Students with CHW examining a patient's knee at home
Community healthcare workers play a vital role in healthcare. They are the backbone of community based services. In community oriented primary care (COPC) they are assigned to households in defined geographical areas, where they provide a range of healthcare services and support to individuals and families. CHWs do health promotion and disease prevention. This means they screen for infectious diseases like TB and HIV. They check to make sure women who are pregnant are in antenatal care, that babies and children are growing well and are immunised, and that anyone in need of urgent help gets it. CHWs also provide treatment support to people who need to take medicines every day. They are there to help people overcome the barriers to care. And they develop health literacy, guiding people to make better rather than worse choices, educating them on how to take and store medicine or prevent accidents and injuries.
The 32 community healthcare workers who fall under the University of Pretoria’s Daspoort Clinic in Tshwane work in the Zama Zama and Melusi informal settlements and in Daspoort. They have been trained to do household registration, assessment and triage using the Aitahealthtm app. They use it to guide their interactions with individuals and families, record relevant data and arrange followup visits. CHWs work with students and health care professionals from a range of disciplines. By participating in structured workplace learning they also have the opportunity to develop their capacity to provide people with quality care.
Betty Motsepe and Cheki Molubi have worked as CHWs since 2014. Their roles stretch from linking people to services to caring for very vulnerable people. Motsepe says: “Some of our day-to-day tasks include identifying health and social problems among individuals and referring patients to relevant stakeholders for adequate treatment.”
Molubi notes the importance of CHWs as a ground force for the community, especially families who are destitute. “We are appointed to an area in which we work with primary healthcare teams and stakeholders. Many require more than healthcare. They need food, identity documents, and housing.”
Sister Mulalo Mukwevho, a professional nurse who works as the team leader, started with the UP DFM in August this year. She emphasises the importance of communication and says the most valuable part of her job is being able to treat people holistically. “There are many people who require a range of assistance beyond medical care. As well as health problems, our teams assist in reporting and referring social problems.” Together with students and a dietician, they run cooking demonstrations and they also help people grow vegetables to improve nutrition.
As much as COPC is designed to help improve the health of the community, it has also helped to empower CHWs. Molubi started doing community healthcare because he was unemployed and needed to work. “I didn’t know much about the programme, but I became interested and started to take health issues more seriously, helping my own family and neighbours to maintain a healthy lifestyle. I have learnt a lot through the programme.” Now, he says, “meeting the needs of households and celebrating their happiness as my own, keeps me going.”
Molubi says he thrives on the relationships he has fostered. “I’m happy I get to teach people about the importance of healthcare and create bonds with those around me.” Motsepi too says she has grown as an individual. “At first it was difficult, but now I am confident. I enjoy helping others and I am a leader in my community.”
Community based work is not easy. CHWs are at the frontline. They have to overcome people’s fears about their health as well as their doubts and mixed experiences of service delivery. There are also language barriers and problems of low health literacy. And building trust takes time. As Sister Mulalo Mukwevho observes, perseverance and being part of clinical care that extends from people in their homes to and from clinic and hospital services is the recipe for their success.“At first they resist us. Then we win them over, and with our help they feel better. ”