Abstract
While integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities to clinics. In the contexts of new roles and re-engineered primary healthcare (PHC), the objectives were to: (a) implement a training intervention to support local decision-making capability of CHWs; and (b) assess learning and impacts from the perspectives of CHWs.
Methods
CHWs from three rural villages (n = 9) were trained in rapid Participatory Action Research (PAR) with peers and community stakeholders (n = 33). Training equipped CHWs with tools and techniques to convene community groups, raise and/or respond to local health concerns, understand concerns from different perspectives, and facilitate action in communities and public services. CHWs’ perspectives before and after the intervention were gained through semi-structured interviews. Data were collected and analysed using the decision space framework to understand local actors’ power to affect devolved decision-making.
Results
CHWs demonstrated significant resilience and commitment in the face of COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical and health systems support, poor role clarity, precarious employment, low and no pay, unstable organisational capacity, fragile accountability mechanisms and belittling treatment in clinics. Together, these restricted decision space and were seen to reflect a low valuing of the cadre in the system. CHWs saw the training as a welcome opportunity to assert themselves as a recognised cadre. Regular, spaces for dialogue and mutual learning supported CHWs to gain tools and skills to rework their agency in more empowered ways. The training improved management capacity, capabilities for dialogue, which expanded role clarity, and strengthened community mobilisation, facilitation and analysis skills. Development of public speaking skills was especially valued. CHWs reported an overall ‘tripe-benefit’ from the training: community-acceptance; peer support; and dialogue with and recognition by the system. The training intervention was recommended for scale-up by the health authority as an implementation support strategy for PHC.
Conclusions
Lack of recognition of CHWs is coupled with limited opportunities for communication and trust-building. The training supported CHWs to find and amplify their voices in strategic partnerships, and helped build functionality for local decision-making.
Original language | English |
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Article number | 66 |
Number of pages | 21 |
Journal | Human Resources for Health |
Volume | 21 |
Issue number | 1 |
Early online date | 18 Aug 2023 |
DOIs | |
Publication status | Published - 1 Dec 2023 |
Bibliographical note
The study was funded by the Joint Health Systems Research Initiative from theDepartment for International Development/MRC/Welcome Trust/Economic
and Social Research Council (MR/P014844/1). Funders had no role in any
part of the work including design and conduct of the study, data collection,
data management, data analysis and interpretation, preparation, review, and
approval of the manuscript
Correction: Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district, Lucia D'Ambruoso, Nana Akua Abruquah, Denny Mabetha, Maria van der Merwe, Gerhard Goosen, Jerry Sigudla, Sophie Witter, Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform, 2023, vol. 21, issue 1, 2023, p. 78. Human resources for health http://dx.doi.org/10.1186/s12960-023-00863-z
Data Availability Statement
Data are available from the research team upon reasonable request. Anon-author point-of-contact to feld future requests (where authors are not
available) is achds@abdn.ac.uk. Public deposition of the data set would be
in breach of the data management plan (DMP) within the study protocol
approved by the research ethics boards in South Africa, the UK, and the permission for the study granted by the provincial health research committee, as
well as the DMP within the funding proposal and the conditions upon which
the research funding was granted.
Supplementary information: The online version contains supplementary material available at https://doi.org/10.1186/s12960-023-00853-1.
Keywords
- Community Health Workers
- Participatory Action Research
- Decision space
- South Africa
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Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district
D'Ambruoso, L. (Creator), Abruquah, N. A. (Creator), Mabetha, D. (Creator), van der Merwe, M. (Creator), Goosen, G. (Creator), Sigudla, J. (Creator) & Witter, S. (Creator), Figshare, 2023
DOI: 10.6084/m9.figshare.c.6796743.v1, https://springernature.figshare.com/collections/Expanding_Community_Health_Worker_decision_space_learning_from_a_Participatory_Action_Research_training_intervention_in_a_rural_South_African_district/6796743/1 and one more link, https://springernature.figshare.com/collections/Expanding_Community_Health_Worker_decision_space_learning_from_a_Participatory_Action_Research_training_intervention_in_a_rural_South_African_district/6796743 (show fewer)
Dataset