Good evening,
So far, in most readings concerning a concerted community response to pandemic influenza, the focus appears to be either on public health programs or on individual education and preparedness. In seeking to learn by analogy from other situations, we might heed some words from M?decins Sans Fronti?res (Doctors Without Borders) about a novel yet very important category of staff person: the Home Visitors. This is indeed one area which, if planned for in advance, could cast a vast and effective safety net over our communities.
The Home Visitor approach is one very concrete way in which community groups such as churches could play a crucial role in bridging the span between formal pandemic response leadership (be it public health or municipal government) and the common person.
Tim Foggin,
Oct 29, 2006
from : REFUGEE HEALTH?An approach to emergency situations by M?decins Sans Fronti?res (1997) ISBN 0-333-72210-8
page 42:
Home-visitors are a particularly important category of staff required to ensure the link between the refugee community and assistance programmes. They should be chosen from among the refugee or displaced population. Particular attention must be paid to both their training, and to that of other local health staff.
pages 219-220:
REFUGEE-SPECIFIC CATEGORY OF STAFF : HOME-VISITORS
Home-visitors are an essential component of any refugee programme ensuring the link between refugees and the services offered to them and conducting outreach activities in the settlement. Home-visitors should berecruited rapidly at the start of programmes (within the first few weeks) and function as a network covering the whole refugee population.
Home-visitors (HVs) should be distinguished from community health workers (CHWs) or village health workers (VHWs): CHWs are an essential aspect of (long-term) primary health care programmes in stable countries, aimed at extending health services to all communities and supporting them in solving their own health problems. CHWs are members of the community, who have received a short training on health-related matters and are already integrated into the public health system of their country. HVs are also selected from the community, but only in response to a refugee crisis. Their tasks differ from those of the CHWs, and it is preferable that they do not provide curative health care. The CHWs already present in the refugee community will generally be assigned to health services (e.g. health posts) because of the health knowledge they have already acquired.
The characteristics of home-visiting programmes include the following:
Home visitors should be selected from among the sections of the population they will care for; initially there should be 1 HV for every 500-1,000 refugees. The most important selection criteria is that they are accepted and recognized by their community, whether or not they have previous skills or are literate. Difficulties in the HV selection process arise when refugee leaders try to unduly influence it, or designate friends or relatives who may not be suitable. Care should be taken that women are among those recruited (see above, Staff recruitment). The number of HVs can be increased depending on how events and activities evolve.
The main tasks to be performed by HVs are listed below (see also 6. Health Care in the Emergency Phase).
- Data collection: HVs ensure the regular collection of population figures (census, new arrivals and departures, births, etc.) and mortality figures (number and causes of deaths in the population).
- Active screening: they make regular visits to shelters to screen for sick persons, malnourished children and those not immunized against measles, and refer these to health or nutritional facilities. They may also be required to screen for other problems: defaulters from particular programmes (e.g. feeding centre), vulnerable groups with specific problems, etc. In the case of disease outbreaks, this screening task will have to be reinforced.
- Informing the population: they are responsible for transmitting necessary messages in regard to, for example, the availability of services, distributions that are to take place, the need to bring children for measles immunization etc. They should also conduct health education, for instance, on the use of latrines, the importance of personal hygiene, etc.
- Assistance to other programmes: HVs can assist in many activities: mass immunization, health posts, feeding programmes, conducting surveys, etc. However, this should not be at the expense of making home visits.
A main role of HVs is thus to facilitate the flow of information by informing refugees about relief services and informing relief agencies on refugee needs and problems.
? Supervision and training of home-visitors: A few HVs who demonstrate superior skills should be assigned a supervisory role; one supervisor for ten HVs. Overall supervision of the home-visiting programme should be ensured by a health professional (for instance, an experienced nurse). Frequent and regular meetings between HVs and their supervisors must be instituted from the start, on a daily basis in the initial stages. This allows HVs to make a daily report, hand over data collected, exchange information about refugee needs, etc. It also provides an opportunity for training: an initial and basic training session should be organized on the first tasks to be performed (mainly data collection, possibly active screening), and is continued through these regular meetings to cover other tasks and specific issues related to refugee programmes. The general guidelines for training in a refugee context are given above under Training.
? Contact with other refugee activities: HVs should maintain close contacts with staff working on other programmes. Collaboration with health services is particularly important: HVs should be linked to the health post to which they refer patients; the person in charge of the health post may also supervise their work and provide them with support.
