Linkworkers in antenatal care: facilitators of equal opportunities in health provision or salves for the management conscience?

A number of reports have highlighted non-English speaking Asian women as being at risk from limited health care provision (eg Whitehead, 1987). Of particular relevance to the present survey is their low uptake of antenatal care which may contribute to the above-average perinatal mortality rates for this group. In an attempt to ameliorate this problem, a Linkworker service was introduced in a number of multi-racial health districts. The survey reported here was an attempt to establish the efficacy of this service. From an initial sample of 30 health districts, 20 replies were obtained which provided some valuable insights on the current status of the Linkworker provision. In summary, the responses indicated that there is a worrying mis-match between client need and service planning, largely because relevant information about supply and demand is not collated. The net result is that many of the at-risk group are still denied the full and appropriate services of the Linkworker. It is concluded that if Linkworker provision is seen as a valuable commodity in enhancing equal opportunities in health care, then the service needs to be systematised. If it is perceived to be of little demonstrable value, then it should be scrapped. In either case, some clear policy decisions are required.