CHWs and community caregivers : towards a unified model of practice : human resources

This article commences with a brief historical review of community health workers (CHWs), a now also referred to as Community Caregivers, explaining that there was a favourable change in national policy commencing in October 2003 with significant commitment by the Minister of Health. The rationale for this cadre of worker has been previously reviewed. During 2004, a National Community Health Worker Policy Framework was drafted. The essential elements are outlined. Despite the progress, there remains a bewildering array of CHW cadres. First steps to deal with this involve the development of unified training standards. Both short-term and longer-term learning programme initiatives are well under way towards achieving this. Four levels of qualification have been registered with the South African Qualification Authority. Accreditation of programmes will provide learners with greater opportunities for career advancement and the ability to operate in a more generalist manner. Other important steps to deal with the confusion will be the promotion of intra- and inter-sectoral collaboration. This will involve developing appropriate coordination mechanisms, which will link with municipalities and local ward committees. District health managers will have a key role in promoting coordination and monitoring quality. Community health committees should be responsible for governance. Recommendations are provided for achieving integration at provincial, district and household level. In the absence of documented evidence, many of the observations made in this chapter are based on the author's personal opinion and offered as a contribution to understanding a complex situation. Given the absence of evidence, the views expressed should be understood as tentative.