A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa

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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Community health worker home visiting in deeply rural South Africa: 12-month outcomes

Global Public Health ◽

10.1080/17441692.2020.1833960 ◽

2020 ◽

pp. 1-14

Author(s):

Linnea Stansert Katzen ◽

Karl W. le Roux ◽

Ellen Almirol ◽

Panteha Hayati Rezvan ◽

Ingrid M. le Roux ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Home Visiting ◽

Rural South ◽

Rural South Africa

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The evolving socio-political context of community health worker programmes in South Africa: Implications for historical analysis. A commentary on van Ginneken, Lewin and Berridge "the emergence of community health worker programmes in the late-apartheid era in South Africa: An historical analysis"(2010)

Social Science & Medicine ◽

10.1016/j.socscimed.2011.01.026 ◽

2011 ◽

Vol 72 (7) ◽

pp. 1021-1024 ◽

Cited By ~ 4

Author(s):

Dingie J. van Rensburg ◽

Edwin Wouters ◽

Katinka de Wet

Keyword(s):

South Africa ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Historical Analysis ◽

Political Context

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Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa

BMJ Open ◽

10.1136/bmjopen-2019-030677 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030677

Author(s):

Frances Griffiths ◽

Olukemi Babalola ◽

Celia Brown ◽

Julia de Kadt ◽

Hlologelo Malatji ◽

...

Keyword(s):

South Africa ◽

Quality Of Care ◽

Community Health ◽

Health Worker ◽

Community Health Workers ◽

Community Health Worker ◽

Health Workers ◽

Comprehensive Care ◽

Household Visit

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

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Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa

International Journal for Equity in Health ◽

10.1186/s12939-017-0565-3 ◽

2017 ◽

Vol 16 (1) ◽

Cited By ~ 14

Author(s):

Helen Schneider ◽

Nonhlanhla Nxumalo

Keyword(s):

South Africa ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Case Analysis ◽

Cross Case Analysis

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

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v12i1.2104 ◽

2020 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Michelle N.S. Janse van Rensburg ◽

Tessa S. Marcus

Keyword(s):

South Africa ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Education And Training ◽

World Health ◽

Primary Health ◽

Part Time ◽

Guidelines And Recommendations ◽

And Training

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.

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Community health worker-delivered counselling for common mental disorders among chronic disease patients in South Africa: a feasibility study

BMJ Open ◽

10.1136/bmjopen-2018-024277 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024277 ◽

Cited By ~ 14

Author(s):

Bronwyn Myers ◽

Petal Petersen-Williams ◽

Claire van der Westhuizen ◽

Crick Lund ◽

Carl Lombard ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Chronic Disease ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Qualitative Interviews ◽

Chronic Disease Patients ◽

Hazardous Alcohol ◽

Health Counselling

ObjectivesTo examine the feasibility and acceptability of integrating a ‘designated’ approach to community health worker (CHW)-delivered mental health counselling (where existing CHWs deliver counselling in addition to usual duties) and a ‘dedicated’ approach (where additional CHWs have the sole responsibility of delivering mental health counselling) into chronic disease care.DesignA feasibility test of a designated and dedicated approach to CHW-delivered counselling and qualitative interviews of CHWs delivering the counselling.SettingFour primary healthcare clinics in the Western Cape, South Africa allocated to either a designated or dedicated approach and stratified by urban/rural status.ParticipantsForty chronic disease patients (20 with HIV, 20 with diabetes) reporting hazardous alcohol use or depression. Interviews with seven CHWs.InterventionThree sessions of structured mental health counselling.Main outcome measuresWe assessed feasibility by examining the proportion of patients who were willing to be screened, met inclusion criteria, provided consent, completed counselling and were retained in the study. Acceptability of these delivery approaches was assessed through qualitative interviews of CHWs.ResultsRegardless of approach, a fair proportion (67%) of eligible patients were willing to receive mental health counselling. Patients who screened positive for depression were more likely to be interested in counselling than those with hazardous alcohol only. Retention in counselling (85%) and the study (90%) was good and did not differ by approach. Both dedicated and designated CHWs viewed the counselling package as highly acceptable but requested additional training and support to facilitate implementation.ConclusionsDedicated and designated approaches to CHW-delivered mental health counselling were matched in terms of their feasibility and acceptability. A comparative efficacy trial of these approaches is justified, with some adjustments to the training and implementation protocols to provide further support to CHWs.

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