Training and evaluation of community health workers (CHWs): towards improving maternal and newborn survival in an urban setting in KwaZulu-Natal, South Africa

Abstract

In South Africa, Community Health Workers (CHWs) are a key component of community outreach teams as part of Primary Health Care (PHC) re-engineering. Although the value of CHW programs has been increasingly recognized, published evaluations of CHWs training programs are rare. This study documents the training and evaluation of CHWs on maternal and neonatal care towards improved maternal-newborn survival in an impoverished urban setting in KwaZulu-Natal, South Africa. Using a descriptive study design, CHWs were trained to do home visits, assess and support the mother to settle in well at home post-discharge, check on babies warmth, cord care, breastfeeding, basic hygiene, size of the baby if underweight and advise on Kangaroo mother care. They were also trained to check if the mothers were given the Road to Health card and to inquire about the immunization and subsequent follow-up visits to the PHC, and encourage mothers to adhere to their follow up dates at PHC clinics. Pre-and post-test scores, shadow visits, and spot checks were used to evaluate their performance. Generally, CHWs (n=47) from all three PHC clinics performed well. Overall, the highest post-test score among the PHC CHWs was 72% and the lowest was 50%. On average during shadow visits 67% CHWs were rated as good, 2% were rated as poor, and most CHWs received the highest score at 92% during spot checks. CHWs demonstrated social commitment and purpose in the short term observed. The evaluation of the training of CHWs revealed that most demonstrated the necessary skills for referrals to prevent complications, caring for newborns and their mothers at home immediately after discharge from health care centers. CHW upskilling training on maternal-newborn services should be prioritized in the most affected areas.