|Responding to Drug and Alcohol Problems in the Community (WHO, 1991, 109 p.)|
|3. Organizing primary health care services to combat drug and alcohol abuse|
If services for dealing with drug- and alcohol-related problems are organized according to the principles mentioned on page 29-that is to say, decentralized services, with active participation of the community, and undertaken by nonspecialized health workers-it will be important to demonstrate their effectiveness in achieving targets, as well as their efficiency in the use of resources. In addition, health workers, especially those who are not specialized and who work at the community level, need to keep track of what they are doing through feedback from supervisors.
In order to meet these needs, a process of data collection and monitoring is required. Data must be relevant to the everyday work of the PHC worker, and the source of information should be the individual health workers.
Personal contact in the transfer of information is important in order to clarify the relevance of the data, reinforce the motivation for data collection, and give timely feedback. This process can become the basis for continuing in-service training and support for the PHC worker.
Indicators of these activities or of the performance of a team have to be clear and simple. Examples are:
· number of cases per week, and the types of drugs used;
· frequency of visits to families and individuals;
· proportion of cases referred;
· number of contacts with other sectors;
· number of people identified as being at risk;
· number of meetings with self-help groups;
· type and quantity of medications used.
It is also necessary to assess the service and the programme, and to evaluate its management and its relevance to the needs of the community. Information for this evaluation is not always quantitative. Sometimes it will be necessary to carry out formal research. Such research undertakings need not be expensive and can be done as part of a training programme for health workers.
Information on the way in which services operate should be simple and relevant to possible improvements. Such information could be collected by asking questions such as:
· Is there a logical structure for referral and supervision?
· What mechanisms are used to engage other sectors?
· Are drug and alcohol abusers helped in peripheral centres and in the community?
· Are there registries and systems for data collection?
· Does a community action team meet regularly?
Other types of indicator will be needed to show the impact of the programme and its advantages, as reflected in savings in other areas, for example:
· reduction in re-admission rates;
· savings in costs of specialized hospital treatment;
· reductions in incidence and prevalence of drug- and alcohol-related problems.
All this must be accomplished with continuing support and discussion, so that the health workers understand the relevance of the data collection and monitoring.