Voluntary village health workers in Papua New Guinea.

The aid post orderly system remains the cornerstone of primary health services in Papua New Guinea (PNG). Inadequate supervision limits its impact. Recent promotion of voluntary village health aides (VVHA) is leading some provincial Divisions of Health to start large-scale projects, which are even more likely to break down through poor supervision. VVHAs are in general inappropriate to provide widespread curative care in PNG. Health personnel should rather reinforce and support existing services. However, voluntary village aide schemes may be appropriate in localized disadvantaged areas. Health planners should consider carefully their goals in setting up such schemes; how they are going to develop projects; and, if villagers want VVHA schemes, the staff required for training and supervision. Monitoring and evaluation should be incorporated into the initial design and provide feedback to participants. Intensive supervision may be appropriate for a defined period, with subsequent closure of the project, or its absorption into the existing health care framework.