Factors influencing effectiveness of a community health worker program in an urban South African setting.
1
Public Health Unit, Gauteng Health Department AND University of Pretoria AND University of Witwatersrand, Pretoria, South Africa
2
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
3
Director: HIV& TB delivery., Gates Foundation., Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1697
ABSTRACT
ABSTRACT:
Introduction &
BACKGROUND:
Globally, community health worker (CHW) programs are increasingly seen as an important part of health systems, especially in low- and middle-income countries. Within the Gauteng health department, the Ekurhuleni health district program with over 1000 CHWs looking after a million people has been implemented and managed for over a decade. This intervention has been shown to be effective in improving health outcomes in the district, but reasons for CHW program effectiveness are often not well documented. Understanding these factors of effectiveness that influence performance effectiveness can help strengthen the implementation and management of such programs.
METHODS:
A cross-sectional analytical study involving interviews with community health workers and clinic staff was conducted in a large urban health district in South Africa. Community health workers (n=157), their nurse team leaders (n=15), and clinic staff (n=65) from six district clinics were interviewed in May 2019.
RESULTS:
Team members and clinic staff felt that the district CHW program was effective. Team members felt confident in what they were doing and satisfied with their work; they felt equipped and supervised. Clinic staff also acknowledged the benefits of their efforts; with staff wanting to support and strengthen the teams. Individual and team factors contributed towards performance effectiveness. Factors influencing performance included characteristics of team members (honesty, diligence, dedication), motivators (intrinsic and extrinsic), and health system support through training, supervision, recognition and appreciation from colleagues and the community.
CONCLUSIONS:
The CHW program in this urban district was well appreciated and supported within existing services and found to be an integral part of the district health services. This demonstrates good training, supervision, implementation, satisfaction and integration into district health services. These findings are important for the long-term sustainability of such CHW programs in developing countries.
Introduction &
BACKGROUND:
Globally, community health worker (CHW) programs are increasingly seen as an important part of health systems, especially in low- and middle-income countries. Within the Gauteng health department, the Ekurhuleni health district program with over 1000 CHWs looking after a million people has been implemented and managed for over a decade. This intervention has been shown to be effective in improving health outcomes in the district, but reasons for CHW program effectiveness are often not well documented. Understanding these factors of effectiveness that influence performance effectiveness can help strengthen the implementation and management of such programs.
METHODS:
A cross-sectional analytical study involving interviews with community health workers and clinic staff was conducted in a large urban health district in South Africa. Community health workers (n=157), their nurse team leaders (n=15), and clinic staff (n=65) from six district clinics were interviewed in May 2019.
RESULTS:
Team members and clinic staff felt that the district CHW program was effective. Team members felt confident in what they were doing and satisfied with their work; they felt equipped and supervised. Clinic staff also acknowledged the benefits of their efforts; with staff wanting to support and strengthen the teams. Individual and team factors contributed towards performance effectiveness. Factors influencing performance included characteristics of team members (honesty, diligence, dedication), motivators (intrinsic and extrinsic), and health system support through training, supervision, recognition and appreciation from colleagues and the community.
CONCLUSIONS:
The CHW program in this urban district was well appreciated and supported within existing services and found to be an integral part of the district health services. This demonstrates good training, supervision, implementation, satisfaction and integration into district health services. These findings are important for the long-term sustainability of such CHW programs in developing countries.
| eISSN: | 2654-1459 |
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