Primary health workers in north east Brazil.

One approach to providing primary health care in developing countries is to implement programs which rely on minimally trained primary health workers (PHWs). Originally, such programs were primarily designed for rural areas with intact social structures--where a community--based PHW could easily establish a link between the community and the conventional health services (delivery programs). However, faced with increasing migration of the rural population to urban centers in developing countries, the present need for elementary health care in urban slums raises the question of whether PHWs can also provide health assistance to the population there. This paper deals with the issue of whether PHWs in North East Brazil can improve health care delivery and the health situation of the poor population in rural and urban areas. The investigations covered both PHWs and the population. Questionnaire-guided interviews and participant observation were used as research tools. The conclusion is drawn that the PHW-program there has succeeded, if the PHWs have increased the coverage of the health service delivery and also the level of health-related knowledge, attitudes and practices (KAP) in the population--although with significant differences between rural and urban areas (higher coverage and higher KAP in rural areas). The quality of training and supervision and the characteristics of the area and local framework were also found to influence the quality of the work (performance) of the PHWs.