Community Care Workers, Poor Referral Networks and Consumption of Personal Resources in Rural South Africa

Abstract

Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data – CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.

Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry

“…In South Africa, the healthcare system struggles to cope with the high demand for services due to a large burden of disease, and as a result, households and communities are said to be responsible for 90% of the caring of the ill, often provided at home [12,13]. In rural areas, access to healthcare is further compromised by a number of health system and socio-economic barriers [14].…”

“…In rural areas, access to healthcare is further compromised by a number of health system and socio-economic barriers [14]. Providing care in the home can reduce unmet PHC needs, and ultimately reduce health inequalities of marginalised and hard-to-reach communities [13]. In response to its national health crisis, the South African Government had developed a comprehensive plan to transform the health system of the country in order to achieve the goal of health for all.…”

“…If, after two years, the CHWs do not meet the job competency requirements, they are no longer eligible to continue working within the outreach teams [20]. The role of the CHWs within the outreach teams is mainly to strengthen the interface between the households and health facility services [12,13]. The CHWs provide various services, which include linking communities to the healthcare system, preventative care and keeping track with disease outbreak [21], as well as offering community-based healthcare and social support to complement rather than substitute the more specialised services of the healthcare system [13].…”

“…The role of the CHWs within the outreach teams is mainly to strengthen the interface between the households and health facility services [12,13]. The CHWs provide various services, which include linking communities to the healthcare system, preventative care and keeping track with disease outbreak [21], as well as offering community-based healthcare and social support to complement rather than substitute the more specialised services of the healthcare system [13]. In a study conducted in rural South Africa, it was reported that the CHWs negotiated and established a personalised client-centred package of care, and that they continually assessed and adapted the package of services for each client and household as circumstances evolved [12].…”

“…In a study conducted in rural South Africa, it was reported that the CHWs negotiated and established a personalised client-centred package of care, and that they continually assessed and adapted the package of services for each client and household as circumstances evolved [12]. CHWs repeatedly visits clients, personally attend to them, collect their medicines and advocate for them with either their families or health providers in cases of access barriers [13]. The WHO indicate that CHWs are essential in PHC as they have been shown to assist in improving health outcomes in communities [12,21].…”