The Valuable Role of the Community Health Worker in South Africa

Housing in Jackson

Yesterday, I visited two communities in the Eikenhof suburb, around 20km outside of Johannesburg. First stop was Jackson, an ‘informal’ settlement made up of mass of small, self-built, single story dwellings made of corrugated iron, wood, plastic and any other materials people can lay their hands on. The only Government provision is a few porta-loos and a handful of water tanks placed every few hundred meters. There is also a school, housed in a number of portacabins, funded by the local NGO and the ‘Hope Centre’ which is run by a local catholic nun and provides soup once a day to people in the community. Our second stop was to Lehaye, a community of public housing not far from Jackson. Here the housing is single story, built from breeze blocks, and has more amenities in terms of water, sanitation and electricity. This housing is for those people earning less than R1000 (around £78)per month.

Housing in Lehaye

Access to health care services is problematic for the people of Jackson and Lehaye due to the location and the lack of public transport. However, a small, basic, health clinic serves both communities. 

The Health Clinic that serves Jackson and Lehaye

The clinic is staffed by 9 nurses and has a TB ‘centre’ (housed in a shipping container), where people can be tested for TB and receive treatment and a new HIV ‘centre’ (another portacabin) where people can be tested for HIV, receive counselling and pick up their treatment.

Eleven Community Health Workers (CHWs) also use the clinic as a base. As well as undertaking basic health promotion activities, the Community Health Workers fulfil a number of important roles for the community including delivering medicines to people too ill to get to the clinic, identifying possible symptoms of disease and alerting clinic staff, identifying any social needs beyond health care and signposting people to other services and sources of help.   

Housing in Jackson

We spent the morning with one of the CHWs, Glenys, and visited some of the people she supports. Glenys lives in Lehaye and has been working as a CHW since 2004. Glenys main task of the day was delivering food (in the form of porridge mix) to some members of the community who are HIV positive. Anti-viral medication for HIV needs to be taken with food, otherwise it causes the person to feel very nauseous and many people avoid taking the medication when they have not eaten for this reason. Food poverty (or a lack of food) can therefore mean that the symptoms of AIDs progress much faster as medication is not taken as and when it should be.

One man, who had recently been diagnosed with HIV, had travelled by taxi (which he could ill afford) to a clinic some distance away to collect his medication. He was worried he would have to find money to pay for a taxi each time he needed more medication. Glenys was able to advise him that he could collect his medication from the local clinic instead.

Glenys delivers porridge mix to a HIV patient in Jackson

Another man, who lived alone, had suffered serious burns to his upper body in an accident 12 months ago and has not been able to work since. He has been unable to claim any disability grant to which he may be entitled, and so needed help to get this.

There are around 40,000 CHWs in South Africa. They are recruited from the communities in which they work so they have an understanding of the communities needs.  They receive 69 days of training after which time they are (in theory at least) employed by a local NGO and  paid a stipend for the work they do. However, many CHWs still work as volunteers as arranging payment can be problematic. Also, as this is low paid work, there tends to be a high staff turnover.

Whilst the context, health issues and the inequalities here in South Africa are very different to the UK - CHWs, not unlike Community Health Champions, have a vital role in helping address the barriers to accessing services for many people. Nonhlanhla Nxumalo, a researcher from the Centre for Health Policy at the University of Witswatersrand, told me how CHWs can also be a crucial link and an enabler in communities and a facilitator for the identification of community resources and assets. They can also be a conduit for the development of social capital through identifying and enabling connections and building networks which help people get what they need. In South Africa, even more so than in the UK, there is a clear need for adequate resources, training and support to enable CHWs to continue the valuable role they have in helping those in most need. Nonhlanhla explained how, "a lack of support and resources can undermine the CHWs standing in a community - as well as their ability to make a difference." There is also ongoing debate about the role of the CHW within the wider primary health care system meaning that CHWs often go unrecognised and are under-utilised by health professionals.