The role of community health workers in the re-engineering of primary health care in rural Eastern Cape

Background: Primary Health Care in South Africa is being re-engineered to create a model of integrated care across different levels of the health care system. From hospitals to clinics, in the community and in the home, health care will focus more on prevention, health promotion, and advocacy for healthy lifestyles and well-being, in addition to clinical services. We provide a best-practice model of integrating community health workers (CHWs) trained as generalists into a multi-level health system in the Oliver Tambo district of the rural Eastern Cape. Methods: Based at Zithulele Hospital, a health care network between the hospital, 8 clinics, and 50 CHWs has been created. The functions of each tier of care are different and complementary. This article describes the recruitment, training, supervision, monitoring, and outcomes of CHWs who deliver maternal, child health, nutrition, and general care through home visits. Results: CHWs, especially in rural settings, can find and refer new TB/HIV cases, ill children, and at-risk pregnant women; rehabilitate malnourished children at home; support TB and HIV treatment adherence; treat diarrhoea, worm infestation, and skin problems; and distribute vitamin A. CHWs provide follow-up after clinic and hospital care, support families to apply health information, problem-solve the health and social challenges of daily living, and assist in accessing social grants. Case examples of how this model functions are provided. Conclusion: This generalist CHW home intervention is a potential model for the re-engineering of the primary health care system in South Africa.