Health program and use of community health workers: the example of scorpion envenomation in Tunisia

Scorpion envenomation is a public health problem in Tunisia (40.000 cases/year), particularly in the zone of central Tunisia (region of Sidi Bouzid). The size of the province, its low rate of urbanization and the relatively limited health ressources required an anti-scorpion approach based on the implication of community health workers. During the year 1997, the 338 health workers who assure 76% of the emergency points treated 42% of scorpion envenomation cases. In spite of the success of the experience, authors discuss "the specialization" of these agents whose the contribution to others aspects of primary care could be improven. These health workers don't constitute a basic component of the organization of health care, but an exceptional measure for special geographical considerations.