Title: The impact of training of community health care workers providing ward based community outreach services in Dr Kenneth Kaunda district of the Northwest Province
Abstract:
I n recent years, community health workers (CHWs) have emerged as the main role players in implementing communitybased public health interventions in racially diverse communities. Yet little is known about the extent to which CHW training curriculums influence intervention effectiveness in marginalized racial and ethnic minority communities. This review summarizes evidence on the relationship between CHW training curricula and intervention outcomes conducted among South African communities in Dr Kenneth Kaunda district. A literature search was conducted of intervention studies that focused on CHW public health interventions in. Included studies were quantitative, qualitative, and mixed methods studies employed to conduct outcome (e.g., registering a new household) and process evaluations (e.g., knowledge and self-efficacy) of CHW-led interventions. 43 managers and other categories of managers were trained. 89 OTL’s and 634 CHW’s were trained, and they all met the inclusion criteria. Overall, the strength of evidence linking specific CHW training curricula components to primary intervention health outcomes proved to be very effective, Studies that described training related to didactic sessions or classified as high intensity reported higher percentages of positive outcomes compared to other CHW training features. These findings suggest that CHW training may positively influence intervention effectiveness but additional research using more robust methodological approaches is needed to clarify these relationships. The ward based primary health care outreach team (WBPHCOT) in service skills development package has been compiled to strengthen the capacity of WBPHCOT’s to provide quality health care services in the community through developing cross-cutting CHW and OTL skills. The South African national department of health mandated I-TECH South Africa, a subsidiary of the university of Washington, school of public health and medicine to develop training toolkits and roll out the process of training in PEPFAR priority districts in the whole of South Africa, using the cascade model. Research objectives: To assess the impact of training of CHW’s To establish a link between theory and practice To measure the outcomes of training conducted To evaluate the effectiveness of OTL’s 1.1 Research environment: The study took place in all sub districts of Dr Kenneth Kaunda district of the Northwest Province, JB Marks, Matlosana and Maquassi Hills. 3 expert trainers trained 4 master trainers, who in turn, under direct supervision oof expert trainers, trained about 52 OTL’s. These OTL’s then trained close to 600 community health workers on the skills required in the implementation of the outreach program. 2. Background information 2.1 Literature review: Fortunate L (2016:4) asserts that the shortage of human resources in the health sector has played a major role in the revival of the CHW programme. Task shifting became a strategy of choice identified to address human resource shortages and to decrease the workload of the existing healthcare workforce (Hoke, et al, 2012). This means that some work activities are shifted from other health care workers to be the responsibilities of CHW, thereby reducing the Segomotso Magzimah Ntlhaile1* and Abraham G. van der Vyver2 1 Masedi Foundation, Northwest Province, South Africa 2 School of IT, Monash SA, Ruimsig, South Africa Day 02 42 NURSING 2022 workload in PHC services. Improved service delivery in the health sector has been the outcome in areas where there was successful implementation of program policies. (Fulton, et al, 2011). The more improved service delivery, the better the health outcomes. Published studies on maternal and child health, HIV/AIDS treatment, and care support by community health workers in African countries endorsed the above finding (Callaghan, et al., 2010). In a study conducted in Kenya where CHWs diagnosed and treated children, they found that CHWs successfully implemented 80% of the treatment guidelines for children (Rowe, et al, 2007) a very good measurable outcome indeed emphasizing the critical role that community health care workers play. Research from a Cochrane systematic review has shown that community health care workers could effectively deliver services such as promoting immunization uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality rates in the communities that they serve. (Lewin, et al, 2010). They are currently involved in the said program and are doing remarkably well. The roles and responsibilities of the CHW’s are outlined below: They advocate for the communities that they serve They link patients and communities with the health care system especially PHC’s They work as lay counsellors in other countries as they provide HIV counseling They carry out other psycho-social needs They do community mobilization and outreach campaigns for health care services They target households’ coverage for health care services 3. Thesis statement: The researcher emphasises the importance and relevance of a cascade model of training which was used to train expert trainers, master trainers, outreach team leaders who in turn trained community health care workers. This team was equipped with skills to empower them to implement the program in respective wards that they have been allocated to. The desired outcome is for the communities to have improved quality of life. Activities include household visits where families are registered in the program. Then history taking, screening and assessments are done to establish their health statuses. Health education is then given to each household based on their specific needs. They are then referred to PHC facilities for testing of different diseases, examination, diagnosis, and treatment where necessary. It is the responsibility of the trained OTL’s to see to it that CHW’s carry out their duties. It is the responsibility of trained CHW’s to ensure that communities and families prevent diseases and promote healthy lifestyles, that they visit PHC centres at given dates, they adhere to treatment to prevent complications which may lead to loss of lives. If the cascade model of training of WBCOT’s is effective, then the impact of such training will yield positive outcomes and strong linkages and referrals to PHC services as well as increased livelihoods. 4. Methodology: This study was conducted during 2021 using the post era approach. All WBOTs in the district at the time were included in the study. Data were collected through: • A questionnaire surveys. • Key informant interviews and a review of records used by the team • A process evaluation was conducted to describe inputs (training, team composition, resources, and knowledge) • Pprocesses (service delivery, referral linkages, support, and supervision) and outputs (number of clients referred and followed up). • Logistic regression was performed to identify CHW characteristics (Age, education, experience, training, and knowledge) associated with adherence to national guidelines. 5. Summary 5.1 Research question: Are trainings that are given to community health care workers using the best methodologies effective enough to equip them with knowledge, skills, and expertise to help communities improve their life expectancy by taking charge of their own health care needs? Day 02 43 NURSING 2022 5. 2 Findings: Trainings given to community health care workers in Dr Kenneth Kaunda district equip them with the skills, knowledge, and expertise to help communities address their own health care needs. They become more confident to provide services most needed in communities. They build rapport with communities in such a way that they are trusted and even protected during unrests even in townships where gangsterism is rife. The RTC is the unit that is responsible for planning and implementation of all trainings in the district. This is where the RTC manager and clinical trainers converge to plan before clinical trainers can go back to their different sub-districts to continue with planned activities. CHWs can serve as a means of improving outcomes for underserved populations for some health conditions. The effectiveness of CHWs in numerous areas requires further research that addresses the methodological limitations of prior studies and that contributes to translating research into practice. 6. Recommendations: The researcher recommends the following steps to be strictly adhered to by clinical trainers to ensure program sustenance and skills gap, after every training of new recruits, Eight weeks WIL and one week assessment Each clinical trainer should support 6-8 OTLs in their sub-district of operation. Plan the schedule of support and inform the OTLs in advance of your visit to their facilities Using the tools provided, mentor the OTLs on application of components of skill development: • Household visit • Facilitation sessions • Team meetings • Records Identify teachable moments and conduct debriefing sessions to improve the skills Last week of WIL, support OTLs in assessing their CHWs. Take them through the tools to be used to ensure common understanding Develop sustainability plan for the continuation of the programme
