The role of community health workers in the South African public healthcare system has been
unclear and controversial. How many do we need? What exactly should their role be? Who should employ them? What should they be paid? Is there good evidence to inform policy? Sasha Stevenson of SECTION27 lead Spotlight’s in-depth investigation into these pressing questions.
The structure of our health system and the nature of our healthcare workforce are unsuited to the goals that we have set ourselves: universal health coverage; an ‘end to AIDS’; and the reduction in non-communicable diseases through preventative and health promotion services. These goals can’t be reached in a hospital-centric health system with unsupervised, NGO-employed and underpaid community health workers (CHWs) serving as the only community-based services in the absence of capacitated and reliable clinic and hospital outreach programmes.
For some time, the national and provincial departments of health have been discussing and partly implementing a CHW programme. There have been multiple policy documents and there has been some action from provincial departments but we remain a long way from establishing a standardised CHW programme, let alone one that is capable of meeting the objectives of the health system, the National Strategic Plan (NSP), and the population.