So far, in most readings concerning a concerted community response to pandemic influenza, the focus appears to be either on public health programs or on individual education and preparedness. In seeking to learn by analogy from other situations, we might heed some words from M?decins Sans Fronti?res (Doctors Without Borders) about a novel yet very important category of staff person: the Home Visitors. This is indeed one area which, if planned for in advance, could cast a vast and effective safety net over our communities.
The Home Visitor approach is one very concrete way in which community groups such as churches could play a crucial role in bridging the span between formal pandemic response leadership (be it public health or municipal government) and the common person.
Tim Foggin,
Oct 29, 2006
from : REFUGEE HEALTH?An approach to emergency situations by M?decins Sans Fronti?res (1997) ISBN 0-333-72210-8
page 42:
Home-visitors are a particularly important category of staff required to ensure the link between the refugee community and assistance programmes. They should be chosen from among the refugee or displaced population. Particular attention must be paid to both their training, and to that of other local health staff.
pages 219-220:
REFUGEE-SPECIFIC CATEGORY OF STAFF : HOME-VISITORS
Home-visitors are an essential component of any refugee programme ensuring the link between refugees and the services offered to them and conducting outreach activities in the settlement. Home-visitors should berecruited rapidly at the start of programmes (within the first few weeks) and function as a network covering the whole refugee population.
Home-visitors (HVs) should be distinguished from community health workers (CHWs) or village health workers (VHWs): CHWs are an essential aspect of (long-term) primary health care programmes in stable countries, aimed at extending health services to all communities and supporting them in solving their own health problems. CHWs are members of the community, who have received a short training on health-related matters and are already integrated into the public health system of their country. HVs are also selected from the community, but only in response to a refugee crisis. Their tasks differ from those of the CHWs, and it is preferable that they do not provide curative health care. The CHWs already present in the refugee community will generally be assigned to health services (e.g. health posts) because of the health knowledge they have already acquired.
The characteristics of home-visiting programmes include the following:
Home visitors should be selected from among the sections of the population they will care for; initially there should be 1 HV for every 500-1,000 refugees. The most important selection criteria is that they are accepted and recognized by their community, whether or not they have previous skills or are literate. Difficulties in the HV selection process arise when refugee leaders try to unduly influence it, or designate friends or relatives who may not be suitable. Care should be taken that women are among those recruited (see above, Staff recruitment). The number of HVs can be increased depending on how events and activities evolve.
The main tasks to be performed by HVs are listed below (see also 6. Health Care in the Emergency Phase).
- Data collection: HVs ensure the regular collection of population figures (census, new arrivals and departures, births, etc.) and mortality figures (number and causes of deaths in the population).
- Active screening: they make regular visits to shelters to screen for sick persons, malnourished children and those not immunized against measles, and refer these to health or nutritional facilities. They may also be required to screen for other problems: defaulters from particular programmes (e.g. feeding centre), vulnerable groups with specific problems, etc. In the case of disease outbreaks, this screening task will have to be reinforced.
- Informing the population: they are responsible for transmitting necessary messages in regard to, for example, the availability of services, distributions that are to take place, the need to bring children for measles immunization etc. They should also conduct health education, for instance, on the use of latrines, the importance of personal hygiene, etc.
- Assistance to other programmes: HVs can assist in many activities: mass immunization, health posts, feeding programmes, conducting surveys, etc. However, this should not be at the expense of making home visits.
A main role of HVs is thus to facilitate the flow of information by informing refugees about relief services and informing relief agencies on refugee needs and problems.
? Supervision and training of home-visitors: A few HVs who demonstrate superior skills should be assigned a supervisory role; one supervisor for ten HVs. Overall supervision of the home-visiting programme should be ensured by a health professional (for instance, an experienced nurse). Frequent and regular meetings between HVs and their supervisors must be instituted from the start, on a daily basis in the initial stages. This allows HVs to make a daily report, hand over data collected, exchange information about refugee needs, etc. It also provides an opportunity for training: an initial and basic training session should be organized on the first tasks to be performed (mainly data collection, possibly active screening), and is continued through these regular meetings to cover other tasks and specific issues related to refugee programmes. The general guidelines for training in a refugee context are given above under Training.
? Contact with other refugee activities: HVs should maintain close contacts with staff working on other programmes. Collaboration with health services is particularly important: HVs should be linked to the health post to which they refer patients; the person in charge of the health post may also supervise their work and provide them with support.
