Community understanding and patients’ experiences with the ward-based outreach teams (WBOT) programme in Lesedi sub-district, Gauteng

Abstract

Introduction: Hospicentric primary health care (PHC) limited access to essential health services and resulted in perverse health disparities within and between countries. Community- based PHC was then needed to bring services to where people lived. South Africa implemented a community-based PHC programme called the ward-based outreach teams (WBOT) programme in 2011 as part of PHC re-engineering aimed at achieving equity and improving health outcomes. Since implementation, the programme has not been optimal in attaining its objectives due to the poor supervision of community health workers (CHWs), lack of resources and poor remuneration. Many studies have investigated programme implementation and functioning from the perspectives of managers and CHWs. There are limited studies on the insights and experiences of patients and community members who receive services provided by the CHWs. Methods: This qualitative study used secondary data collected as part of the Bathlokomedi project in Gauteng Province. The Bathlokomedi project studied six WBOT/CHW teams with variations in supervision and location (e.g. clinic and health post-based teams) in 2016/17. Community health workers, supervisors, facility-based staff members, patients and community representatives were interviewed for the project. The primary study gathered data using a combination of qualitative and quantitative methods. The secondary study uses community representatives' and patients’ interviews to analyse their understanding of the WBOT programme. Thematic analysis method was used to analyse data. Findings: CHWs played a significant role in the WBOT programme by providing services such as delivering chronic medication to the elderly, ensuring medication adherence and support, supporting immunisation and growth monitoring. The employment of local people to serve as CHWs and active collaboration between the WBOT and the community helped to nurture a positive relationship. However, the lack of community engagement, lack of resources, non-comprehensive services, and CHWs' inability to maintain patient confidentiality and privacy impeded the success of the WBOT programme. Generally, the community representatives and patients reported dissatisfaction with the WBOT programme because the CHWs provided limited services to the community. Conclusion: WBOTs can extend health services to people in need. Community-based PHC and CHWs are imperative for attaining universal health coverage (UHC) and health goals in v resource-constrained settings such as South Africa. For community-based PHC systems to be effective, services should be comprehensive and include a wide range of promotive, preventive, curative, rehabilitative and palliative services.