Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

Abstract

BackgroundCommunity care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks.ObjectiveThe aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network.DesignWe analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants.FindingsThe results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards.ConclusionsCCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to the client, and preferences of the clients remain central to the process of negotiating care.

Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry

“…In South Africa, the healthcare system struggles to cope with the high demand for services due to a large burden of disease, and as a result, households and communities are said to be responsible for 90% of the caring of the ill, often provided at home [12,13]. In rural areas, access to healthcare is further compromised by a number of health system and socio-economic barriers [14].…”

“…If, after two years, the CHWs do not meet the job competency requirements, they are no longer eligible to continue working within the outreach teams [20]. The role of the CHWs within the outreach teams is mainly to strengthen the interface between the households and health facility services [12,13]. The CHWs provide various services, which include linking communities to the healthcare system, preventative care and keeping track with disease outbreak [21], as well as offering community-based healthcare and social support to complement rather than substitute the more specialised services of the healthcare system [13].…”

“…The CHWs provide various services, which include linking communities to the healthcare system, preventative care and keeping track with disease outbreak [21], as well as offering community-based healthcare and social support to complement rather than substitute the more specialised services of the healthcare system [13]. In a study conducted in rural South Africa, it was reported that the CHWs negotiated and established a personalised client-centred package of care, and that they continually assessed and adapted the package of services for each client and household as circumstances evolved [12]. CHWs repeatedly visits clients, personally attend to them, collect their medicines and advocate for them with either their families or health providers in cases of access barriers [13].…”

“…CHWs repeatedly visits clients, personally attend to them, collect their medicines and advocate for them with either their families or health providers in cases of access barriers [13]. The WHO indicate that CHWs are essential in PHC as they have been shown to assist in improving health outcomes in communities [12,21]. …”

Early detection of developmental delays in vulnerable children by community care workers using an mHealth tool

“…[11] In many South African studies, they are also referred to as community care workers (CCWs). [12,13,14,15] CCWs play an unprecedented role in the social welfare of community members, in addition to focusing on health needs. [16] No clear distinctions between these terms (CHWs vs CCWs) exist across current literature, mainly due to tasks that are formally or informally added to their job description.…”