South African Health Workers Need More Support

Community health workers seek better resources, fair compensation

Community health workers (CHWs) in South Africa are essential for primary healthcare, particularly in underserved areas. However, they face significant challenges, including inadequate resources and support. A recent study highlights the need for improved working conditions to enhance their effectiveness.

Crucial Roles of Community Health Workers

Across the globe, community health workers deliver vital healthcare services, especially in rural and disadvantaged communities. Their responsibilities include educating the public on health issues, assisting patients with chronic diseases, administering vaccinations, and supporting pandemic control efforts. **Perry et al** noted that CHWs form the foundation of primary healthcare in areas with poor health delivery.

Challenges Faced by South African CHWs

In South Africa, CHWs tackle health promotion, chronic medication support, household risk assessments, and maternal and child health services. Despite their broad responsibilities, they encounter numerous obstacles: lack of training, insufficient resources, staff shortages, poor supervision, transportation issues, distrust, low pay, heavy data collection burdens, safety concerns, cultural beliefs, and unclear roles.

Study in Buffalo City Metropolitan Municipality

Researchers used a qualitative approach to explore the opinions of CHWs in the Buffalo City Metropolitan Municipality in the Eastern Cape Province. Twenty-three CHWs were selected from community health centers and clinics for individual interviews and focus group discussions conducted in early 2023.

Participants reported that the historical injustices of apartheid left the Eastern Cape Province with scarce resources and services, exacerbating the challenges faced by community health workers.

Key Suggestions for Improvement

CHWs offered specific suggestions to improve their working conditions and overall program effectiveness.

Transportation

Many CHWs emphasized the need for reliable transportation to reduce fatigue and improve safety, particularly when traveling to and from work in high-crime areas. Some workers reported using their own funds for transportation.

“We don’t have transportation; we must trek, which makes us tired. Sometimes, we use our personal transport. Whenever we visit our community, we fear for ‘tsotsi’ (thieves). Even though we don’t go alone, we are told that we must move as a group to keep from getting harm,” CHWs said.

Supervision

Participants requested active supervision to manage their workloads effectively. One CHW stated that the absence of a community-based supervisor made their work significantly more difficult.

Training Workshops

Ongoing training was another key request, enabling CHWs to perform their duties more effectively and efficiently, especially in assessing and managing difficult situations.

“Workshops and training, particularly when evaluating someone and determining that her situation is not favourable, allow you to communicate with the manager. But with training, you will be able to know certain things and what to say,” one participant noted.

Communication Support

Financial allowances for cell phones and data were requested to facilitate after-hours communication with clients, promoting a better work-life balance. Without dedicated phones, CHWs felt obligated to answer calls at all hours, disrupting their personal lives.

Work Identifiers

Uniforms and name tags were deemed essential for easy identification and to enhance trust and respect within the communities they serve. CHWs reported being promised uniforms for years without receiving them.

Human Resources

CHWs expressed concerns about low salaries, heavy workloads, and job insecurity. They requested increased staffing to alleviate the burden and improve overall job satisfaction.

“If they can increase our salary, they pay us very little for what we do, which is not at all encouraging. From year-to-year, promise. Is hard,” some participants lamented.

Discussion of Findings

The concerns raised by CHWs in this study align with findings from other research. For instance, a 2022 study in Nigeria by **Olateju et al** highlighted similar issues regarding financial incentives and staffing needs.

Moreover, according to a recent report by the World Health Organization (WHO), community health workers often lack the resources and support needed to perform their duties effectively (WHO, 2024).

Conclusion

Addressing the needs of community health workers is crucial for enhancing healthcare delivery and promoting health equity in underserved communities in South Africa. Implementing the supportive strategies suggested by CHWs, such as providing transportation, regular training, adequate supervision, and fair compensation, can improve their effectiveness and motivation.

The study’s authors urge policymakers and stakeholders to prioritize strengthening the CHW program, recognizing its vital role in achieving universal health coverage and reducing health disparities.