Effective utilization and evaluation of indigenous health care workers.

The use of indigenous health care workers (IHCWs), who were key elements in community health care programs in the United States in the 1960s, has gone in and out of fashion in subsequent years. The author and his colleagues recently established a service program at Wayne State University's Institute of Maternal and Child Health that employs IHCWs. Characterizations of IHCWs in previous health care programs were reviewed in the process of developing criteria and guidelines for the recruitment, selection, training, employing, and evaluating these workers in the Institute's program. The unique applicability of indigenousness to the delivery of health care services is addressed in terms of the rationale for the use of IHCWs as well as criteria for their success, benefits and problems encountered in the use of these workers, and deficiencies in evaluations of IHCWs. A model of program evaluation, action research, is proposed that assesses the processes and outcomes of providing health services by indigenous paraprofessionals.