Factors Associated With Workplace and Interpersonal Trust in the Supervisory System of a Community Health Worker Programme in a Rural South African District.

Tumelo Assegaai,Helen Schneider

doi:10.34172/ijhpm.2021.03

Abstract

Background: Key to effective supportive supervision, and ultimately performance of community health workers (CHWs), is the nature of relationships in the formal health system at the coal face of programmes. The central character and defining feature of effective relationships, in turn, is the ability to engender trust. This study describes factors associated with workplace and interpersonal trust, the relationship between the two sets of trust factors and how this shaped perceived performance of CHWs in ward-based outreach teams (WBOTs) in a rural South African district. Methods: In the context of a wider study of supportive supervision of CHWs, factors recognised to be associated with trust in the literature were studied qualitatively in Ngaka Modiri Molema district, North West Province. Focus group discussions (FGDs) and individual interviews were conducted by the first author with CHWs (23), team leaders (12), facility managers (10) and middle managers (5). Interviews were recorded, translated and transcribed. Perceptions of trust factors associated with workplace and interpersonal trust were analysed thematically. Results: The interviews revealed a climate of considerable workplace mistrust due to the perceived abandonment of the WBOTs programme by managers at all levels, and this affected support and supervision of WBOTs. However, there was a degree of variability and discretion in expressions of interpersonal trust at the coal face, leading to different perceptions of the competence and functionality of the WBOTs. Mistrust in the workplace and poor interpersonal relationships translated into low confidence in the ability of CHWs, which in turn compromised the performance of these teams. Conclusion: The study contributes empirical evidence on how workplace trust factors impact on interpersonal trust factors and the possible implications of both sets of trust factors on perceived performance of CHWs. Wider trust in the health system have a significant bearing on interpersonal trust between CHWs and other players in the primary healthcare (PHC) system.

Highlights

We conceptualised workplace trust factors as referring to factors associated with health worker trust in the wider health system, and interpersonal trust factors as those associated with interactions amongst health workers
With respect to management support, respondents described an environment of minimal support and apparent wholesale disengagement on issues relating to ward-based outreach teams (WBOTs) from all layers of management in the health system
This study examined factors of trust and mistrust in a Community health worker (CHW) programme at sub-national level

Summary

Introduction

Community health worker (CHW) programmes require effective support and supervision systems.[1,2] Supervision of CHWs impacts on the performance of programmes as well as the ability of community-based services to coordinate with other players in the primary healthcare (PHC) system.[3,4] Key to supportive supervision, and performance of CHWs, is the nature of relationships with both the formal health system and communities at the coal face of programmes.[2,5] Health systems, more generally, can be viewed as fundamentally social systems of relationships which in part determine the performance of these health systems.[5,6,7] The central character and defining feature of effective relationships, in turn, is the ability to engender trust.[6,8,9,10,11] As pointed out: “health systems comprise a complex web of relationships whose overall functioning and performance is influenced by the institutions, trust, that govern human behaviour.”[6]

Methods

Results

Discussion

Conclusion