The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province
Abstract
:1. Introduction
- How is the primary health care ward-based outreach programme currently being implemented in the Nkangala district?
- How acceptable is the ward-based outreach programme to managers, community health workers, and clients in the district?
- What are the barriers and facilitators for the implementation of the ward-based outreach programme?
- What are the recommendations of managers, CHWs, and clients to improve the implementation of the WBOT programme in the district?
2. Materials and Methods
2.1. Design
2.2. Evaluation Sites
2.3. Sampling and Data Sources
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. Description of the Study Sample
3.2. Themes
3.2.1. Satisfaction with the Outreach Teams
The Perspectives of Recipients of the Programme
“They are not harsh; they are so down to Earth and talk to you nicely. They ask for your permission. If it were not for them, we wouldn’t be where we are today. Even if there is someone who refuses to test, they talk to him or her nicely; in the end they agree to go and test. They help us a lot in our families since they arrived. They have this way of talking to you. I do not know if that is how they have been trained. They are so polite in a way that you will feel important.”CM
“Their visit made me feel better…I had already stopped taking my medication because the staff at the clinic were shouting at me. So, when they came to visit me, I explained what had happened at the clinic. They gave me a referral letter to take with when I go to the clinic. They assisted me.”CM
“The other thing is when you have a problem and you need them, they do come to you and assist with your problem.”CM
“The community does accept it, but not the whole community; at times in other houses, when they arrive and greet the people, they throw them out in a nasty manner. Some do accept them, but not all the community.”CM
“That is why at times they are scared to go to some homes, because the people become nasty and become impatient.”CM
“We also hide when they come, we tell our children that they must say we are sick obvious they will be dishearten and go back. The fact is that we do turn them back.”CM
“They should change their system if they can visit us monthly and ask how we are doing; they should not come only in December. They should come every month and check if there is no one who is sick. They should not come at the end of the year only and not know what is happening during the whole year.”CM
“They are not many, they are very few, and they knock off at twelve. They are few and this area is big. So, they only see you once a year or after three months; it is impossible for them to see you every month.”
The Perspectives of the CHWs
“The community trust us. When they see us, they see help even if we don’t have anything with us. By just entering their households with a smile, they feel healed already.”CHW
“The community appreciate the programme a lot. They wish to be with us every day, but it is impossible because we work with many homes.”CHW
“In some homes, it’s difficult; they say, “No, we are busy, you are taking our time.” Even though it’s like that, we are forced to sit down and have a conversation with them.”CHW
“Some people in the households used to chase us away; others unleash their dogs on us so they could bite us.”CHW
“The chiefs and community development workers support the programme.”CHW
“At first, I loved this, and I was having the strength, but now I no longer have the strength. I am thinking of getting another job in town, just cleaning for someone instead.”CHW
“They cannot even give us a decent salary, with that R1200.00 I am expected to buy clothes to wear when I am in the community. They will not allow me not to be in uniform.”CHW
“It hurts a lot because sometimes when you come back from the field, you are tired, and you don’t know what you are going to eat. But just because we’re aware of what we are dealing with in the field, we don’t have a choice and we are willing to help these people so that they can have a good life.”
“The referral system is not working…it’s bad, we refer patients to the clinic, but the nurses do not refer back to us. They undermine us. They say we are not trained, we don’t know this job, and then they ignore us.”CHW
The Perspectives of Health Professionals
“If there were ratings, I would give them ten out of ten. I would give the OTL nine-and-a-half out of ten because she was really performing. Most of the facility outcomes were at the level that I needed.”Facility manager
“I think I am satisfied because the outreach teams assist a lot in tracing chronic patients who have defaulted.”Supervisor
“I am so satisfied because in the field, I know when they are there, they will make sure everything is done perfectly.”Facility manager
“I am happy because the immunisation statistics is very good. Very few defaulters have valid reasons to default the treatment. So, we have achieved a lot. Even the TB rate and pregnancy rate has dropped.”OTL
“The community is now used to the outreach programme and there are many communities that do not have this outreach programme and they wish to have it in their communities.”OTL
“I’m actually satisfied, you know. It becomes so self-fulfilling when you see something that was started from scratch…and we had to put systems in place to make sure that we start implementing the programme which was never implemented anywhere in the country.”District manager
“We have community meetings with the counsellors to discuss how we can work together.”OTL
“I am not satisfied because if the OTL is in the clinic doing admin work, I feel she can also help with clinic-related work.”Facility manager
“I am not that satisfied because basic things like uniform for CHWs is not that expensive, these are things that the department can do. The same applies to the CHWs that we are working with, to absorb them in the system. I feel it’s something very easy.”OTL
3.2.2. Benefits of the Outreach Teams
Benefits to the Communities
“I don’t like drinking my pills, but when the outreach teams arrived in my household, I received them. They talked to me and put me in a right place, and I saw that taking medication is good for me.”CM
“They help us a lot by coming to visit us in our homes and take good care of us. There are sick people who are scared to go to the clinic because the nurses do not approach them well. So, if they come to households, many people get well, because they are able to talk to them about anything. Even secrets, we are able to share with them.”CM
