Dear Sian, really thanks for your letter.
Diagnosis: the cornerstone of medicine.
As you said therapy will follow guidelines available.
Diagnosis must be written down in the health book which stays in the hands of the patient. So simple... so impossible to obtain.
CHWs will never be able to make right diagnose, unless they study medicine in university. The formal cadres in health-care, those in white uniform that work in rural dispensaries (and feel abandoned!!) can make diagnose. They must be regularly refreshed, motivated, supported(!).
They, They and not the CHWs are the health providers recognized by the community.
Unfortunately emphasis today is on CHWs, despite the fact that majority of governments in poor countries have no money neither intention to recruit them.
Greetings from Dodoma
HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com