Abstract
ABSTRACTCommunity health workers (CHWs) affiliated with community-based organisations are central to the implementation of primary health care in district health services in South Africa. Here, we explore factors that affect the provision of and access to care in two provinces – Gauteng and Eastern Cape. Drawing on narratives of care recipients and the CHWs who support them, we illustrate the complex issues surrounding health maintenance and primary care outreach in poor communities, and describe how the intimate interactions between providers and recipients work to build trust. In the study we report here, householders in Gauteng Province had poor access to health care and other services, complicating the impoverished circumstances of their everyday lives. The limited resources available to CHWs hindered their ability to meet householders’ needs and for householders to benefit from existing services. CHWs in the Eastern Cape were better able to address the needs of poor householders because of the organisational support available to them. Based on an ethos of integrated and holistic care, this enabled the CHWs to address the recipients’ context-related needs, and health and medical needs, while building greater levels of trust with their clients.
Highlights
The persistence of health inequities in low and middle income countries has been a strong driver for changes in health systems and in mechanisms for the provision of health care
While difficulties in ensuring synergies and collaboration have continued at national policy levels, primary health care (PHC) has been emphasised as central to achieving better health outcomes
In the delivery of PHC, community health workers (CHWs) are commonly identified as critical because of their capacity to work closely with vulnerable communities and individuals, and to address problems arising from limitations in the number of trained health workers able to work at this level (Christopher, Le May, Lewin, & Ross, 2011; Maes & Kalofonos, 2013)
Summary
The persistence of health inequities in low and middle income countries has been a strong driver for changes in health systems and in mechanisms for the provision of health care. In contemporary South Africa, the district health system remains poorly structured and unintegrated, and is characterised by lack of resources, health worker shortages and weak managerial capacity (Kautzky & Tollman, 2008) These all continue to limit the efficacy of CHW programmes. The community-based model has been conceptualised with three streams: district health specialists to provide core support; school-based PHC to provide school health services; and ward-based PHC outreach teams, primarily constituted of CHWs and led by a nurse. In this model, CHWs are recognised to be central to the “re-engineering” of PHC. There is personalised engagement and relatively holistic care provided by CHWs to householders
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