Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa

Abstract

BackgroundIn 2010, South Africa’s National Department of Health launched a national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to provide a preventive and health-promoting community-based PHC model. A key component of rPHC is the use of community-based outreach teams staffed by generalist community health workers (CHWs).MethodsWe conducted focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province.ResultsThe CHWs we studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community.ConclusionsThere is a need to provide CHWs with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.

Sustaining the National Health Insurance Scheme in South Africa: The Roles and Challenges of Community Health Workers

“…In addition, this study revealed that CHWs are not well accepted in communities. Austin-Evelyn advised that monitoring clients' temperature, blood pressure and weight would enhance CHWs' acceptance in communities [22]. According to him, many members of the community are currently buying and using such screening tools, yet they are not trained, which means that CHWs who have undergone some training would use the screening tools more accurately than the general members of the community [22].…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[24] In the absence of such support, CHWs reverted to dispensing shorter-acting methods. [26] CHWs in SA, especially at 'primary healthcare re-engineering' sites, [27] and HIV lay counsellors -already adept at 'task shifting' -could play an important role in implant services through demand creation, conducting pre-insertion counselling around LARCs and providing follow-up support.…”

Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

“…They are employed to mitigate the ongoing professional health workforce shortages in South Africa [2,3]. In addition, they facilitate linkage between communities most in need and PHC facilities, thereby increasing access to basic health services and contributing to improved health [2,3,[7][8][9][10][11][12].…”

“…Their involvement in active case nding contributes towards the reduced transmission of TB in communities [25]. CHWs conduct systematic household contact TB investigation (SHCI) and refer undiagnosed individuals for clinical evaluation and treatment, trace patients lost to follow-up, and also provide basic behavioural and treatment adherence counselling [7,[9][10][11]. This study sought to understand the dimensions that underly CHWs' motivation to perform SHCI, to ascertain the level of their motivation, and to establish the determinants of their motivation.…”