Background: The difficulty in recruiting and retaining doctors in rural areas has encouraged the use of substitute
health workers in the provision of primary care for undiagnosed patients with undifferentiated health problems.
This study was performed to report the experience of the use of Community Health Extension Workers (CHEWs) in
the provision of primary care in a private rural health care facility in a community in Nigeria.
Methods: The study was carried out over a 6-month period in a private health facility in a semiurban community. The
CHEWs were recruited through the recommendation of their schools and were retrained and deployed incognito, but
with a clear job description. Their performances were monitored using the level of patient satisfaction, the type of
cases seen, the number of telephone consultations made with the doctors of the NGO, the length of prescriptions
and the number of adverse events that followed the consultations.
Results: A total of 1,028 patients were seen in the health facility during the 6-month study period, of which 294
(28.6%) telephone consultations were made with the doctors of the NGO, 215 (20.9%) of the patients were admitted
in the hospital, while 81 (7.9%) were referred to other health facilities. Most of the cases were malaria (54.2%),
typhoid (6.9%) and minor injuries (12%). The average length of the prescriptions given to the patients per encounter
was 6.3, and most of the patients (86.5%) were satisfied with the quality of care provided by the CHEW. A total of
7.6% of the patients seen by the CHEWs were readmitted as emergencies, mainly with severe anemia (47.4%) and
the deterioration of previously treated ailment (24.4%).
Conclusions: CHEWs, working under the direct supervision of doctors can provide safe and good quality care, to the
satisfaction of most of their patients, when required to provide primary care. It cannot however be assumed that
similar results would be obtained if the health workers are used in different settings or with more complicated patients