Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa

PLOS Global Public Health · 5 authors, 3 centres

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TL;DR

This qualitative case study explored South African community health worker (CHW) programmes and found they were not fully aligned with community-orientated primary health care principles due to low community participation and poor health system support. The study concludes that effective CHW programmes require better integration, funding, and supervision within the health system.

Full summary

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Using a qualitative case study design, researchers explored community health worker (CHW) programmes across seven South African primary healthcare facilities. Data were collected through in-depth interviews with managers, supervisors, and community representatives, and through focus groups and observations with CHWs. The study assessed programme implementation against community-orientated primary health care (COPC) principles. Findings indicated limited community involvement in programme design and implementation, as residents prioritised other issues like housing. CHW effectiveness was hampered by insufficient training and supervision, though multidisciplinary training from medical doctors improved skills. Programmes also faced challenges from an unsupportive health system, unreliable technology, and funding instability. Limitations include potential for socially desirable responses and the subjective nature of assessing COPC principles. The implications are that for CHW programmes to be effective in resource-limited settings, they require sustained government funding, systemic integration, and structured support for supervision and training.

STUDY TYPE

other

SPECIALTY

public health

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10021906

Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa

PLOS Global Public Health

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ABSTRACT

Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services’ were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.

CITATION EXPORT

Hlologelo Malatji, Frances Griffiths, Jane Goudge et al.. Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa. PLOS Global Public Health. (2023). https://doi.org/10.1371/journal.pgph.0000881

AUTHORS

5 · 3 CENTRES

Hlologelo Malatji, Frances Griffiths, Jane Goudge, Shailendra Prasad, Shailendra Prasad

1 Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2 Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
University of Minnesota, UNITED STATES

EDITOR / REVIEWER

Shailendra Prasad