[Note from HIFA moderator (NPW): I am forwarding this on behalf of Daniel Stern, Tanzania/Uganda]
Dear Becky, thank you; seems you have hit the nail on the head; how do we maintain the dynamism and diversity of CHWs as programs formalize?
I believe there is a trade-off, i.e. the illiterate CHW whose extraordinary healthcare skills to a great extent depend upon her ability, as an illiterate person, affords him or her to enter other worlds, seamlessly, and would be in danger of losing this magnificent facility, were required literacy foisted upon them in an unnatural way. I had the pleasure of hosting a leader of the Ik people at my home in Kampala. The Ik are hunter gatherers in the extreme north east of Uganda. His people are illiterate, yet he had university degrees that enabled him to deal with government officials such that his people would not be unnecessarily abused, even by well meaning government. And yet he could still move comfortably between the two or more worlds he lived in. I believe we must be more sensitive in respecting the spiritual side of healing. If you will read Harvard's Dr. Atul Gawande' book, Complications about his surgical residency he touches on this subject delicately, in the last chapter, The Red Leg. The Ugandan traditional midwives I spent time with would deliver breach births effortlessly, without an ultrasound, for they SEE, by virtue of their spiritual gifts.
Dr. Joseph Ana recently mentioned in this same forum how "inter professional disharmony (which seems to be an oxymoron) was a huge problem that undermined the strengthening of quality care, which I would suggest was part of the downside of literacy.
Thanks again, and best wishes, Daniel
HIFA profile: Daniel Stern is a HIFA Representative and member of the mHIFA WG. He is a member of Uganda MCH TWG. Daniel is Co-founder of the educational NGO Uconnect, and of the Innovation Hub, Hive Colab, and is also Cofounder of ISOC Uganda and Uganda IXP. He is a UN WSA National Expert. His Uconnect team distributes off-line E-Learning content, including Hesperian Health Guides to schools in East Africa since 2008. During his six-years as Lead for Uganda Mobile Monday he regularly organized events with mobile health themes, usually in collaboration with UNICEF’s Uganda team, and their pan African IntraHealth efforts to improve interoperative healthcare systems, both within and between countries,in mHero, such that developer- entrepreneurs’s apps would align with the latest trends by MoH policies. http://www.hifa.org/support/members/daniel
DStern AT Uconnect.org