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Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa
Thesis (DPhil)--Stellenbosch University, 2020.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2020
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| _version_ | 1867613799940358144 |
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| access_status_str | Open Access |
| author | Laurenzi, Christina |
| author2 | Tomlinson, Mark |
| author_browse | Laurenzi, Christina Tomlinson, Mark |
| author_facet | Tomlinson, Mark Laurenzi, Christina |
| author_sort | Laurenzi, Christina |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (DPhil)--Stellenbosch University, 2020. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/109113 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:41:53.663Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2020 |
| publishDateRange | 2020 |
| publishDateSort | 2020 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/109113 Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa Laurenzi, Christina Tomlinson, Mark Coetzee, Bronwyne Skeen, Sarah Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. Rural health UCTD Community health nursing Maternal and child health services Thesis (DPhil)--Stellenbosch University, 2020. ENGLISH ABSTRACT:Community health worker (CHW) programmes are regarded as important solutions for improving health care services and outcomes for mothers and children globally. In low- and middle-income countries (LMICs), CHWs may be able to bridge widening gaps between limited human resource capacity and population health needs. However, despite the expansion of CHW programmes, we lack evidence for their effectiveness at scale. Even well-researched evidence-based programmes, when broughtto scale, tend to lose some of their effectiveness. Implementation science methods have emerged as one way to investigate why programmes succeed or fail, by providing researchers with frameworks to examine processes related to delivery, quality, and context. In this dissertation, I explore the processes underpinning the delivery of a CHWprogramme in rural South Africa. This study addressed four related research questions, focused on CHW fidelity to training, client responses to and engagement with the programme, and contextual aspects that affect the programme’s delivery. I utilised a combination of data sources, including transcripts from audio recordings of CHW home visits (n=84), interviews with clients of the programme (n=26), and interviews with CHWs themselves (n=10). The findings of this study identify programmatic strengths, with high levels of fidelity to training in communication skills; instructive and mutually supportive relationships between CHWs and their clients; and dedicated CHWs who regularly prioritise their clients’ needs. These findings also echo persistent challenges in programme implementation, including occupational burdens and pressures for CHWs, and barriers for clients in linking to health care within an under-functioning health system. This dissertation points to the importance of continued training, client and community consultation, and identification of contextual challenges to make programme implementation more effective before they are able to be scaled. It also emphasises the need to adopt a human-centred approach to designing and implementing CHW programmes, shifting away from a technical, vertical mode of providing much-needed services. AFRIKAANSE OPSOMMING: Gemeenskapgesondheidswerkers (GGW) programme word beskou as ‘n belangrike oplossing vir die verbetering van gesondheidsorgdienste en gesondheidsuitkomstes vir moeders en kinders wêreldwyd. In lae en middel-inkomste lande (LMIL'e) kan GGWs in staat wees om breë gapings tussen beperkte menslike hulpbronkapasiteit en bevolkingsgesondheidsbehoeftes te oorbrug. Ten spyte van die uitbreiding van GGW programme, het ons steeds ʼn tekort aan bewyse vir die effektiwiteit daarvan op skaal. Selfs deeglike nagevorsde bewysgebaseerde programme, as dit op die skaal gebring word, is geneig om hul doeltreffendheid te verloor. Implementeringswetenskaplike metodes het na vore gekom as ʼn moontlike manier om te ondersoek waarom programme slaag of misluk. Hierdie implementeringswetenskaplike metodes voorsien navorsers met die raamwerke om die prosesse wat verband hou met die lewering, kwaliteit en konteks van die program te ondersoek. In hierdie proefskrif ondersoek ek die prosesse wat onderliggend is aan die lewering van 'n GGW program in landelike Suid-Afrika.Hierdie studie het vier verwante navorsingsvrae wat gefokus is op die getrouheid van GGW aan opleiding, die reaksie van kliënte op die program, die betrokkenheid van kliënte by die program, en kontekstuele aspekte wat die lewering van die program beïnvloed. Ek het 'n kombinasie van databronne gebruik, wat transkripsies van klankopnames van GGW-tuisbesoeke (n=84), onderhoude met kliënte van die program (n=26), en onderhoude met GGWs self (n=10) insluit. Die bevindinge van hierdie studie identifiseer programmatiese sterk punte, met hoë vlakke van getrouheid aan opleiding in kommunikasievaardighede; leersame en wedersydse ondersteunende verhoudings tussen GGWs en hul kliënte; en toegewyde GGWs wat gereeld hul kliënte se behoeftes prioritiseer. Hierdie bevindinge weerspieël ook die aanhoudende uitdagings met die implementering van programme, insluitend beroepslaste en druk op GGWs, en hindernisse vir kliënte om te skakel met gesondheidsorg binne 'n onderfunksionerende gesondheidstelsel. Die proefskrif dui aan die belangrikheid van aanhoudende opleiding, konsultasie met kliënte en gemeenskappe, en die identifisering van kontekstuele uitdagings om die implementering van die program meer effektief te maak voordat dit opgeskaal kan word. Dit beklemtoon ook die noodsaaklikheid om 'n mensgesentreerde benadering in die ontwerp en implementering van GGW-programme toe te pas en om weg te beweeg van 'n tegniese, vertikale manier in die lewering van noodsaaklike dienste. Thesis (DPhil)--Stellenbosch University, 2020. Doctoral 2020-10-15T07:40:43Z 2021-01-31T19:35:53Z 2020-10-15T07:40:43Z 2021-01-31T19:35:53Z 2020-12 Thesis http://hdl.handle.net/10019.1/109113 en_ZA Stellenbosch University 258 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Rural health UCTD Community health nursing Maternal and child health services Laurenzi, Christina Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title | Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title_full | Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title_fullStr | Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title_full_unstemmed | Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title_short | Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa |
| title_sort | exploring the implementation of a community health worker programme for maternal and child health in the rural eastern cape south africa |
| topic | Rural health UCTD Community health nursing Maternal and child health services |
| url | http://hdl.handle.net/10019.1/109113 |
| work_keys_str_mv | AT laurenzichristina exploringtheimplementationofacommunityhealthworkerprogrammeformaternalandchildhealthintheruraleasterncapesouthafrica |