CHW Platform
The CHW platform provides a space for community health worker representatives from different community based organisations to connect with the sub-district focal person for ward-based primary health care outreach teams and each other; allowing for engagement on aspects of common interest and escalation of the CHW inputs within the formal health system structures.
The trainer-of-trainers project will further expand the capacity of CHWs to conduct community engagement, thereby expanding the opportunities to understand community needs and address exclusion from the health system; at the same time elevating the role of CHWs within the local health system.
COMMUNITY HEALTH WORKERS: CARING FOR THE CARERS
Community health workers (CHW) are at the forefront of primary health care service delivery, acting as the direct link between health service users (communities) and providers (the public health system). However, this cadre of health workers face persistent challenges. While organisational challenges are acknowledged, the engagement with CHW during a ‘community café’ setting on 29 November 2022, in Bushbuckridge sub-district, Mpumalanga, South Africa, focused on the challenges experienced by CHWs at a personal and relating to their experience as ‘peer supporters’ within their communities. The session was attended by six CHWs, from community-based organisations contracted to provide ward-based primary health care outreach services by the provincial Department of Health.
CHWs reflected on their personal experiences with regards to facing challenges at personal and inter-personal level and how they deal with these. With the high level of alcohol and other drug abuse in the local communities, many of the CHWs are directly affected within their households, either as parent or spouse of a person who abuses alcohol and / or drugs. CHWs have historically been responsible for the care for individuals with chronic communicable disease, with additional duties and responsibilities being added when the cadre was formalized as ward-based outreach teams. While the communicable disease burden remains high, the increase in non-communicable disease prevalence significantly increased the workload of CHWs. This burden is also disproportionately affecting poor households, with significant gaps remaining with regards to the extent of this burden; along with a seemingly non-existent response from the health system, beyond providing chronic medication.
The CHWs also face challenges in their line of work, including being confronted with hardship suffered by individuals and households within their communities. Due to the nature of their work, CHWs work with community members at an intimate level, accessing homesteads and being entrusted with personal and health information. While the duties of CHWs do not include the provision of personal care services, many CHWs previously worked as home-based care givers and still provide these services, e.g. cleaning the house, bathing the elderly or ill, preparing food for the frail, when they identify a need.
This exposure to personal hardship, ill health, poverty and at times also abuse, affect the mental health of CHWs; especially when they regard situations to be beyond their control or are not able to provide the support and assistance required. However, there is no system in place for CHWs to debrief or receive counseling and support to deal with the trauma they face or personally experience.
Partly due to the lack of mental health support within their workplace and / or communities, and partly due to their caring and nurturing nature, many CHWs have taken it upon themselves to provide personal support to their peers. While this support is acknowledged and appreciated and also relates to the concept of ‘Ubuntu’, the lack of formal and structured support still leaves CHWs exposed to unresolved trauma.
The cohesion amongst this cadre of workers is very strong, with several accounts of support provided amongst themselves and to community members beyond their scope of work, at a direct or indirect cost to the individual CHW. The lack of psychologic and other workplace support for CHWs remain a priority concern to CHWs, impacting their mental and physical health.