University of the Witwatersrand: Implementing comprehensive, integrated, community-based health care for vulnerable communities in South Africa: An evidence-informed model

Low and middle income countries (LMICs) aim for universal health coverage (UHC) but there is a shortage of resources and qualified personnel. Community Health Workers (CHWs) take on tasks to release nurse time, e.g. household screening. Evidence indicates infectious disease specific CHW programmes are effective in vulnerable communities. But for UHC, comprehensive CHW programmes are needed to tackle the rising prevalence of non-communicable disease. There is little evidence on how to achieve this. We will identify the features of an evidence-informed CHW service model, and lessons for scale up. The study will be in South Africa where: policy is to establish comprehensive CHW services; innovative service models exist in Sedibeng District; policy makers have requested the research. An observation study will describe, cost and compare six CHW programmes (two sites each of three different innovative models) to identify what facilitates or impedes success. Data collection: household survey (n=352/model) for health care indicators (e.g. antenatal clinic attendance, vitamin A to under 5s), observation of CHW household visits, interviews with health service and community key informants, CHWs and householders. Analysis will elicit: coverage; costs; affordability; causal links between service model, operationalization, context and effect. The service model development will be informed by the observation study, three scoping literature reviews, opinions of international experts, and local stakeholders in a consensus workshop using Nominal Group Technique. We will implement the resulting evidence informed CHW service model for 15 months (where there is no existing CHW programme) and evaluate its impact with survey and process evaluation, using similar data collection to the observation study. Analysis will indicate: impact; how impact is achieved or not; and, costs to health service. Results will be used by policy makers in South Africa and other LMICs.

Programme: Joint Health Systems Research Award

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