The coverage and impact of community health worker programmes in South Africa’s Gauteng province

Abstract

Objectives To provide an analysis of household coverage and the impact of community health worker (CHW) programmes in South Africa’s Gauteng province. More specifically, the study aims to explore the key characteristics of household coverage of CHW programmes and assess the impact of CHW visits on physical and mental health. Methods Analyses of waves IV and V of the Quality of Life (QoL) survey, from 2016 and 2018 respectively, using Stata’s multiple logistic regression and treatment effects models. Results Only 11.3% of households reported a visit from a CHW in the last year in 2016. Household coverage was positively associated with being female (OR: 1.11, P=0.01), age (OR: 1.01,P<0.001), employment status (OR for unemployed versus employed: 1.28, P<0.001), and negatively associated with health insurance (OR for insured versus uninsured: 0.80, P=0.002), wealth quintile (OR for quintile five versus one: 0.57, P<0.001), and population group (OR for Coloured versus African: 0.77, P=0.026; OR for White versus African: 0.53, P<0.001). Household coverage varied widely by municipality. On average, respondents visited by a CHW reported higher degrees of experiencing depressed moods, higher likelihood of being classified as having a potential depressive disorder, and lower likelihood of reporting good health. This would apply if all households in Gauteng were to be visited by a CHW. The results vary by sex and wealth quintile. Conclusions Household coverage of the CHW programme in Gauteng is falling short of universal coverage for households in need. Overall, respondents visited by CHWs have worse physical and mental health outcomes. This may be owing to effective targeting of households in need in Gauteng, but this study highlights the need to evaluate and improve CHW programmes in Gauteng.