Open AccessCommunity health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework
Author(s) -
Joshua Murphy,
Aneesa Moolla,
Sharon Kgowedi,
Constance Mongwenyana,
Sithabile Mngadi,
Nkosinathi Ngcobo,
Jacqui Miot,
Denise Evans,
Sophie Pascoe
Publication year - 2020
Publication title -
health policy and planning
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.608
H-Index - 92
eISSN - 1460-2237
pISSN - 0268-1080
DOI - 10.1093/heapol/czaa172
Subject(s) - outreach , focus group , health care , implementation research , work (physics) , nursing , qualitative research , service delivery framework , medicine , public relations , business , psychological intervention , political science , sociology , service (business) , marketing , mechanical engineering , social science , law , engineering
South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.