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

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.

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Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Health Policy and Planning ◽

10.1093/heapol/czaa172 ◽

2020 ◽

Author(s):

Joshua P Murphy ◽

Aneesa Moolla ◽

Sharon Kgowedi ◽

Constance Mongwenyana ◽

Sithabile Mngadi ◽

...

Keyword(s):

South Africa ◽

Qualitative Study ◽

Policy Implementation ◽

Community Health ◽

Resource Constraints ◽

Health Workers ◽

Healthcare Providers ◽

Successful Implementation ◽

Programme Implementation ◽

Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

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

10.21203/rs.3.rs-36222/v1 ◽

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.

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Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

Social Science & Medicine ◽

10.1016/j.socscimed.2017.04.046 ◽

2017 ◽

Vol 183 ◽

pp. 97-105 ◽

Cited By ~ 17

Author(s):

Alastair van Heerden ◽

Danielle M. Harris ◽

Heidi van Rooyen ◽

Ruanne V. Barnabas ◽

Nithya Ramanathan ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Hiv Testing And Counseling ◽

Home Based ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Testing And Counseling

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Balancing roles and blurring boundaries: Community health workers’ experiences of navigating the crossroads between personal and professional life in rural South Africa

Health & Social Care in the Community ◽

10.1111/hsc.13153 ◽

2020 ◽

Author(s):

Christina A. Laurenzi ◽

Sarah Skeen ◽

Stephan Rabie ◽

Bronwynè J. Coetzee ◽

Vuyolwethu Notholi ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Professional Life ◽

Rural South ◽

Rural South Africa

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Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa.

South African Family Practice ◽

10.1080/20786190.2019.1613061 ◽

2019 ◽

Vol 61 (4) ◽

pp. 144-149

Author(s):

SLN Nyalunga ◽

JV Ndimande ◽

GA Ogunbanjo ◽

A Masango-Makgobela ◽

T Bogongo

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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

International Health ◽

10.1093/inthealth/ihz082 ◽

2019 ◽

Vol 12 (4) ◽

pp. 281-286 ◽

Cited By ~ 2

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.

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