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The term CHW in this report, encompasses the wide variety of those who have been selected to be trained and to work in the communities where they reside. CHW activities aim to promote general health by addressing local needs.

In response to the swelling numbers of children living in disadvantaged communities who are infected and/or affected by HIV/AIDS, and in an attempt to address their social and health needs, Provincial Health Departments were encouraged initially by the National Health Ministry funded initially by conditional HIV and AIDS grants and more recently by the Social Cluster of the Expanded Public Works programme (EPWP Annual Report, 2006) to introduce new cadres of communitybased workers who had a specifi c focus on HIV and AIDS. This included Home and Community Based Carers (HCBC) who nursed the sick and dying and Early Childhood Development (ECD) workers who focused on programmes for orphans and other vulnerable children. The fast-track way that these new cadres were introduced was characterized by many shortcuts in the accepted practice of existing community health worker programmes including very limited training focused almost exclusively around specific issues related to HIV. Although this training was lengthened to a standardized 59 day training programme (Fox 2002) , the content remained very focused around the single issue of HIV and AIDS. As a result this group of workers was not able to deal with the wide range of presenting problems that a community-based health worker encounters in their daily practice. As a result in 2004, the National Health Ministry made explicit its intention to introduce generalist CHW training While many of the initial HCBC were volunteers, the National Health Ministry, supported by the National Treasury encouraged the payment of very modest stipends though local non-governmental organizations (NGO)s and Community Based Organisations (CBO). The Kwa Zulu Natal Department of Health had already established and funded such a CHW programme from the early 1980s and a few other provinces had similar fl edgling programmes in place. It was envisaged that the KwaZulu Natal programme would serve as a model for the establishment elsewhere.

The State further decided to regulate CHW training in order to prevent under-qualifi ed CHWs and to ensure that this cadre had the competency to address current health and related needs at community level appropriately. It was decided that the entry level for such training would be at Ancillary Health Care (NQF level 1) and that immediate efforts would be made to graduate a generic group of Community Caregivers at (NQF level 2/3). There would be common training content for both community based workers in the social development sector and those addressing health issues. The ultimate goal in the health sector would be for these community based workers to continue their training until completing the CHW module at NQF (Level 4) (DoH, 2004 Friedman, 2005).

The development of a CHW policy and suitable training material are a priority, so that CHWs are equipped to function as mid-level workers within the public health sector (DoH, 2005). The human resource plan for the health sector in South Africa incorporates CHWs as integral members of the future health care force (Chabikuli et al., 2005).

Despite the widely acknowledged anecdotal value of CHW activities, policy-makers in Government and other funders require objective information that accurately refl ects the accurate value added by CHW activities in the populations they serve (Swider, 2002). Various literature searches confirmed a paucity of publications on surveillance systems that measure CHW impact. Objectives set for CHW interventions often serve as the benchmark against which their effectiveness is evaluated (Lewin et al., 2004). However, as objectives and methodologies vary from programme to programme, without a common monitoring and evaluation system in place, it is diffi cult to uniformly measure the impact various CHWs programmes have.

The National Department of Health (Research Directorate) mandated research towards developing a generic surveillance tool that will objectively evaluate the impact CHWs have at community level. This information would enable National Treasury and/or outside funding organisations, to apply an evidence-based approach to decisions regarding funding and/or secure ongoing funding of CHW projects, thereby increasing the possibility of long-term sustainability of performing CHW interventions. This data would also inform and assist health management to deliver an equitable, quality primary health care service to the majority who live in poverty stricken, hard-to-reach areas and in particular to deal effectively with TB/HIV/AIDS in high-burdened settings. Furthermore, this evidence can enable the development and implementation of standardised operating procedures, strengthen human resources and build capacity at appropriate levels of health care delivery.

This study aimed to identify standard measurable outcomes with a view to developing a generic surveillance system of indicators to enable ongoing measurement of the outputs and impacts of CHW activities.