Ward-based primary health care outreach teams in South Africa: developments, challenges and future directions

Abstract

In 2011, South Africa adopted the Ward-based Primary Health Care Outreach
\nTeam (WBPHCOT) Strategy. The WBPHCOTs are made up of generalist community
\nhealth workers (CHWs) supported by nurse team leaders, and linked to local
\nprimary health care (PHC) facilities (via referral, support and oversight). These
\noutreach teams build on a pre-existing NGO-based community care and support
\nsystem that emerged in response to HIV and AIDS in South Africa. By early 2017,
\n42% of the estimated required total of 7 800 teams were reporting activity data
\nthrough the District Health Information System.
\nThe WBPHCOTs are envisaged as a key element of PHC in the future National
\nHealth Insurance (NHI) system, and a WBPHCOT Policy Framework was launched
\nin December 2017. An accredited curriculum for a comprehensive CHW cadre
\nhas been approved nationally and is being implemented through a decentralised
\ntraining infrastructure. Although an investment case for the WBPHCOT policy has
\nbeen finalised, additional resources have yet to be allocated for rollout of the strategy.
\nThis chapter draws on policy documents, research conducted by the authors, and
\ngrey and published literature to recap the history of CHW programmes in South
\nAfrica and the emergence of the WBPHCOT strategy and policy. Key dimensions
\nof WBPHCOT policy and implementation are reviewed, including scope of work,
\nselection, supervision, training, financing and monitoring and evaluation. The
\nchapter concludes with a set of recommendations addressing a number of significant
\nconstraints on performance and future development of WBPHCOTs in light of their
\nintended role in NHI.