Community Health Workers in South Africa: Where in This Maze Do We Find Ourselves? (Primary Health Care)

Community Health Workers in South Africa: Where in This Maze Do We Find Ourselves? (Primary Health Care)

Using lay members in the community to provide health care is a practice with a long history in South Africa. (1) The development and implementation of community health worker (CHW) programmes grew during the 1970s and 1980s, following the Alma-Ata Declaration (2) and in response to the inadequate provision of primary health care under apartheid. A CHW may be defined as ‘any health worker delivering health care, trained in the context of the intervention, and having no formal professional, certificated or degreed tertiary education’. (3) CHW project development and implementation in South Africa is well described. (4,5) After the 1994 elections, the new South African government was unexpectedly reluctant to support CHW programmes, instead favouring a primary health care system staffed by nurses and doctors. However, official support for CHWs has grown recently. There are several reasons for this, including the growing HIV/AIDS and tuberculosis epidemics and the ongoing migration of health professionals. (6-8) CHW initiatives are seen as a way of addressing the human resource crisis in health in many low- and middle-income settings, including South Africa. (9) The recently launched South African Expanded Public Works Programme incorporates a plan for implementing a nation-wide roll-out of this cadre by 2009. (10) Provincial health departments are encouraged to identify nongovernmental organisations (NGOs) to employ and implement CHW programmes, and the State has agreed to fund certain NGO costs and CHW monthly stipends. (11)

Community Health Workers in South Africa: Where in This Maze Do We Find Ourselves? (Primary Health Care)

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