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Household coverage, quality and costs of care provided by community health worker teams and the determining factors : findings from a mixed methods study in South Africa
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Goudge, Jane, de Kadt, Julia, Babalola, Olukemi, Muteba, Michel, Tseng, Yu-Hwei, Malatji, Hlologelo, Rwafa, Teurai, Nxumalo, Nonhlanhla, Levin, Jonathan, Thorogood, Margaret, Daviaud, Emmanuelle, Watkins, Jocelyn and Griffiths, Frances (2020) Household coverage, quality and costs of care provided by community health worker teams and the determining factors : findings from a mixed methods study in South Africa. BMJ Open, 10 (8). e035578. doi:10.1136/bmjopen-2019-035578 ISSN 2044-6055.
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WRAP-Household-coverage-quality-costs-care-health-worker-Griffiths-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (349Kb) | Preview |
Official URL: https://doi.org/10.1136/bmjopen-2019-035578
Abstract
Objective: Community health workers (CHWs) are undertaking more complex tasks as part of the move towards universal health coverage in South Africa. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle with insufficient supervision. In this paper, we assess coverage (proportion of households visited by a CHW in the past year and month), quality of care and costs of the service provided by CHW teams with differing configurations of supervisors, some based in formal clinics and some in community health posts. Participants: CHW, their supervisors, clinic staff, CHW clients. Methods: We used mixed methods (a random household survey, focus group discussions, interviews and observations of the CHW at work) to examine the performance of six CHW teams in vulnerable communities in Sedibeng, South Africa. Results: A CHW had visited 17% of households in the last year, and we estimated they were conducting one to two visits per day. At household registration visits, the CHW asked half of the questions required. Respondents remembered 20%–25% of the health messages that CHW delivered from a visit in the last month, and half of the respondents took the action recommended by the CHW. Training, supervision and motivation of the CHW, and collaboration with other clinic staff, were better with a senior nurse supervisor. We estimated that if CHW carried out four visits a day, coverage would increase to 30%–90% of households, suggesting that some teams need more CHW, as well as better supervision. Conclusion: Household coverage was low, and the service was limited. Support from the local facility was key to providing a quality service, and a senior supervisor facilitated this collaboration. Greater investment in numbers of CHW, supervisors, training and equipment is required for the potential benefits of the programme to be delivered.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||||||||
| SWORD Depositor: | Library Publications Router | |||||||||||||||
| Library of Congress Subject Headings (LCSH): | Community health services, Community health services -- South Africa, Community health services -- Utilization -- South Africa, Outcome assessment (Medical care) -- South Africa | |||||||||||||||
| Journal or Publication Title: | BMJ Open | |||||||||||||||
| Publisher: | BMJ Publishing Group | |||||||||||||||
| ISSN: | 2044-6055 | |||||||||||||||
| Official Date: | 20 August 2020 | |||||||||||||||
| Dates: |
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| Volume: | 10 | |||||||||||||||
| Number: | 8 | |||||||||||||||
| Article Number: | e035578 | |||||||||||||||
| DOI: | 10.1136/bmjopen-2019-035578 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||
| Date of first compliant deposit: | 2 September 2020 | |||||||||||||||
| Date of first compliant Open Access: | 3 September 2020 | |||||||||||||||
| RIOXX Funder/Project Grant: |
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