Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa

Abstract

Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services’ were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.

Mobilisation towards formal employment in the healthcare system: A qualitative study of community health workers in South Africa

“…We applied the maximum variation technique to select the two provinces based on their location (urban vs rural), history and contrasting models of implementing the CHW programmes. The CHW programmes in the three districts of Gauteng province were implemented by the Provincial Department of Health with a payroll administration company contracted to pay the CHWs on behalf of the Department [ 17 ]. The Mpumalanga province, where the rural case studies were located, had not fully implemented the national CHW programme [ 17 ].…”

“…The CHW programmes in the three districts of Gauteng province were implemented by the Provincial Department of Health with a payroll administration company contracted to pay the CHWs on behalf of the Department [ 17 ]. The Mpumalanga province, where the rural case studies were located, had not fully implemented the national CHW programme [ 17 ]. Here, the Provincial Department of Health funded existing local NGOs that provided home-based care services, to deploy some of its carers to constitute the CHW programme in local health facilities [ 17 ].…”

“…The Mpumalanga province, where the rural case studies were located, had not fully implemented the national CHW programme [ 17 ]. Here, the Provincial Department of Health funded existing local NGOs that provided home-based care services, to deploy some of its carers to constitute the CHW programme in local health facilities [ 17 ]. The NGOs remained the primary employers of the CHWs, while supervision and resources were being provided by the health facilities [ 17 ].…”

“…Here, the Provincial Department of Health funded existing local NGOs that provided home-based care services, to deploy some of its carers to constitute the CHW programme in local health facilities [ 17 ]. The NGOs remained the primary employers of the CHWs, while supervision and resources were being provided by the health facilities [ 17 ]. Though we had an interest in the two provinces, we spent 3 years in one district of Gauteng province.…”

Crisis Readiness and Innovation for Burnout Prevention Among Community Health Workers

“…There is an ongoing discussion on how public health systems can support health worker’s professional development [30] [31]. Country-specific literature reviews from Brazil[32] South Africa[33] and Botswana[34] echo similar themes. The staff development programmes in these reviews highlight gaps in policy to incentivize CHWs to provide health services to underserved communities.…”