Voices from the Field: Perspectives from community health workers on health care delivery in rural KwaZulu-Natal, South Africa

Abstract

Background. As the primary link between the formal health care sector (clinics, physicians, and nurses) and the household level in South Africa, community health workers (CHWs) provide a critical perspective on barriers that exist in rural health care delivery. Methods. A 30-question written questionnaire assessing CHW perspectives on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and potential CHW program improvement was administered to 120 CHWs in the Outer West Region of KwaZulu-Natal, South Africa. Interviews with CHWs, administrators of the CHW program, physicians, and nurses from district clinics were also conducted. Results. CHWs identify TB, HIV/AIDS, and poverty as the greatest challenges facing the community and suggest stigma, denial, and lack of education as the primary reasons for failure to complete TB treatment and avoidance of HIV counseling and testing. Additionally, the results highlight inadequate support and monitoring for the program as a result of a lack of administrative supervision and of basic work-related supplies. Conclusions. These results suggest that CHWs recognize the need for HIV/AIDS- and TB-related interventions but are unable to provide a response commensurate to this need. To fully enable the existing CHW program to effectively fight the HIV/AIDS and TB coepidemics, substantial improvements in supervision and collaboration must be made in KwaZulu-Natal. © 2007 by the Infectious Diseases Society of America. All rights reserved.