Current Status of Community Control Measures in Dermatology
Despite the logic of developing community-focused services for dermatology, such services have seldom been achieved (Hay, Andersson, and Estrada 1991). Perhaps the best current example of a concerted, community-based approach is the Regional Training Center for Dermatology in Moshi, Tanzania, which focuses on developing a primary care skills base in African countries for the care of patients with skin and sexually transmitted diseases (Kopf 1993). The program has now trained more than 100 medical assistants and nurses, who were placed in 15 different countries at the primary care level and who, in many cases, play key roles in developing local health programs. A key issue is that action proportional to the severity of the problem is needed. For instance, one option would be to help nonspecialized health workers significantly improve their skills in managing common skin diseases. That option would present a new challenge for the teaching of dermatology. Along those lines, a recent initiative to effect change through a control and education program in Mali targeted at pyoderma, scabies, and tinea capitis is currently being evaluated. Early assessments indicate that the teaching methods have been effective in instilling recognition skills among primary care health workers. The effect on community levels of skin diseases is not yet known.
Skin diseases remain a low priority for many health authorities, despite the large demand for services. Addressing the potential for controlling skin problems by means of simple and effective public health measures should be a realistic target for alleviating a common and solvable source of ill health. An effective plan, team, and basic dermatological formulary can do much to improve matters (Estrada and others 2000). This chapter outlines some of the challenges for such programs and some of the deficiencies of current provision.
