Support and Supervision of CCGs in WBOTs

Community health workers (CHW) play a pivotal role in primary health care delivery in low- and middle-income countries. The PHC Re-engineering policy introduced in South Africa in 2010 advocated for the establishment of ward-based outreach teams (WBOTs). These teams were to comprise registered nurses, enrolled nurses and CHWs who work together to:

  • provide accessible and appropriate services at community level,
  • improve continuity of care, and
  • increase coverage of key interventions by improving the linkages to primary health care services.

In KwaZulu-Natal (KZN), CHWs, known as community caregivers (CCGs), are a key component in the health system ensuring quality of care for mothers and their children by addressing barriers to care, and bringing care closer to families – particularly those in the poorest communities.

In 2011, the Centre for Rural Health, working in partnership with the National Department of Health, undertook a study to explore the acceptability and feasibility of the community-based maternal, neonatal, child and women’s health programme, funded by UNICEF. This study showed that a lack of trust was a key contextual barrier to acceptance of community-based MCH services provided by CHWs in homes and suggest that successful community-based public health interventions are built on relationships of trust and good rapport with individuals – both in the household and in the community.

Later, in 2014, while working in other projects involving CCGs in KZN, it became apparent that CHW support and supervision was fragmented and lacked co-ordination. This led to the Centre for Rural Health being tasked to develop a framework for the support and supervision of CHWs within WBOTs and to evaluate the framework. As part of the development of the framework, a qualitative study was undertaken to explore the content of household interactions, and experiences and perceptions of mothers and CHWs about the CHWs. The study showed that although CHWs were well accepted and appreciated by mothers, and they provided important appropriate health promotion messages at a level that was understood by mothers, they often missed opportunities to provide important information to mothers that could directly impact health outcomes for mothers and their children.  

The framework that was developed was shared with KZN Department of Health and UNICEF who funded the project.