“She (OTL) stays in our vicinity, even at night, this woman wakes up, she does not have a problem, when you knock, she wakes up, you tell her your challenge and she helps you. I have never seen a person like her at the clinic, I come at night and stay for a long time, but she always accompanies me.”CM
“If you are living with someone who is sick in the household and you cannot leave that person alone, they are able to get medication on your behalf.”CM
“When a person is sick and bed-ridden, they take the person to the clinic and get treatment for them. They help a lot.”CM
“I once defaulted treatment, so they came and encouraged me to go back and start my treatment again. They found me in a horrible state, and I was very weak. They encouraged me, they helped me, and I now adhere to my treatment.”CM
“They collect food parcels for children. When the children eat, they ask them about their families, and they do a follow-up, and they go to the homesteads to see conditions of those families.”Community member
“Sometimes, there are orphans who don’t have birth certificates and do not receive grant. We have a centre where we are referring them to go and eat. We have vulnerable and child-headed households who are not getting grant. We send them again to SASSA to get food packages.”CHW
“The community appreciates what the Department of Health does for them as they bring the health services to their households, because the community appreciates us.”CHW
“The WBOT help with health issues so that the people shouldn’t go long distances to the clinic. Like our ward is very broad and they walk distances they are very far to reach the clinic so we are able to go to them.”CHW
Benefits to CHWs and OTLs
“As far as I’m concerned, I have learned a lot; I am now independent as far as my work is concerned, but because I have been given a team leader, I do need her all the time.”CHW
“You know, I’ve understood one thing ever since I worked outside of the clinic. Since I became part of the outreach teams, I saw that it is very easy to turn somebody away when you are at the clinic, when you don’t know where these people are coming from.”OTL
“I mean, you learn more about your job description as a team leader, what you are expected to do as a team leader, and how to attend to other challenges, where to report to as a team leader, as well as the tools you are going to use as a team leader.”OTL
Benefits to the Service Provision
“Through the WBOT, we are able to increase our priority indicators. Some of the mothers do not send their children for immunisation in the clinic. So, the outreach teams go out and finds these children and then we help them catch up with the immunisation. That helps to increase the statistics of the clinic. They are also able to find those who defaulted their treatment.”Facility manager
“Since the programme started, we are getting more pregnant women and they are booking early for ANC. We also do not have more defaulters as before, and on the TB cases, we ask them to go trace patients who are defaulting, so the defaulter rate has been reduced.”Facility manager
“Without the outreach team, the clinic won’t survive because even if they introduce vitamin A, the outreach team will go to the crèche and help the clinic by giving the children de-worming and vitamin A.”Facility manager
“The fact is that the PHC utilisation rate, which is supposed to be around 3.5, but it is now around 2.7 and 1.8. Our view and analysis is that it appears as if the implementation of the WBOTs may have played a role. We don’t see a lot of patients at PHC level any more. This suggest that maybe the burden of diseases is reduced or the pressure put on PHC facilities is reduced.”District manager
“We were looking mostly at the indicators, facility indicators like ANC visits at twenty weeks, immunisation coverage, and post-natal visits within six days, vitamin A, and deworming. So, when you look at the DHIS and the facilities that are being supported by the ward-based outreach teams, there is a slight of improvement of these indictors.”District manager
“Currently, we have seen an improvement in some of the priority indicators like the TB cure rate and the improvement in the early bookings for women and reduction on the defaulter rates on TB treatment, which we said it may be due to support of the WBOTs.”Provincial WBOT manager
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AIDS | Acquired Immunodeficiency Syndrome |
CHW | Community health worker |
CM | Community member |
DHIS | District Health Information System |
FGD | Focus group discussions |
HCW | Health care worker |
HIV | Human Immunodeficiency Virus |
OTL | Outreach team leader |
PHC | Primary health care |
TB | Tuberculosis |
WBOT | Ward-based outreach team |
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Evaluation Site | Data Source | Population | Sample |
---|---|---|---|
Provincial Office | Coordinator | 1 | 1 |
Nkangala District Office | District managers | 1 | 1 |
Nkangala District Office | Coordinator | 1 | 1 |
Dr JS Moroka Sub-District | Supervisors | 2 | 1 |
Facility managers | 4 | 1 | |
Team leaders | 4 | 4 | |
Community health workers | 44 | 6 | |
Community members (clients) | 2 FGDs | ||
Thembisile Sub-District | Supervisors | 2 | 1 |
Facility managers | 4 | 1 | |
Team leaders (OTLs) | 4 | 4 | |
Community health workers (CHWs) | 35 | 6 | |
Community members (clients) | 2 FGDs | ||
Emalahleni Sub-District | Supervisors | 2 | 1 |
Facility managers | 2 | 1 | |
Team leaders (OTLs) | 2 | 2 | |
Community health worker (CHWs)s | 24 | 6 | |
Community members (clients) | 2 FGDs |
Participants | Number | Gender | Age |
---|---|---|---|
Provincial coordinator | 1 | Female | 50 |
District manager | 1 | Male | 51 |
District coordinator | 1 | Female | 37 |
Supervisors | 3 | Females | 45–58 |
Facility managers | 3 | 1 Male, 2 females | 45–55 |
Team leaders (OTLs) | 10 | 2 Males, 9 females | 40–59 |
Community health workers (CHWs) | 18 | Females | 30–55 |
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Nelson, C.; Madiba, S. The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province. Healthcare 2020, 8, 464. https://doi.org/10.3390/healthcare8040464
Nelson C, Madiba S. The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province. Healthcare. 2020; 8(4):464. https://doi.org/10.3390/healthcare8040464
Chicago/Turabian StyleNelson, Cheryl, and Sphiwe Madiba. 2020. "The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province" Healthcare 8, no. 4: 464. https://doi.org/10.3390/healthcare8040464