Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

Ilona Sips,Francoise Barten,Mosa Moshabela,Helen Schneider,Ahmad Haeri Mazanderani,Minrie Greeff

doi:10.1371/journal.pone.0095324

Abstract

Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data – CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.

Highlights

South Africa’s health care system, like other low and middle income countries, struggles to cope with the collision of four excessive health burdens: (1) communicable diseases, especially HIV/AIDS and Tuberculosis (TB); (2) non-communicable diseases; (3) maternal, neonatal and child deaths and; (4) deaths from injury and violence and underlying determinants [1,2]
The deficiencies in the health system are caused by a combination of factors, including South Africa’s colonial and apartheid history [3], inefficient government spending, shortage of material and human resources, especially in rural areas, and lack of clear policy reform [4]
The current study formed part of a larger three-year project conducted in Bushbuckridge, South Africa that investigated the quality of care and support provided to care recipients in their homes and their respective primary caregivers

Summary

Introduction

South Africa’s health care system, like other low and middle income countries, struggles to cope with the collision of four excessive health burdens: (1) communicable diseases, especially HIV/AIDS and Tuberculosis (TB); (2) non-communicable diseases; (3) maternal, neonatal and child deaths and; (4) deaths from injury and violence and underlying determinants [1,2]. The deficiencies in the health system are caused by a combination of factors, including South Africa’s colonial and apartheid history [3], inefficient government spending, shortage of material and human resources, especially in rural areas, and lack of clear policy reform [4]. These difficulties mount additional pressure on the already vulnerable and weak health care system [5,6], with a particular negative impact in rural areas [7]. Care at home can potentially alleviate many of the unmet primary health care needs in the developing world, including reducing health inequalities of marginalized and difficult to reach rural communities [10]

Objectives

Methods

Results

Conclusion