Community health workers, recipients' experiences and constraints to care in South Africa - a pathway to trust.
Community health workers (CHWs) affiliated with community-based organisations are central to the implementation of primary health care in district health services in South Africa. Here, we explore factors that affect the provision of and access to care in two provinces - Gauteng and Eastern Cape. Drawing on narratives of care recipients and the CHWs who support them, we illustrate the complex issues surrounding health maintenance and primary care outreach in poor communities, and describe how the intimate interactions between providers and recipients work to build trust. In the study we report here, householders in Gauteng Province had poor access to health care and other services, complicating the impoverished circumstances of their everyday lives. The limited resources available to CHWs hindered their ability to meet householders' needs and for householders to benefit from existing services. CHWs in the Eastern Cape were better able to address the needs of poor householders because of the organisational support available to them. Based on an ethos of integrated and holistic care, this enabled the CHWs to address the recipients' context-related needs, and health and medical needs, while building greater levels of trust with their clients.
['Nxumalo|Nonhlanhla|N|', 'Goudge|Jane|J|', 'Manderson|Lenore|L|']
D003153:Community Health Services D003150:Community Health Workers D003159:Community-Institutional Relations D003695:Delivery of Health Care D019033:Delivery of Health Care, Integrated D006297:Health Services Accessibility D006801:Humans D009938:Organizations D011320:Primary Health Care D011369:Professional-Patient Relations D036301:Qualitative Research D064890:Social Determinants of Health D013019:South Africa D035502:Trust D000078329:Workforce
community health workers South Africa primary health care Barriers to care integrated care policy social determinants of health