Community-orientated primary health care: exploring the interface between community health worker programmes, the health system and communities in South Africa

ABSTRACT Due to insufficient number of health workers in low- and middle-income countries, and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent a nation-wide CHW programme in South Africa is attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, the study was conducted in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors and community representatives, and focus groups and observations of CHWs. The implementation of community-orientated community worker programmes remains complex. In the different sites we studied, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the programmes. However, many residents were more concerned about access to housing that health services delivery issues. The CHW services’ were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource constrained setting like South Africa. Significant socio-economic issues are barriers to community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.