Lay health workers and HIV programmes: implications for health systems

Abstract

One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.

“She is my teacher and if it was not for her I would be dead”: Exploration of rural South African community health workers' information, education and communication activities

“…Interviews were conducted with the CHWclient-caregiver trio in order to provide multiple perspectives (Schneider & Lehmann, 2010) and to improve the trustworthiness of findings through triangulation.…”

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

“…It recommends that 115 of these tasks can be performed by CHWs, highlighting the immense potential of CHWs in HIV services (145). CHWs fill diverse roles in HIV prevention and care, including provision of home-based, palliative care, voluntary HIV counseling and testing services, treatment preparation and support services, community mobilization, and HIV prevention/health promotion (108). CHWs are particularly important in mobilizing pregnant women to undergo HIV testing and encouraging them to adhere to treatment with ART as well as to practice exclusive breastfeeding (all of which are important strategies for reducing mother-to-child transmission of HIV).…”

“…Awareness of the need for more human resources in sub-Saharan Africa became heightened following the emergence of HIV and the availability of ART services (10,108,156 …”

Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi

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