Ending preventable child deaths in South Africa : what role can ward-based outreach teams play?

South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmiss...

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Bibliographic Details
Published in:South African medical journal 2016-07, Vol.106 (7), p.672-674
Main Authors: Sanders, D., Doherty, T., Kroon, M., Rhoda, N.
Format: Article
Language:English
Subjects:
Child
Child Health Services - standards
Child Health Services - supply & distribution
Child Mortality
Child, Preschool
Community health aides
Community Health Workers - organization & administration
Community Health Workers - standards
Forecasts and trends
Humans
Infant
Infant Mortality
Infants
Patient outcomes
Practice
Public health administration
South Africa - epidemiology
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Summary:South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more.
ISSN:0256-9574
2078-5135
DOI:10.7196/SAMJ.2016.v106i7.10790