Research

The unmet needs and health priorities of the urban poor: Generating the evidence base for urban community health worker programmes in South Africa

A van Rie, N S West, S R Schwartz, L Mutanga, C F Hanrahan, J Ncayiyana, J Bassett

Abstract


Background. There is a growing interest in involving community health workers (CHWs) into the formal healthcare system in South Africa (SA).

Objectives. To generate evidence for defining CHW tasks in urban SA.

Methods. A cross-sectional survey of residents of Diepsloot, northern Johannesburg, was performed using geographically weighted random sampling, with home-based health assessment and a questionnaire on sociodemographics, medical history, experience of violence, health-seeking behaviour and perceived health priorities.

Results. Between May 2013 and March 2014, 1 230 adults participated. Self-reported medical conditions included hypertension (12%), HIV (10%), diabetes (3%), cancer (1%) and mental illness (1%). Health assessments identified a high prevalence of undiagnosed conditions: hypertension (26%), obesity or overweight (46%), mild to severe depression (23%), HIV infection (5.8%) and tuberculosis (TB) (0.4%). Among women, 18% had unmet family planning needs and 77% had never had a Pap smear. Sexually transmitted infection symptoms were reported by 7% of participants. Physical violence was widespread, with 13% having experienced and 16% witnessing violence in the past year, with women mostly experiencing violence at home and men in the community. Participants’ top health concerns were crime, safety and violence (49%) and HIV (18%); healthy living/weight control was listed by only 8% of participants.

Conclusions. Alignment of CHW roles to unmet health needs and perceived health priorities will be important for optimal impact of CHW programmes in urban communities. Our data suggest that the CHW role should expand from a traditional focus on HIV, TB and maternal health to include non-communicable diseases, healthy lifestyle, and the intersection of violence and health.

 


Authors' affiliations

A van Rie, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium

N S West, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md, USA

S R Schwartz, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md, USA

L Mutanga, Witkoppen Health and Welfare Centre, Johannesburg, South Africa

C F Hanrahan, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md, USA

J Ncayiyana, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J Bassett, Witkoppen Health and Welfare Centre, Johannesburg, South Africa

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Keywords

Public health; Community health workers; South Africa; Community survey

Cite this article

South African Medical Journal 2018;108(9):734-740. DOI:10.7196/SAMJ.2018.v108i9.13054

Article History

Date submitted: 2018-08-28
Date published: 2018-08-28

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