Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

Doherty, Tanya; Kroon, Max; Rhoda, Natasha; Sanders, David

doi:10.7196/samj.2016.v106i7.10790

Cited by 14 publications

(34 citation statements)

References 10 publications

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“…The scale-up of the prevention of mother-to-child transmission programmes reduced HIV transmission from mother to child, but this has not been sustained owing to limitations in community-based child health services. [1] Child mortality has declined, but has now plateaued. [2] Children continue to die from preventable and treatable causes of death.…”

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confidence: 99%

“…Although SA has a strategy to re-engineer primary healthcare (PHC) through ward-based PHC outreach teams, its impact is currently limited because of a low healthcare worker-topopulation ratio and lack of training. [1] A purely biomedical approach to reduce such deaths is therefore inadequate, and our CDR process highlights the need to consider social and behavioural influences in combination with health systems factors. [4] Interviews with families performed as part of the CDR process have revealed a large number of cases where infants with no previous medical history of note were apparently well and were fed and put to bed, but later found dead.…”

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confidence: 99%

“…[3] Current data sources are incomplete, and do not provide information on deaths occurring out of health facilities. [1] The child death review (CDR) pilot explores the pattern of child deaths and informs prevention strategies to improve child survival in SA. In this editorial we draw on the conclusions of the CDR pilot, [4] where multiagency teams were established to investigate non-natural and unexpected deaths referred to two mortuary sites in order to strengthen child health and protection response systems and to prevent child deaths.…”

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confidence: 99%

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Child deaths in South Africa: Lessons from the child death review pilot

et al. 2016

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Child deaths in South Africa: Lessons from the child death review pilot

et al. 2016

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“…WHO argues for a volunteer‐to‐child ratio of 1:10 (Doherty et al, ). In Ethiopia, success in reducing SAM centred on manageable ratios, since CHWs oversaw a minimum of 10–15 and a maximum of 50 households, enabling them to achieve regular follow‐ups (White & Mason, ).…”

Section: Discussionmentioning

confidence: 99%

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

Mambulu-Chikankheni

Eyles

Ditlopo

2018

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As primary providers of preventive and curative community case management services in low- and middle-income countries (LMICs), community health workers (CHWs) have emerged as a formalised part of the health system (HS). However, discourses on their practices as formalised cadres of the HS are limited. Therefore, we examined their role in care, referral (to clinics) and rehabilitation of severe acute malnutrition (SAM) cases. Focusing on SAM was essential since it is a global public health problem associated with 30% of all South Africa's (SA's) child deaths in 2015. Guided by a policy analysis framework, a qualitative case study was conducted in two rural subdistricts of North West province. From April to August 2016, data collected from CHW's training manuals and guideline reviews, 20 patient record reviews and 15 in-depth interviews with four CHW leaders and 11 CHWs. Using thematic content analysis which was guided by the Walt and Gilson policy triangle, data was manually analysed to derive emerging themes on case management and administrative structures. The study found that although CHWs were responsible for identifying, referring, and rehabilitating SAM cases, they neglected curative roles of stabilisation before referral and treatment of uncomplicated cases. Such limitations resulted from restrictive CHW policies, inadequate training, lack of supportive supervision and essential resources. Concurrently, the CHW program was based on weak operational and administrative structures which challenged CHWs practices. Poor curative components and weak operational structures in this context compromised the use of CHWs in LMICs to strengthen primary healthcare. If CHWs are to contribute to Sustainable Development Goal (SDG) 3 by reducing SAM mortality, strategies on community management of acute malnutrition coupled with thorough training, supportive supervision, firm operational structures, adequate resources and providers' motivation should be adopted by governments.

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“…There is growing evidence that sub-Saharan African countries that have done well at reducing child mortality have invested in CHWs and empowered them with therapeutic roles within their health systems. [44] This curative role is supported by RESEARCH World Health Organization guidelines, a Cochrane review [45] and the integrated community case management strategy. [46] The call is out for SA to increase the number of CHWs, and to include treatment of the common causes of child deaths (pneumonia and diarrhoea) within their scope of practice.…”

Section: Scale Up Evidence-based Medical Interventions To 80% Coveragementioning

confidence: 99%