TY - JOUR
T1 - The unmet needs and health priorities of the urban poor
T2 - Generating the evidence base for urban community health worker programmes in South Africa
AU - van Rie, A.
AU - West, N. S.
AU - Schwartz, S. R.
AU - Mutunga, L.
AU - Hanrahan, C. F.
AU - Ncayiyana, J.
AU - Bassett, J.
N1 - Funding Information:
Acknowledgements. We extend our thanks to all the survey participants who contributed their valuable time, and the data collection team for their hard work. We also thank Ian Sanne, the Community Advisory Forum, Diepsloot service providers, the Diepsloot ward counsellors and offices of the Diepsloot ward counsellors, and the Diepsloot South African Police Service for their support. Author contributions. AvR, SS, CH and JB designed the study, NW and LM supervised all data collection, JN participated in data collection, AvR, NW, SS, CH and JN contributed to data analysis, AvR drafted the manuscript, and all authors contributed to and approved the final version of the manuscript. Funding. This study was funded by the United States Agency for International Development (USAID) under award number AID-674-A-12-00033, with additional funding from AID 674-A-12-00020. Conflicts of interest. None.
Publisher Copyright:
© 2018, South African Medical Association. All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - Background. There is a growing interest in involving community health workers (CHWs) into the formal healthcare system in South Africa (SA). Objectives. To generate evidence for defining CHW tasks in urban SA. Methods. A cross-sectional survey of residents of Diepsloot, northern Johannesburg, was performed using geographically weighted random sampling, with home-based health assessment and a questionnaire on sociodemographics, medical history, experience of violence, health-seeking behaviour and perceived health priorities. Results. Between May 2013 and March 2014, 1 230 adults participated. Self-reported medical conditions included hypertension (12%), HIV (10%), diabetes (3%), cancer (1%) and mental illness (1%). Health assessments identified a high prevalence of undiagnosed conditions: hypertension (26%), obesity or overweight (46%), mild to severe depression (23%), HIV infection (5.8%) and tuberculosis (TB) (0.4%). Among women, 18% had unmet family planning needs and 77% had never had a Pap smear. Sexually transmitted infection symptoms were reported by 7% of participants. Physical violence was widespread, with 13% having experienced and 16% witnessing violence in the past year, with women mostly experiencing violence at home and men in the community. Participants’ top health concerns were crime, safety and violence (49%) and HIV (18%); healthy living/weight control was listed by only 8% of participants. Conclusions. Alignment of CHW roles to unmet health needs and perceived health priorities will be important for optimal impact of CHW programmes in urban communities. Our data suggest that the CHW role should expand from a traditional focus on HIV, TB and maternal health to include non-communicable diseases, healthy lifestyle, and the intersection of violence and health.
AB - Background. There is a growing interest in involving community health workers (CHWs) into the formal healthcare system in South Africa (SA). Objectives. To generate evidence for defining CHW tasks in urban SA. Methods. A cross-sectional survey of residents of Diepsloot, northern Johannesburg, was performed using geographically weighted random sampling, with home-based health assessment and a questionnaire on sociodemographics, medical history, experience of violence, health-seeking behaviour and perceived health priorities. Results. Between May 2013 and March 2014, 1 230 adults participated. Self-reported medical conditions included hypertension (12%), HIV (10%), diabetes (3%), cancer (1%) and mental illness (1%). Health assessments identified a high prevalence of undiagnosed conditions: hypertension (26%), obesity or overweight (46%), mild to severe depression (23%), HIV infection (5.8%) and tuberculosis (TB) (0.4%). Among women, 18% had unmet family planning needs and 77% had never had a Pap smear. Sexually transmitted infection symptoms were reported by 7% of participants. Physical violence was widespread, with 13% having experienced and 16% witnessing violence in the past year, with women mostly experiencing violence at home and men in the community. Participants’ top health concerns were crime, safety and violence (49%) and HIV (18%); healthy living/weight control was listed by only 8% of participants. Conclusions. Alignment of CHW roles to unmet health needs and perceived health priorities will be important for optimal impact of CHW programmes in urban communities. Our data suggest that the CHW role should expand from a traditional focus on HIV, TB and maternal health to include non-communicable diseases, healthy lifestyle, and the intersection of violence and health.
KW - Community health workers
KW - Community survey
KW - Public health
KW - South Africa
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U2 - 10.7196/SAMJ.2018.v108i9.13054
DO - 10.7196/SAMJ.2018.v108i9.13054
M3 - Article
C2 - 30182898
AN - SCOPUS:85052642411
SN - 0256-9574
VL - 108
SP - 734
EP - 740
JO - South African Medical Journal
JF - South African Medical Journal
IS - 9
ER -