Abstract
Community health workers (CHWs) play a significant role in Primary health Care due to their proximity to households, communities and the health care system. Many studies focus on CHWs and the work they do. However, few have examined their experiences and identity and how that might influence how they view and perform their roles. The objectives of the study were to: Describe the role of CHWs in community-based health care in Northern Cape, Identify the perceived barriers and enablers to CHWs role performance, Explore CHWs views regarding the support from the communities and the formal healthcare system in Northern Cape. An exploratory qualitative design using focus groups was adopted. Forty-six (46) CHWs were purposively selected using the critical case sampling approach. Data were collected through three focus group interviews in three regions. Analysis followed the Graneheim & Lundman thematic analysis. Three themes emerged from data: perceived contribution to Primary Health Care, recognition of CHWs role, measures to improve working conditions. Findings showed that CHWs were engaged in various health and social care roles, they believed that they made a significant contribution to PHC, and that the health system persistently relied on their services. The enabler for finding meaning in their work was the positive community response and the good relations they had with the team leaders. The major barrier was the structure of the CHWs programme and the perceived lack of support by the government. The complex issues CHWs address in the community call for a review of their roles and workload as well as the support they receive from the formal healthcare system.
Highlights
The Primary Health Care Re-engineering Model established in South Africa in 2010, puts strong emphasis on community-based care and includes social determinants of health in its approach
The service is provided in collaboration with local health care facilities, other sectors and non-governmental organisations (NGOs) [1]
The interpretation of the results is presented under the headings of the three themes and sub-themes with quotations to show the emic perspective of Community health workers (CHWs)
Summary
The Primary Health Care Re-engineering Model established in South Africa in 2010, puts strong emphasis on community-based care and includes social determinants of health in its approach. It integrates healthcare with health promotion and community participation [1] Within this model, Wardbased PHC Outreach Teams (WBPHCOTs) were established to deliver health promotion at ‘household and community level’ [2]. Each team comprises a professional nurse (team leader) linked to a health care facility, supervising six to ten CHWs. The main focus of the activities of teams is to strengthen health promotion, identify and support vulnerable individuals and families, based on the concept of a “healthy. The District Health System primary role is to organize, manage and deliver PHC, including the CHWs programmes [6], skilled key health professionals and adequate resources are critical for the for the District to function optimally
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