Geo-Analysis: The Distribution of Community Health Workers in Relation to the HIV Prevalence in Kwazulu-Natal Province, South Africa

Abstract

Background: The Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that community health workers (CHW)s should be distributed mainly according to poverty lines for each catchment population. We aimed to describe the spatial distribution of CHWs in relation to the HIV prevalence which has been associated with poverty in previous studies.Methods: We utilized geographic information system (GIS) method to visualize the distribution of CHWs in relation to HIV prevalence in KwaZulu-Natal (KZN) districts. Dot density mapping, was used to visualize the random distribution of CHWs in relation to HIV prevalence in the districts. The districts’ HIV prevalence, number of PLWH, CHW: PLWH ratio and poverty scores were mapped using choropleth mapping. MapInfo 17, a GIS software was used to map geospatial presentation of the data.Results: Ten out of 11 KZN districts had more than a required CHW:PLWH ratio of 1:160-267, which indicates a significant shortage of CHWs regardless of the HIV prevalence or poverty scores. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution CHWs in relation to the HIV prevalence and poverty scores in the districts Conclusion: This finding represents inequalities in the provision of HIV services by the CHWs. It is critical to strengthen response to the HIV epidemic through the well informed and justified distribution of CHWs especially to the poor districts.