Emerging from the Shadows: Intrinsic and Extrinsic Factors Facing Community Health Workers in Western Cape, South Africa.

Wilson Majee,Anthea Rhoda,Jose Frantz,Laura Schopp,Adaobi Anakwe,Levona Johnson

doi:10.3390/ijerph17093199

Abstract

Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa. All interviews were audiotaped, transcribed verbatim, coded and analyzed using NVivo 12. Drawing on narratives of CHWs, we illustrate the complex issues surrounding CHW outreach in poor rural communities. The CHWs identified five key areas of challenges with respect to personal health, gender issues, poor community understanding of CHWs roles, environmental challenges and lack of patient adherence. These all hinder the ability of CHWs to meet their personal and familial needs, as well as those of the community members they support. There is a need to address the intrinsic needs of CHWs in order to ensure their emotional and physical well-being, as well as a need to create an awareness of the roles of CHWs.

Highlights

Ensuring a healthy population is one of the essential goals of any government
The results of this study show that the challenges faced by community health workers are both intrinsic and extrinsic
Our study revealed that patient attitudes toward male community health workers (CHWs) were sometimes negative, as the CHW role is often viewed as a “female” profession [15]

Summary

Introduction

Ensuring a healthy population is one of the essential goals of any government. Globally, governments have recognized the importance of providing primary health care at community levels.In 2010, South Africa implemented strategies to transform the health system from an individualized, passive, curative, vertical system to a population-based, integrated, proactive model [1]. Ensuring a healthy population is one of the essential goals of any government. Governments have recognized the importance of providing primary health care at community levels. In 2010, South Africa implemented strategies to transform the health system from an individualized, passive, curative, vertical system to a population-based, integrated, proactive model [1]. Because of this proactive approach, community health workers (CHWs) have increasingly become central to the “re-engineering” of health care services. CHWs are lay people who live and work almost exclusively in the communities they serve They perform multiple functions, including patient and community education, health service provision, decreasing cultural, linguistic and literacy barriers, linking people with community resources, and facilitating patient communication and adherence to care [2].

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Discussion

Conclusion