Ward-based primary health care outreach teams in South Africa: developments, challenges and future directions

In 2011, South Africa adopted the Ward-based Primary Health Care Outreach Team (WBPHCOT) Strategy. The WBPHCOTs are made up of generalist community health workers (CHWs) supported by nurse team leaders, and linked to local primary health care (PHC) facilities (via referral, support and oversight). These outreach teams build on a pre-existing NGO-based community care and support system that emerged in response to HIV and AIDS in South Africa. By early 2017, 42% of the estimated required total of 7 800 teams were reporting activity data through the District Health Information System. The WBPHCOTs are envisaged as a key element of PHC in the future National Health Insurance (NHI) system, and a WBPHCOT Policy Framework was launched in December 2017. An accredited curriculum for a comprehensive CHW cadre has been approved nationally and is being implemented through a decentralised training infrastructure. Although an investment case for the WBPHCOT policy has been finalised, additional resources have yet to be allocated for rollout of the strategy. This chapter draws on policy documents, research conducted by the authors, and grey and published literature to recap the history of CHW programmes in South Africa and the emergence of the WBPHCOT strategy and policy. Key dimensions of WBPHCOT policy and implementation are reviewed, including scope of work, selection, supervision, training, financing and monitoring and evaluation. The chapter concludes with a set of recommendations addressing a number of significant constraints on performance and future development of WBPHCOTs in light of their intended role in NHI