Training of community health workers in ward-based outreach teams: exploring experiences and perceptions in Tshwane district

Abstract

Background: The training of community health workers (CHWs) remains a crucial component to strengthening their role in primary health care and Universal Health Coverage. South Africa has made strides to strengthen its national CHW programme; the Ward-Based Primary Health Care Outreach Team (WBPHCOT) model. Envisaged to be generalists, CHWs have a defined comprehensive set of roles within this model. This has been coupled with the establishment of an accredited national CHW curriculum to capacitate this cadre – a crucial element to the success of this programme. Several challenges have been raised regarding the implementation of the training of CHWs. Understanding the dynamics of the implementation of the training is needed to identify ways to strengthen it.

Aim: This study sought to understand the experiences and perceptions of CHWs and managers of the training of Community Health Workers in WBPHCOTs in the Tshwane district.

Methods: An exploratory qualitative research design consisting of focus group discussions with 16 CHWs and key informant interviews with 12 key informants (ward-based outreach team coordinators, outreach team leaders, facility managers, district managers, district Department of Health trainers, a Provincial Department of Health representative and trainers from non-governmental organisations) was conducted. Collected data were then transcribed and a thematic content analysis was used to analyse the data.

Results: The findings indicated that CHWs provided a wide range of services that were in line with the current objectives of the policy. Despite the mixed views about the implementation of the training, there was general agreement that the training enabled CHWs to carry out their roles and responsibilities and to respond to community needs. The identified gaps in the training included insufficient updating of the curriculum to ensure that it aligned with current information, lack of resources such as transport to training venues, and a need to build in components that are sensitive to aspects such as cultural practices or beliefs into the curriculum.

Conclusion: The study indicated that CHWs are playing a crucial role in providing the required comprehensive services in communities. The implementation of the CHWs training programme had some successes, however, some gaps required consideration to improve the provision of training. For instance, the existing CHW policies need to stipulate the minimum recruitment criteria to address significant entry-level qualifications. The study illustrated that for any CHW training programme to achieve the intended objective, there needs to be an overall evaluation of the curriculum and the implementation to ensure its efficacy and quality.