The perceived role of community health workers (CHW) in voluntary medical male circumcision (VMMC) demand creation

Diomande, Matata N.
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Background: South Africa is home to the largest population of PLHIV globally. Biomedical interventions such as the WHO and UNAIDS endorsed voluntary medical male circumcision (VMMC) are instrumental in strategies to prevent new infections and contain current rates. However, the nation has consistently failed to reach VMMC targets, in large part due to challenges in creating demand for the procedure. With community health workers (CHWs) at the centre of demand creation initiatives, literature surrounding CHWs roles within their contextual programmes and structures is pertinent. While studies have examined expert and management insight onto CHWs within disease prevention and primary health care support programmes, research on CHW in VMMC is limited, particularly the voices of CHWs themselves. Findings from this study contribute to said gaps by comparing managerial and CHW perceptions of their roles within VMMC programming. Aim: This study aimed to describe the perceptions of both CHWs and key management staff at one VMMC implementing agency on CHW roles, enabling and hindering factors and impact during the period of June-July 2018. Methods: A cross sectional qualitative research study design was employed through conducting IDIs with CHWs (a.k.a. recruiters) from two VMMC clinical sites in Gauteng and key management from head office. Interviews were recorded, transcribed and coded to enable thematic content analysis of both inductive and deductive codes. Ethical consideration was taken throughout all stages of research. Results: A total of 13 IDIs were conducted with nine recruiters and four key informants employed by the VMMC implementing agency. All participants described the role of recruiters as canvassing the community through outreach activities to enlist patients for the procedure. This role was described as essential in improving overall health status of the community, while also achieving organisational goals. Central factors were described as organisational technical support and emotional incentives as well as motivations provided by the organisation. Community factors that enabled or inhibited their role consisted of the level of belonging and integration recruiters experienced within the community context. Recruiter motivation was a point of contrasting perceptions between the two study samples which resulted in a heightened importance being placed on the relationships recruiters have with higher management. Conclusion: Study findings have shown roles of recruiters mirror those of CHWs deployed for PHC system support, as do their support need levels. Key factors for success of CHW programmes are concurrent literature however this study shows the influence of organisational relationships over evidenced-based approaches to programme design resulting in insufficient support provision. Thus,enhanced integration of single-scoped CHWs in government support systems is needed to enhance support and the use of evidence-based participatory approaches are recommended.
A research report submitted in partial fulfilment of the requirement for the award of the degree of Master of Public Health,2019
Diomande, Matata Nolene (2019) The perceived role of Community Health Workers (CHW) in Voluntary Medical Male Circumcision (VMMC) demand creation, University of the Witwatersrand, Johannesburg, <>