scholarly journals Community health workers’ efforts to build health system trust in marginalised communities: a qualitative study from South Africa

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044065
Author(s):  
Jocelyn Anstey Watkins ◽  
Frances Griffiths ◽  
Jane Goudge
Keyword(s):  
South Africa ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Interpersonal Trust ◽  
Institutional Trust ◽  
Employment Conditions ◽  
Workplace Trust ◽  
Structural Poverty

IntroductionCommunity health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient–provider relationships, is difficult to build in such communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread. CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury.ObjectivesIn this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system.Design, participants, settingWithin the observation phase of a 3-year intervention study, we conducted interviews, focus groups and observations with patients, CHWs, their supervisors and, facility managers in Sedibeng.ResultsCHWs had low levels of workplace trust. They had recently been on strike demanding better pay, employment conditions and recognition of their work. They did not have the equipment to perform their work safely, and some colleagues did not trust, or value, their contribution. There was considerable interpersonal trust between CHWs and patients, however, CHWs’ efforts were hampered by structural poverty, alcohol abuse and no identification documents among long-term migrants. Those supervisors who understood the extent of the poverty supported CHW efforts to help the community. When patients had withdrawn from care, often due to nurses’ insensitive behaviour, the CHWs’ attempts to repair patients’ institutional trust often failed due to the vulnerabilities of the community, and lack of support from the health system.ConclusionStrategies are needed to build workplace trust including supportive supervision for CHWs and better working conditions, and to build interpersonal and institutional trust by ensuring sensitivity to social inequalities and the effects of structural poverty among healthcare providers. Societies need to care for everyone.

scholarly journals Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicole Salazar-Austin ◽  
Minja Milovanovic ◽  
Nora S. West ◽  
Molefi Tladi ◽  
Grace Link Barnes ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Implementation Strategies ◽  
Healthcare Services ◽  
Preventive Therapy ◽  
Provider Perceptions ◽  
Symptom Screening ◽  
Study Implementation

Abstract Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017.

scholarly journals Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Nireshni Naidoo ◽  
Jean P. Railton ◽  
Sellina N. Khosa ◽  
Nthabiseng Matlakala ◽  
Gert Marincowitz ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Community Survey ◽  
Programme Implementation

scholarly journals Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries

2020 ◽  
Author(s):  
Madeleine Ballard ◽  
Carey Westgate ◽  
Rebecca Alban ◽  
Nandini Choudhury ◽  
Rehan Adamjee ◽  
...  
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Legal Framework ◽  
Law Firms ◽  
Advantages And Disadvantages ◽  
Compensation Mechanisms ◽  
Legal Frameworks

Abstract Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

What are the roles of community health workers? Looking back at the philosophies of primary health care

2019 ◽  
Vol 27 (2) ◽  
pp. 117-120
Author(s):  
Marietou Niang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Development ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Health ◽  
Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

scholarly journals Contextual factors affecting the integration of community health workers into the health system in Limpopo Province, South Africa

2019 ◽  
Vol 12 (4) ◽  
pp. 281-286 ◽  
Author(s):  
Geoffrey Jobson ◽  
Nireshni Naidoo ◽  
Nthabiseng Matlakala ◽  
Gert Marincowitz ◽  
Jean Railton ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Limpopo Province ◽  
Community Members ◽  
Middle Income ◽  
Factors Affecting ◽  
Challenges And Opportunities ◽  
Decision Making Processes

Abstract Background Community health workers (CHWs) are an essential cadre in the health systems of many low- and middle-income countries. These workers provide a wide variety of services and are key to ongoing processes of task shifting within human immunodeficiency virus programmes in particular. Ward-based outreach teams (WBOTs) are South Africa’s latest iteration of the CHW programme and have been introduced as part of the National Department of Health’s Primary Health Care Re-engineering programme. Methods In order to assess the perceived effectiveness of the WBOTs in supporting the ongoing rollout of antiretroviral therapy, tuberculosis care and patient support, we conducted a qualitative investigation focusing on the perceived successes and challenges of the programme among CHWs, community leaders, healthcare workers and community members in the Mopani district, Limpopo province, South Africa. Results The CHW programme operates across these contexts, each associated with its own set of challenges and opportunities. Conclusions While these challenges may be interrelated, a contextual analysis provides a useful means of understanding the programme’s implementation as part of ongoing decision-making processes.

TB/HIV-related training, knowledge and attitudes of community health workers in the Free State province, South Africa

2013 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Christo Heunis ◽  
Edwin Wouters ◽  
Gladys Kigozi ◽  
Ega Janse van Rensburg-Bonthuyzen ◽  
Nandipha Jacobs
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Free State ◽  
Free State Province ◽  
Knowledge And Attitudes
Sign in / Sign up

Export Citation Format

Share Document