The perceived role of community health workers (CHW) in voluntary medical male circumcision (VMMC) demand creation
Date
2019-06-04
Authors
Diomande, Matata N.
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Abstract
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.
Description
A research report submitted in partial fulfilment of the requirement for the award
of the degree of Master of Public Health,2019
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Citation
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, <http://hdl.handle.net/10539/28973>