Training

Training is at the core of decentralization. The delegation of skills and functions means that nonspecialized personnel need to be trained to deliver health care at the peripheral centres and within families and homes. Most of the training should be based on an apprenticeship system, using the attitudes and behaviour of senior personnel and professionals as models. Traditionally, psychosocial and interpersonal skills have been regarded as either inherent and intuitive, or acquired only after a long period of trial and error. This supposition is wrong and needs to be changed. Effective delegation of skills can be achieved through direct practical

training, using a variety of teaching methods, e.g., small group discussions, supervised in-service work, and imitative learning. Essential skills to be taught include:

· interviewing skills;

· ability to listen and to be empathic;

· interpersonal skills needed for counselling, guiding and persuading;

· relaxation, meditation, and culture-specific skills, such as acupuncture, prayer, hypnotism, incantation, and the use of medicinal herbs;

· the management of essential medications;

· the detection of behavioural symptoms;

· a complete approach to problems, incorporating biological, psychological, and sociological points of view;

· recognition of the importance of working with other people in the community, outside the health sector;

· ability to understand and deal with local community fears, beliefs, taboos and attitudes.

The learning of these skills is different from the process of acquiring information and psychomotor skills; it depends on having examples to imitate, and on frank discussion of what is being done. The aim is to change attitudes by constantly reinforcing positive opinions and points of view. These attitudinal and behavioural changes have to be instilled and shaped from the very beginning of training and continually reinforced.