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Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers.
Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
Boland District Municipality, Stellenbosch, South Africa.
Nursing Division, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, 7505, South Africa .
Health Systems Unit, Medical Research Council, Cape Town, South Africa.
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2005 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, no 1, 92-103 p.Article in journal (Refereed) Published
Abstract [en]

Ranking ninth in the world for its contribution to the global burden of tuberculosis (TB), South Africa continues to battle the disease. Within the framework of the World Health Organisation's Directly Observed Treatment Short Course (DOTS) strategy, attempts have been made to utilize lay health workers (LHWs) as TB treatment supporters. Previous research has highlighted the benefits and difficulties associated with such an approach, but little attention has been paid to the perceptions of LHWs themselves. A randomised control trial of a LHW intervention in TB treatment in the farming areas of the Western Cape, South Africa has shown a 19% improvement in TB treatment outcomes. This paper describes the experiences of those LHWs drawing on data collected through focus groups with incumbents. The data has shown that once trained, respondents were engaged in a wide range of activities, well beyond simple health care. In the majority LHWs were women. Becoming LHWs opened up their worlds, creating opportunities they would otherwise not have had. But while doing so, it also added extra responsibilities and stresses, which were not easy to manage. Respondents sustained themselves through support from each other, the intervention team, their employers and contact with the public health system. The question this study raises is given the obvious need for LHWs, how can they be motivated to participate in primary health care in such a way that maximises their access to resources while minimising their experience of the role as burdensome?

Place, publisher, year, edition, pages
2005. Vol. 73, no 1, 92-103 p.
Keyword [en]
Lay health workers; Tuberculosis; Farm worker health; Primary health care interventions; Focus groups
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3738DOI: 10.1016/j.healthpol.2004.10.006PubMedID: 15911060OAI: oai:DiVA.org:norden-3738DiVA: diva2:786528
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Lay Health Worker Programmes as aPublic Health Approachin South Africa
Open this publication in new window or tab >>Lay Health Worker Programmes as aPublic Health Approachin South Africa
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim is to assess the appropriateness of Lay Health Worker (LHW)programmes as a public health intervention in South Africa by considering the effectivenessof LHW programmes across the world and the experience of LHW programmeimplementation and policy making in South Africa.

Methods: This thesis comprises 4 papers that explore the issue of LHWs: (I) A systematicreview of randomised controlled trials (RCTs) of LHW interventions in primary andcommunity health care for maternal and child health and the management of infectiousdiseases; (II) A study of the experiences of farm dwellers trained to be LHWs, as exploredthrough focus group discussions; (III) A study of three LHW supervisors who worked on anintervention to support infant feeding mothers, as explored through individual interviews;and (IV) A study of the process of LHW policy development from the perspective of 11 keyinformants who were individually interviewed.

Findings: LHWs were found to be effective in promoting breastfeeding and in improvingpulmonary TB cure rates (I). There was also some indication that LHWs could be effective inreducing child morbidity and child and neonatal mortality, and in increasing the likelihood ofcaregivers seeking care for childhood illness (I). The experience of LHWs and LHWsupervisors suggests that LHW programmes need adequate support and supervision,especially in protecting the LHWs themselves (II, III). The care and protection of LHWs wasconsidered by policy makers (IV), but policy redevelopment processes did not link the needto ensure that LHWs were not exploited to concerns about gender exploitation.

Conclusions: LHW interventions can be effective but implementing them in developingcountries such as South Africa needs to be approached with caution

Publisher
62 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:2
Keyword
Lay health workers, Lay Health worker programmes, public health, primary health care, gender, intervention effectiveness, intervention experience, policy making, programme supervision.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3743 (URN)978-91-86739-30-0 (ISBN)
Public defence
2012-05-11, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved

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