AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #216 - "She is my teacher and if it was not for her I would be dead”: Exploration of rural South African CHWs’ informational and mediating roles in the home
Authors: Presenting Author: Ms Rose Zulliger - University of Cape Town
Additional Authors: Dr. Helen Schneider, Dr. Mosa Moshabela,
Aim: Community Health Workers (CHWs) provide a broad range of preventative, promotive, curative, palliative and mediation services within the context of Human Immunodeficiency Virus (HIV)- affected communities. Despite the extensive literature on the history of CHWs and their application, there is little evidence from the African context on whether they specifically meet the Information, Education and Communication (IEC) needs of their communities. This study sought to determine the quality of preventative and promotive care provided by CHWs within a rural sub-district in Mpumalanga, South Africa.
Method / Issue: Semi-structured interviews were conducted in 2010 with the triad of HBC clients (n=33) and the primary caregivers (PCGs) (n=30) and the CHWs (n=17) who provide care for them. Interviews with the triad of care in the home allowed for data source triangulation. An additional 22 follow-up interviews were conducted to further probe the content of and need for IEC in the home.
Results / Comments: There is extensive evidence that CHWs provide a range of IEC services in the home and draw upon their training and experience to provide locally coherent messages for the clients, PCGs and broader community. IEC messages include both HIV-specific information and general health promotion. CHWs adapt health messaging and incorporate local knowledge and understanding in order to enhance the degree of fit with community members’ understanding of illness and appropriate treatment. CHWs also enhance PCG caregiving and client self-care capacity. CHWs serve as mediators to enhance patient quality of care. CHWs support clients’ entry and maintenance in the formal health system and assist community members to understand and appropriately utilize government services rather than traditional medicine. Additionally, CHWs mediate between PCGs and clients through provision of IEC messages and counseling to reduce stigma and facilitate intra-household communication
Discussion: CHWs are able to bridge the worldviews of the community and the clinic to expedite access and adherence to formal services. As mediators between the two worlds, CHWs re-interpret health information and the conception of illness to make it comprehensible to care recipients. CHWs’ key role in cultural access and health maintenance could, however, be compromised by a lack of appropriate trainings and, ironically, by the increasing formalization of other CHW roles. It is, therefore, imperative that care is taken to support the CHWs’ pivotal role as the interface of informal and formal healthcare.
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