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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
AFRICA
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role in the tuberculosis programme in areas such as directly
observed treatment (DOT) and short-course medications for TB
(tuberculosis-DOTs) to support adherence and retention in care.
5
There is evidence that supports the role of CHWs in the
control of already identified chronic disease.
6
A recent review
examined the effectiveness of CHWs in providing care for
hypertension and noted improvements in keeping appointments,
compliance with prescribed medication regimens, reduction in
risk, blood pressure control and reduced related mortality rates.
7
Studies also show that CHWs are effective in educating
their communities about many health conditions, including
CVD, diabetes and asthma.
8,9
They can also help decrease
healthcare costs, increase access to healthcare and information,
and strengthen the family, community and local economy.
10
Studies undertaken in China, Brazil, Iran and Bangladesh
have shown that using CHWs can help improve health outcomes
of the populations they serve.
11
A study by the Health System
Trust found that in communities with poor health services, the
use of CHWs to conduct home visits led to an increase in the
community’s access to relevant health information.
12
Currently there is no standardised training curriculum for
CHWs in South Africa. As a result, training is customised
by individual organisations or institutions to equip CHWs to
perform specific activities only over the lifetime of individual
projects.
12,13
This article describes the training process to equip CHWs
with knowledge and skills to identify individuals who are at a
high risk for CVD in Khayelitsha, a peri-urban township of
Cape Town. The lessons learned and the challenges identified
will inform the teaching methods/processes for training lay
workers with varied educational levels. This will assist in the
training of a knowledgeable workforce at the community level,
which will play a role in addressing the escalating burden of
NCDs. For the purpose of this article, a CHW is defined as a
lay person who has received some training to deliver healthcare
services but is not a health professional.
Methods
The CHWs who participated in the training programme were
recruited from an NGO that primarily focuses on delivery of
services related to NCDs. It was envisaged that the knowledge
acquired during the training would be utilised beyond the
research period by CHWs in their daily activities. After the
training, CHWs were expected to screen and identify people at
risk for CVD in households in the community and refer them
to four of the closest government health facilities to ensure that
they received appropriate further treatment.
The study protocol was approved by the National Heart,
Lung and Blood Institute (NHLBI), USA, as well as the
respective institutional or ethics review boards in each of the four
participating sites in the country. All staff members associated
with the study successfully completed the ethics courses through
the Collaborative Institutional Training Initiative (CITI).
In preparation for training, the trainers and the training
coordinator visited the NGO to explain the purpose of the
research and to recruit CHWs. The NGO agreed to release 10 to
15 CHWs from their daily activities to enable them to attend the
training and participate in the field-work for the research project.
The actual selection of CHWs for the training was left to the
coordinators at the NGO. They were asked to provide typical
CHWs employed by them and not only the best performers. The
NGO was financially compensated so that they could employ
temporary replacements while the selected CHWs participated
in training and field-work.
To break the ice and to get to know each other, the facilitators
of the training briefly introduced themselves, followed by the
trainees. In addition, each trainee presented his/her experiences
in working with NCDs and expectations from the training. A
summary of trainees’ expectations are listed in Table 1.
The training was conducted for seven hours per week day
from 1 to 12 June 2012. A total of 15 CHWs attended the training
sessions. The training manual developed for the training included
the teaching of theory about CVD and its risk factors, as well as
the practical skills necessary to obtain blood pressure and other
anthropometric measurements (weight, height). The training
was held at the School of Public Health at the University of
the Western Cape by three trainers who had content knowledge,
experience in training and working with CHWs, fluency in the
local language, could easily relate to the CHWs’ situation, and
who had adapted the manual previously used to train the CHWs
in various centres of excellence.
Based on the principles of andragogy, which uses life
experiences and knowledge that adults bring to their learning
experiences, the training was participatory in nature and designed
to encourage sharing of experiences in delivering care for NCDs.
Table 1. Summary of community health workers’ expectations of the training
Expectation
Rationale for expectation
1. To acquire new skills related to chronic disease management New skills would allow them to better serve their community’s NCD needs
2. To be provided with proper equipment
Proper equipment would improve their ability to assess the health of clients
3. To gain respect from the training
Completing the training at the university would mean that their community and
peers would respect them more and regard them as legitimate health workers
4. To learn to provide assistance to persons recovering from
chronic disease-related events
They needed to learn how to provide assistance to people who had suffered from
stroke or complications from diabetes mellitus
5. To learn how to identify resources
They wanted to know how to identify government resources and assistance
programmes that would allow them to assist the elderly and the young find food,
safety and proper shelter
6. To learn how to function as part of a team
They wanted to learn how to work as part of a team that was responsible for providing
care to the community, as they currently felt unsupported in this aspect of their work
7. To learn how to help sick clients who do not attend clinics
despite their illness
They wanted to find ways to help their sick clients who were not able or willing to
spend an entire day sitting at a clinic
8. To further their career goals
They aspired to becoming nurses, doctors or social workers and saw the completion
of training as a stepping stone to these goals