Evaluating community health worker education policy through a National Certificate (Vocational) Primary Health qualification lens

Abstract

Background: In 2018, the South African National Department of Health (NDoH) published a 5-year policy framework and strategy for Ward-Based Primary Healthcare Outreach teams to improve team management and leadership and support service delivery. In the same year, the World Health Organization (WHO) published guidelines on health policy and system support to optimise Community Health Worker (CHW) programmes.Aim: This article aims to assess the National Certificate (Vocational), or NC(V), Primary Health qualification in terms of the education and training guidelines and recommendations of the 2018 NDoH and WHO policy documents.Setting: The qualification was initiated in 2013 at 12 Technical and Vocational Education and Training (TVET) colleges across South Africa. The evaluation covered the period 2013–2017.Methods: Pragmatic qualitative enquiry was used to examine the context, design, implementation and outcomes of the qualification. Data collection involved document reviews, key informant in-depth interviews and focused group discussions, and individual reflections with respondents from one part-time and two full-time offerings at two colleges. Analyses of emergent themes were interpreted using appropriate models and theoretical frameworks.Results: The Department of Higher Education and Training (DHET) created and implemented a standardised, curriculated national programme for CHW education that structured theoretical and practical learning over time to ensure assimilation of content and its application in practice.Conclusion: NC(V) Primary Health, as a single, national, quality-assured qualification for CHWs, meets WHO 2018 guidelines and recommendations, NDoH training needs and CHWs learning expectations, especially when offered part-time. Despite the termination of the programme, it remains a relevant option for CHWs in South Africa and elsewhere.

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

“…(18,19,22,23) This highlights the need to have standardized training that is tailored to the context in which CHWs are working and addresses the burden of NCDs. (24,25) The Department of Health envisage that CHWs will address the risk factors for chronic diseases through lifestyle modi cation strategies aimed at tobacco smoking cessation, physical activity, healthy diet and alcohol reduction. The NDOH recommended that CHW teams should consist of six to ten CHWs supervised by a nurse coordinator (professional nurse) to ensure adequate coverage of the de ned population.…”

“…CHWs with less educational foundation and less experience had di culty conducting health talks and explaining nutritional concepts. Key issues are the selection of CHWs with a su cient educational level, a standardised training programme and alignment of the programmatic learning outcomes with the roles expected of CHWs in policy (24,25). The MHS later made a decision to only appoint CHWs who had completed high school.The roles of CHWs in rehabilitation and palliative care are not well de ned in policy although this forms part of the National Developmental Plan for 2030.…”

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

“…Several studies have also commented on the need for better training of CHWs to tackle NCDs [18,19,22,23]. This highlights the need to have standardized training that is tailored to the context in which CHWs are working and addresses the local burden of NCDs [24,25].…”

“…CHWs with less educational foundation and less experience had difficulty conducting health talks and explaining nutritional concepts. Key issues are the selection of CHWs with a sufficient educational level, a standardised training programme and alignment of the programmatic learning outcomes with the roles expected of CHWs in policy [24,25]. The Metro Health Services later made a decision to only appoint CHWs who had completed high school.…”

Lung cancer awareness training experiences of community health workers in KwaZulu-Natal, South Africa

“…In addition, it has been established that currently, the CHW curriculum does not include lung cancer awareness. 29 , 30 Hence, the opportunity to work with CHWs in raising awareness on lung cancer at community level was considered an important contribution to potentially ensuring early disease detection, diagnosis and treatment, as CHWs often serve as linkages between health facilities and patients. Therefore, the integration of lung cancer awareness interventions on the training of CHWs should be explored.…”