The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town.

Lungiswa P Tsolekile,Thandi Puoane,Helen Schneider

doi:10.4102/curationis.v41i1.1815

Lungiswa P Tsolekile, Thandi Puoane + Show 1 more

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https://doi.org/10.4102/curationis.v41i1.1815

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Abstract

BackgroundThe current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood.ObjectivesTo assess CHWs’ current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town.MethodsA cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs’ knowledge of hypertension and diabetes were conducted.ResultsThe vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs’ roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs’ knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month).ConclusionsThe roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.

Highlights

Non-communicable diseases (NCDs) such as diabetes and hypertension are public health problems that place a heavy burden on health facilities
In South Africa, community health workers (CHWs) provide community-based care, but for years, their efforts have been focused on homebased care for people with HIV and TB, with little done in the area of NCDs
According to the International Diabetes Federation (IDF), 2.28 million South Africans had diabetes in 2015 (IDF 2015), while the prevalence of hypertension is on the increase (Gomez-Olive et al 2013; Lloyd-Sherlock et al 2014; Thorogood et al 2007)

Summary

Introduction

Non-communicable diseases (NCDs) such as diabetes and hypertension are public health problems that place a heavy burden on health facilities. According to the World Health Organization in 2015, three quarters of all NCD-related deaths occur in low- and middle-income countries (LMIC) (WHO 2016), where diabetes prevalence quadrupled between 1980 and 2014 (NCD Risk Factor Collaboration 2016). This rise in NCDs has implications for health systems and populations, affecting the most economically active age groups (Islam & Biswas 2014; Peck et al 2014). One of the constraints to managing NCDs is the poor availability of adequately trained human resources (Islam & Biswas 2014; Peck et al 2014)

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