The provision of TB and HIV/AIDS treatment support by lay health workers in South Africa: a time-and-motion study

Human Resources for Health

Simon Lewin²  Willem A Odendaal¹ 

[1] Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC) and Department of Psychology, University of Stellenbosch, P O Box 19070, Tygerberg 7505, Cape Town, South Africa;Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC) and Global Health Unit, Norwegian Knowledge Centre for the Health Services, St Olavs plass, PO Box 7004, N-0130 Oslo, Norway

关键词: Treatment support;    Time-and-motion study;    TB;    Primary health care;    Low-income;    Lay health workers;    HIV/AIDS;    Community health workers;    Antiretroviral therapy;   

Others  :  821804
DOI  :  10.1186/1478-4491-12-18

 received in 2013-12-04, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Lay or community health workers (LHWs) are an important human resource in primary health care, and contribute to improving access to care. However, optimal use of LHWs within the health system is often hampered by a poor understanding of how this cadre organizes its work. This study aimed to better understand how LHWs organize and structure their time in providing treatment and adherence support to people on TB treatment and/or antiretroviral therapy (ART) in South Africa.

Methods

Fourteen LHWs participated across three low-income peri-urban communities in Cape Town. Each LHW was observed by a researcher for one day, and data collected on each activity and the time spent on it. Data were summarized in the following categories: travel to the patient’s home, waiting time and patient contact time.

Results

Ninety-seven attempted visits to patients were observed, and patients were located in 69 of these. On average, LHWs conducted six visits per day, each lasting an average of nine minutes. Forty-six percent of the observed time was spent with patients, with the balance spent on ‘non-contact’ activities, including walking to and waiting for patients. The average walking time between patients was 8 minutes (range: 3 to 15 minutes). Activities during visits comprised medical care (that is ensuring that medication was being taken correctly and that patients were not experiencing side-effects) and social support. Other tasks included conducting home assessments to determine risks to treatment adherence, and tracing patients who had defaulted from treatment.

Conclusions

Because of their tasks and working environment, LHWs providing support to people on TB treatment and ART in South Africa spend a substantial proportion of their time on ‘non-contact’ activities. Programme managers need to take this into account when developing job descriptions and determining patient case-loads for this cadre. More research is also needed to explore whether these findings apply to other tasks and settings. Strategies should be explored to mitigate the challenges that LHWs experience in locating and supporting patients, including the use of new technologies, such as mobile phones.

【 授权许可】

   
2014 Odendaal and Lewin; licensee BioMed Central Ltd.

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