Doctoral Degrees (Emergency Medicine)

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Browsing Doctoral Degrees (Emergency Medicine) by Subject "mortality and morbidity -- South Africa"

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    Identifying feasible and effective community health worker supervision strategies : experiences of providing and receiving supervision in a rural South African community health worker programme
    (Stellenbosch : Stellenbosch University, 2023-12) Stansert Katzen, Sara Linnea; Tomlinson, Mark; Skeen, Sarah; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.
    ENGLISH SUMMARY: Despite a global focus on reproductive, maternal and child health, maternal and child mortality and morbidity remain real concerns, particularly in low- and middle-income countries (LMICs). The demands on health systems in LMICs continue to escalate due to the high burden of disease and an increased demand for healthcare services, in combination with a shortage of healthcare personnel. Deploying community healthcare workers (CHWs) is an important strategy to bridge the gap in health care and to support the functioning of the healthcare system. While there is substantial evidence of the benefits of CHW programmes, there are concerns regarding the effectiveness of these programmes at scale. Programmatic factors, such as training, access to equipment and sufficient supervision systems, are critical for CHW programme success, yet often lacking or limited in practice – and therefore more focused research is needed. This thesis attempts to address this gap by reporting the results of a qualitative evidence synthesis (QES) and three individual articles presenting findings from qualitative research within the Eastern Cape Supervision Study (ECSS). The ECSS is a cluster randomised controlled trial testing an enhanced supervision and support package for CHWs. In the QES, I report on evidence on how CHWs working in maternal and child health interventions experience supervision. Publications published between 2000 and 2021 were included. In the first qualitative paper I report on qualitative data from interviews with CHWs (who were part of the ECSS study), but which took place during the initial phases of the intervention. This paper reports on their experiences of becoming and remaining CHWs. In the second qualitative paper, I report on qualitative evidence from CHWs in both the intervention and control groups of the ECSS. This paper focuses on how they experience their roles as CHWs, and how they experience supervision, specifically the enhanced supervision intervention. In the third qualitative paper I report on qualitative evidence from interviews with programme stakeholders (in this case supervisors, clinic personnel and programme managers). This paper focuses on their experiences of the CHW programme in general, and the ECSS intervention in particular. The results from these individual substudies highlight substantial shortfalls in the current government-implemented CHW programme in the study area. Limited training, lack of supervision and limited or no access to resources such as equipment and transport were the challenges identified. Four overarching contributions were identified through this work: 1) CHWs’ and stakeholders’ perspectives when developing and improving CHW programmes, 2) Interpersonal skills and relationships to enhance programme delivery, 3) Supportive health system and programmatic environments, and 4: Systems of supportive supervision.