Community-orientated primary health care: Exploring the interface between community health workers, the healthcare system and communities in South Africa
| dc.contributor.author | Malatji, Hlologelo | |
| dc.contributor.supervisor | Goudge, Jane | |
| dc.contributor.supervisor | Griffiths, Frances | |
| dc.date.accessioned | 2024-12-11T07:04:28Z | |
| dc.date.available | 2024-12-11T07:04:28Z | |
| dc.date.issued | 2024 | |
| dc.description | A thesis completed by published work Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy in Public Health to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2024 | |
| dc.description.abstract | Background: To achieve universal health coverage, low and middle income countries (LMICs) are extending primary health care (PHC) services using community health worker (CHW) programmes. However, CHWs are marginalized within the healthcare system. Community-orientated primary health care (COPC) and supportive supervision are two interventions being used to strengthen CHW programmes. Primary aim: To understand whether and how the COPC and supportive supervision approaches strengthen CHW programmes in South Africa. Methods: Data was collected between 2016 and 2019 using qualitative methods in nine PHC facilities in rural and semi-urban areas of Mpumalanga and Gauteng provinces, South Africa. Purposive and snowball sampling techniques were used to recruit participants. The participants included: CHWs, supervisors, facility staff members and community members. Data was collected using focus group discussions, individual interviews and observations, and was analysed thematically. Findings: In line with the COPC approach, there were efforts to engage communities in the implementation of the CHW programmes but community members prioritised other challenges such as lack of housing and running water. In some facilities, in-service training increased CHWs knowledge and skills but challenges such as lack of supervision, lack of resources and outsourced employment without benefits demotivated the CHWs (Paper 1 / Objective 1, Published). In response to challenges, in the semi-urban sites, CHWs unionised to present their grievances to government. This resulted in an increase in stipend but not permanent government employment. During the height of the COVID-19 pandemic, when decision- makers recognised the essential role of CHWs higher remuneration was secured. CHWs in rural areas were not active in demanding permanent employment (Paper 2 / Objective 2, Published). Supportive supervision provided by a nurse mentor over 14 months, (1) trained CHWs and their supervisors resulting in increased knowledge and new skills, (2) addressed their fears of learning and failing and (3) established operational systems to address inefficiencies in CHW core activities (household registration and medication delivery). The intervention was disrupted by union activities. The communities’ demonstrated little interest in the functioning of CHW programmes (Paper/ Objective 3, Published). Conclusion: Both the COPC approach and supportive supervision can reduce marginalisation of CHW within the health system | |
| dc.description.submitter | MM2024 | |
| dc.faculty | Faculty of Health Sciences | |
| dc.identifier | https://orcid.org/ 000-0002-0093-0879 | |
| dc.identifier.citation | Malatji, Hlologelo. (2024). Community-orientated primary health care: Exploring the interface between community health workers, the healthcare system and communities in South Africa [ PhD thesis, University of the Witwatersrand, Johannesburg]. WireDSpace.https://hdl.handle.net/10539/43263 | |
| dc.identifier.uri | https://hdl.handle.net/10539/43263 | |
| dc.language.iso | en | |
| dc.publisher | University of the Witwatersrand, Johannesburg | |
| dc.rights | © 2024 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg. | |
| dc.rights.holder | University of the Witwatersrand, Johannesburg | |
| dc.school | School of Public Health | |
| dc.subject | Communiy-orientated care | |
| dc.subject | commmunity health workers | |
| dc.subject | Resources | |
| dc.subject | Employment | |
| dc.subject | Commmunity health workers | |
| dc.subject | Resources | |
| dc.subject | Employment | |
| dc.subject | UCTD | |
| dc.subject.other | SDG-8: Decent work and economic growth | |
| dc.title | Community-orientated primary health care: Exploring the interface between community health workers, the healthcare system and communities in South Africa | |
| dc.type | Dissertation |