A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa.

BACKGROUND: Non-communicable diseases (NCD) and infectious chronic illnesses are recognised as significant contributing factors to the burden of disease globally, specifically in South Africa, yet clinical management is often poor. The involvement of community health workers (CHWs) in TB and HIV care in South Africa, and other low- and middle-income settings, suggests that they could make an important contribution in the management of NCDs. OBJECTIVES: Using a rapid assessment, this study examines the outcomes of a pilot CHW programme to improve the management of hypertension and diabetes in Gauteng province, South Africa. METHODS: A record review compared outcomes of patients receiving home visits (n56) with a control group (n168) attending the clinic, matched, as far as possible, on age, gender, and condition. Focus group discussions and semi-structured interviews with CHWs, patients, district, clinic, and NGO staff were used to obtain descriptions of the functioning of the programme and patient experiences. RESULTS: Despite the greater age and co-morbidity among those in the pilot programme, the findings suggest that control of hypertension was improved by CHW home visits in comparison to usual clinic care. However, too few doctor visits, insufficient monitoring of patient outcomes by clinic staff, and a poor procurement process for supplies required by the CHWs hampered the programme's activities. CONCLUSION: The role of CHWs in the management of hypertension should be given greater consideration, with larger studies being conducted to provide more robust evidence. Adequate training, supervision, and operational support will be required to ensure success of any CHW programme.

Strengthening the capacity for health promotion in South Africa through international collaboration.

BACKGROUND: This paper describes a project to strengthen the capacity for health promotion in two Provinces in South Africa. The project draws on the key health promotion capacity dimensions of partnership and networking, infrastructure, problem-solving capacity, and knowledge transfer. The project was carried out in a partnership between the Provinces, the Ministry of Health of South Africa, the government of Flanders, Belgium, and the World Health Organization (WHO). OBJECTIVES: The project aimed to: (i) integrate health promotion into national, Provincial and district level health policy plans (ii) strengthen the health promotion capacity in the two Provinces; and (iii) support the development of tools to monitor and evaluate health promotion interventions. METHOD: Starting from a situation analysis and identification of priority health issues and existing actions in each Province, capacity-building workshops were organized for senior participants from various sectors. Community-based health promotion interventions were then planned and implemented in both Provinces. OUTCOMES: A systematic evaluation of the project involving an internal audit of project activities and results based on document analysis, site visits, focus groups and interviews with key persons demonstrated that stakeholders in both Provinces saw an increase of capacity in terms of networking, knowledge transfer, problem solving, and to a lesser extent infrastructure. Health promotion had been well integrated in the Provincial health plans, and roll-out processes with local stakeholders had started after the conclusion of the project. The development of tools for monitoring and evaluation of health promotion was less well achieved. LESSONS LEARNT: The project illustrates how capacities to deliver health promotion interventions in a developing country can be enhanced through international collaboration. The conceptual model of capacity building that served as a basis for the project provided a useful framework to plan, identify and assess the key components of health promotion capacity in an African context.