Moving Towards Best Practice: Documenting and Learning from Existing Community Health/Care Worker Programmes

Community Health Workers (CHWs) or Community Care Workers (CCWs) are community-selected lay persons providing a community-based health service for which they have been trained although their role has become increasingly important, there is currently concern regarding the effectiveness of programmes that utilise them. The research question is what constitutes best practice in the use of such workers. The term CHW includes all categories of such workers.

The objectives of the study were to: Assess the extent to which CHW deployment has been addressing important health priorities document success stories and lessons, identify champions understand the range of ways that CHW programmes have evolved in South Africa and compile recommendations & lessons learned to improve practice.

Methods: Separate studies were commissioned in each of the 9 provinces. A list of organizations was identified from key informants & provincial database in each province. Snowballing techniques & web-based searches were used to identify additional organisations. Qualitative in-depth interviews using checklists were conducted in a purposeful sample of about 3 to 5 projects per province to understand the evolution of projects and learn lessons that could inform bestpractice.

Results: In the past CHW programmes, focused on prevention, health promotion and development issues. Today they are increasingly used to provide services in care and support for people infected and affected by HIV & AIDS with a limited role in prevention, Their role is most notable in resource poor settings where health and social services are inadequate, poverty is endemic and HIV & AIDS challenge community resources and their ability to cope with the burden of care. Fragmentation has characterised the rapid evolution of projects.