scholarly journals Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
L. S. Thomas ◽  
E. Buch ◽  
Y. Pillay ◽  
J. Jordaan
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Large Scale ◽  
Health District ◽  
Health Seeking ◽  
Middle Income ◽  
Seeking Behavior

Abstract Introduction South Africa is an upper middle-income country with wide wealth inequality. It faces a quadruple burden of disease and poor health outcomes, with access to appropriate and adequate health care a challenge for millions of South Africans. The introduction of large-scale, comprehensive community health worker (CHW) programs in the country, within the context of implementing universal health coverage, was anticipated to improve population health outcomes. However, there is inadequate local (or global) evidence on whether such programs are effective, especially in urban settings. Methods This study is part of a multi-method, quasi-experimental intervention study measuring effectiveness of a large-scale CHW program in a health district in an urban province of South Africa, where CHWs now support approximately one million people in 280,000 households. Using interviewer administered questionnaires, a 2019 cross-sectional survey of 417 vulnerable households with long-term CHW support (intervention households) are compared to 417 households with no CHW support (control households). Households were selected from similar vulnerable areas from all sub-levels of the Ekurhuleni health district. Results The 417 intervention and control households each had good health knowledge. Compared to controls, intervention households with long-term comprehensive CHW support were more likely to access early care, get diagnosed for a chronic condition, be put on treatment and be well controlled on chronic treatment. They were also more likely to receive a social grant, and have a birth certificate or identity document. The differences were statistically significant for social support, health seeking behavior, and health outcomes for maternal, child health and chronic care. Conclusion A large-scale and sustained comprehensive CHW program in an urban setting improved access to social support, chronic and minor acute health services at household and population level through better health-seeking behavior and adherence to treatment. Direct evidence from households illustrated that such community health worker programs are therefore effective and should be part of health systems in low- and middle-income countries.

scholarly journals Are large scale, urban, comprehensive CHW programs effective? The South African experience

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L S Thomas ◽  
E Buch ◽  
Y Pillay ◽  
J Jordaan
Keyword(s):  
Social Support ◽  
South Africa ◽  
Health Care ◽  
Chronic Disease ◽  
Health Outcomes ◽  
Disease Control ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Large Scale

Abstract Background South Africa is an upper middle-income country, but has one of the widest GINI co-efficients in the world. It faces a heavy burden of disease and poor health outcomes remain a challenge for millions of South Africans. Slow economic growth, rapid urbanization and high unemployment could de-rail the efforts to improve access to health care and health outcomes amongst the most vulnerable in the country. Within this context, the introduction of large scale, comprehensive community health worker (CHW) programs, in urban areas are seen to be game changers. However, there is inadequate global evidence on whether such programs work. Methods This is a multi-method, quasi-experimental intervention study measuring the effectiveness of a CHW program in the Ekurhuleni health district; set in an urban province of South Africa, where CHWs support approximately one million people. Health indicator performance was compared in clinics with good coverage of CHWs and those with low or no CHW support. Poor and vulnerable households with CHW support were compared to those with no CHW support. Results Over a nine-year period since implementation, clinics with CHW programs improved better than clinics without; on identified pregnancy, child health, infectious disease and non-communicable disease indicators. Odds ratios showed that households with good CHW coverage had better social support, health-seeking behavior, morbidity and mortality than households without. p-values were statistically significant (<0.05) for social support, chronic disease diagnosis and chronic disease control outputs. Conclusions This CHW program has shown its worth as it has been effective in improving early screening, referrals, diagnosis and disease control across a number of health conditions in an urban setting. Key messages Large-scale comprehensive CHW programs are a good investment towards achieving universal health coverage for all by improving access and care to the poor and vulnerable. Community Health Worker services in households are effective and should be a legitimate level of health care delivery in developing countries.

Conclusion

2021 ◽  
pp. 195-202
Author(s):  
Laura Hakimi ◽  
Anne Geniets ◽  
James O’Donovan ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Health Worker ◽  
Community Health Worker ◽  
Middle Income ◽  
Middle Income Countries ◽  
Methodological Research ◽  
Training And Supervision ◽  
Low And Middle Income

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

scholarly journals A new resource for developing and strengthening large-scale community health worker programs

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Henry Perry ◽  
Lauren Crigler ◽  
Simon Lewin ◽  
Claire Glenton ◽  
Karen LeBan ◽  
...  
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Large Scale

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

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173863 ◽  
Author(s):  
Katherine Austin-Evelyn ◽  
Miriam Rabkin ◽  
Tonderayi Macheka ◽  
Anthony Mutiti ◽  
Judith Mwansa-Kambafwile ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Eastern Cape ◽  
Primary Health

scholarly journals An analysis of the services provided by Community Health Workers within an urban district in South Africa: a key contribution towards universal access to care.

2021 ◽  
Author(s):  
Leena Susan Thomas ◽  
Eric Buch ◽  
Yogan Pillay
Keyword(s):  
South Africa ◽  
Access To Care ◽  
Community Health ◽  
Health Worker ◽  
Social Services ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Urban Setting ◽  
Early Screening

Abstract Introduction: Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.Methods: Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280 000 households with one million people. Results: Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV & TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services.Conclusion: Community Health Workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother & child related, HIV & TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.

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