The unmet needs and health priorities of the urban poor: Generating the evidence base for urban community health worker programmes in South Africa

Rie, Annelies Van; West, Nora; Schwartz, Sheree; Mutanga, L; Hanrahan, Colleen F.; Ncayiyana, Jabulani; Bassett, J. Todd

doi:10.7196/samj.2018.v108i9.13054

Cited by 8 publications

(12 citation statements)

References 13 publications

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“…The findings in this review [ 14 , 15 , 18 , 33 ] suggested that performance-based incentives were widely used as an income strategy to motivate and engage CHWs in the delivery of NCD-related health interventions, although the large-scale validity is uncertain. Therefore, future studies and policies need to be concerned about how to expand the coverage of NCMS contract to all village clinics, how to allocate funding and limited resources to better remunerate and motivate CHWs, and how to ensure commitments to human resources development and capacity building [ 6 , 60 , 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Long

Huang

Zheng

et al. 2018

IJERPH

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Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.

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Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Long

Huang

Zheng

et al. 2018

IJERPH

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“…Despite the progress achieved with the integration of the CHWs into the formal structure of the ward-based team, there remains ambiguity over the role and scope of CHWs’ tasks as the current ward-based teams are generally top–down, vertical and disease-orientated programmes with challenges arising from poor supervision, inadequate and fragmented disease-specific training. 17,18 Moreover, different interpretation and implementation of the CHW scope, allocated tasks and working conditions are evident in different provinces. 17,18 The National DoH (2015) authorised a rapid assessment of WBOT in seven provinces to understand the challenges and to generate potential solutions.…”

Section: Introductionmentioning

confidence: 99%

“…17,18 Moreover, different interpretation and implementation of the CHW scope, allocated tasks and working conditions are evident in different provinces. 17,18 The National DoH (2015) authorised a rapid assessment of WBOT in seven provinces to understand the challenges and to generate potential solutions. 18 The rapid assessments found that WBOT programmes contribute towards maternal and child health, adherence support and home-based care.…”

Section: Introductionmentioning

confidence: 99%

“…18 The rapid assessments found that WBOT programmes contribute towards maternal and child health, adherence support and home-based care. 17 Despite the rapid assessment of WBOTs finding support in the facility-based extension model, some authors suggest that the current system creates tension in the PHC system, as nurses have to juggle their clinical-based responsibilities with the supervision of CHW, which leads to gaps in CHW supervision. 17,18 Furthermore, there has been insufficient attention focused on infrastructure, provision of materials, leadership and accountability.…”

Section: Introductionmentioning

confidence: 99%

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Community healthcare worker response to childhood disorders: Inadequacies and needs

Naidoo

Govender

2019

African Journal of Primary Health Care & Family Medicine

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Background Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. Aim This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. Setting This study was conducted in an urban district in KwaZulu-Natal, South Africa. Methods This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. Results There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised were also generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. Conclusion Training of CHWs in childhood disorders may assist in improving CHWs’ competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care.

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“…This suggests that investment in the quality of care is highly warranted to reduce barriers that may currently exist in accessing services at PHC facilities. CHWs have been proven to be important to address the unmet need for (health) care in urban communities [20]; in our study, after training, they also managed to mobilise a substantial number of individuals for care of STI-associated symptoms. The traditional structure did not result in the mobilisation of a large number of individuals for care despite the strong role of traditional leaders in these communities [21].…”

Section: Discussionmentioning

confidence: 86%

Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

Hoffman

Fritz

Matlakala

et al. 2019

Tropical Med Int Health

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objectives To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa.methods Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility.results We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30 days; 49% (87/177) had symptoms >6 months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care.conclusions We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population.keywords unmet need, sexually transmitted infections, community-based strategies, primary health care Tropical Medicine and International Health

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The unmet needs and health priorities of the urban poor: Generating the evidence base for urban community health worker programmes in South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 8 publications

References 13 publications

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Community healthcare worker response to childhood disorders: Inadequacies and needs

Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

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