Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Lay Health Worker Programmes as aPublic Health Approachin South Africa
Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, 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

Place, publisher, year, edition, pages
2010. , 62 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:2
Keyword [en]
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: urn:nbn:se:norden:org:diva-3743ISBN: 978-91-86739-30-0 (print)OAI: oai:DiVA.org:norden-3743DiVA: diva2:786535
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
List of papers
1. Developing lay health worker policy in South Africa: a qualitative study.
Open this publication in new window or tab >>Developing lay health worker policy in South Africa: a qualitative study.
2012 (English)In: Health research policy and systems / BioMed Central, ISSN 1478-4505, Vol. 10, 8- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process.

METHODS: The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically.

RESULTS: Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system.

CONCLUSION: LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.

Keyword
Lay health workers; Health policy analysis; Gender; Qualitative research
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3740 (URN)10.1186/1478-4505-10-8 (DOI)22410185 (PubMedID)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved
2. Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study.
Open this publication in new window or tab >>Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study.
Show others...
2010 (English)In: Human resources for health, ISSN 1478-4491, Vol. 8, 6- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap.

METHODS: This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support.

RESULTS: Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors.

CONCLUSIONS: This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3739 (URN)10.1186/1478-4491-8-6 (DOI)20353561 (PubMedID)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved
3. Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers.
Open this publication in new window or tab >>Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers.
Show others...
2005 (English)In: Health Policy, ISSN 0168-8510, 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?

Keyword
Lay health workers; Tuberculosis; Farm worker health; Primary health care interventions; Focus groups
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3738 (URN)10.1016/j.healthpol.2004.10.006 (DOI)15911060 (PubMedID)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved
4. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Open this publication in new window or tab >>Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Show others...
2010 (English)In: The Cochrane database of systematic reviews, ISSN 1469-493X, no 3, CD004015- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions.

OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases.

SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers.

SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained.

MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective.

AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3742 (URN)10.1002/14651858.CD004015.pub3 (DOI)20238326 (PubMedID)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved

Open Access in DiVA

NHV Report 2012:2(2802 kB)209 downloads
File information
File name FULLTEXT01.pdfFile size 2802 kBChecksum SHA-512
308dcd07bc5fc7e581d42ed1e9def78ce829bdaa0a3ac8e2a92cafbca00efa12f4627001286a80e2d2da292c93dd74b185f0db46256de9a89c2479e75a12c2cb
Type fulltextMimetype application/pdf

By organisation
Nordic School of Public Health NHV
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 209 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 129 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf