-
the Diocese of Maseno West. The Diocese is
ness, and effectiveness. A system should |
an enduring institution. It has an established
ensure and maintain good governance
financial management system, with
through rules and regulations. This requires
experienced and skilled staff in place. The
incentives and sanctions that can be en-
Diocese can also relieve the community of the
forced and that compel compliance.
responsibility of directly relating to external
3. There is a-need for regular meetings of
donors.
elected leaders and staff to provide opportu-
7. Self-reliance must be emphasized; the
nities for sharing of views, however divergent,
programme should not be donor-driven.
for giving of feedback, and for sharing of per-
The fact that the resources were external and
sonal and/or group agendas. Such meetings
not generated from within the community meant
also reduce the need for gossip.
that traditional controls and mechanisms to
4. There is a need for regular continuing
ensure accountability could not be applied to ©
education for all persons with program-
the leaders. Access to the external funds then
matic roles, to update their knowledge and
became a big attraction, and community mem-
skills and thus ensure competence in undertak-
bers, mostly the better off, struggled to get into
ing tasks and responsibilities.
leadership positions in order to have priority
5. Lack of regular assessment of the pro- over the rest of the community in accessing
gramme, as measured against programme funds and services.
When things went sour as a result, the donors - the community and not usurp the roles of
took advantage of the situation and abruptly others (another form of greed) in order to
withdrew their suppor, which they should not outshine them and thus create depen-
have done. The endofexternalinput, however, dence;
did not kill the project. In fact, it strengthened
willing to develop leadership qualities in
it. There are now fewer squabbles, less
others, delegating power, authority, and
gossiping and rumour-spreading, fewer
responsibility appropriately and allowing
conflicts, and a greater focus on essential
others to take over from them; after a
activities.
leadership transition, willing to continue
QUALIFICATIONS FOR LEADERSHIP AS serving the community in less prominent
IDENTIFIED BY THE COMMUNITY but vital roles as good followers; less con- |
cerned about titles than tasks to be carried
Community members interviewed in early 1992
out;
identified the following characteristics or quali-
ties as basic requirements for leadership. In . in possession of a basic knowledge and
light of their experience, they now seek leaders the skills to perform appointed leadership
who are tasks. The required education, training,
1. consistentin word and practice, character- and experience cannot be ignored but are
ized by acaring lifestyle and a willingness not enough in themselves;
to put others first andt o fightt oi mprove the
in possession of the vision of health for all
welfare of others;
and the ability to share it effectively with
2. willing to be accountable to the commu- the people in order to elicit their commit-
nity, on whose behalf they hold leadership
ment and contribution to its achievement;
positions; not harbouring a hidden selfish
committed to the principles of equity, part-
agenda, but transparent and willing to
nership, and self-reliance in health care
listen to what the people have to say;
and possessing an understanding of strat-
committed to sharing power rather than.
egies for achieving these; conscientious
monopolizing it;
and committed to the principles of PHC,
3. consistent in religious faith and practice,
specifically equity and justice in health and
giving evidence of spirituality through ac-
development;
tive Christian witness and development.
The community values Bible studies, wor- 10. able to build a strong feeling of community
ship services, and retreats as ways of and family among those led and to main-
equipping themselves for their roles and tain community morale even under difficult
responsibilitieisn
the community;
4. lacking in greed
for money or po-
sitions of power;
good stewards of
resources placed
under their care,
not using their
privileged posi-
tifoor npersson al
gain; respectful
of public prop-
erty;
SRHP com eenshe alth rie Beatice Migwoke and sbhet Yalaonahome visit. Inarecent
5. willing to keep to evaluation of the SRHP, the community agreed that one of the programme's achievements,
despite its problems, had been the fielding of trained community health workers and
roles assigned by
traditional birth attendants to educate the population on health-related matters.
