An analysis of the services provided by community health workers within an urban district in South Africa: a key contribution towards universal access to care

Abstract

Introduction Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap. Methods Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280,000 households with 1 million people. Results Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV and TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services. Conclusion Community health workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother and child related, HIV and TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.

The regulation of healthcare professions and support workers in international context

“…In meeting this need, which is much more pressing in the LMICs, the culture and traditions of countries in the Global South should not be insensitively overridden. As recent research has shown, support workers like the South African community health workers, may not have the same educational levels as their equivalents in more affluent societies, but commendably have an understanding of their own communities and can therefore deliver culturally resonant health services [ 41 ]. Indeed, their areas of success lead us to question whether some less highly flung health professions and support workers in the Global North are using their far more extensive training to best effect in the healthcare arena.…”

“…Examples of lesser trained groups of support workers include those like community health workers operating as part of primary healthcare teams in post-apartheid South Africa who—following a model from Brazil—visit households and communities to screen for diseases and risk factors and educate on basic health issues [ 41 ]. Needless to say, groups such as these and yet to be qualified students have proved invaluable more widely in LMICs in combatting the recent COVID-19 pandemic, as in some more wealthy countries.…”

Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa

“…We infer that this was due to the efforts of the CHWs in checking children and adults without these documents and referring them to social services. Enabling social support services in vulnerable households is an important component of the CHW program in the Ekurhuleni health district [ 7 ] and an opportunity to build trust and credibility between the CHW and households, which over time, can influence other changes.…”

“…Where large-scale CHW programs provide a sustained and comprehensive range of services [ 7 ], it is claimed they can strengthen primary health care within health systems and play an important role in achieving desired health outcomes. However, there is little good-quality evidence in this regard, especially in real-world settings.…”

“…Defaulters are those who fail to turn up for test results, diagnosis or follow-up treatment. According to the data collected by the Ekurhuleni district CHWs, these comprehensive, sustained activities have resulted in improved household referrals, reporting to clinics and access to health care [ 7 ].…”