Contextual factors affecting the integration of community health workers into the health system in Limpopo Province, South Africa

BACKGROUND: Community health workers (CHWs) are an essential cadre in the health systems of many low- and middle-income countries. These workers provide a wide variety of services and are key to ongoing processes of task shifting within human immunodeficiency virus programmes in particular. Ward-based outreach teams (WBOTs) are South Africa’s latest iteration of the CHW programme and have been introduced as part of the National Department of Health’s Primary Health Care Re-engineering programme. METHODS: In order to assess the perceived effectiveness of the WBOTs in supporting the ongoing rollout of antiretroviral therapy, tuberculosis care and patient support, we conducted a qualitative investigation focusing on the perceived successes and challenges of the programme among CHWs, community leaders, healthcare workers and community members in the Mopani district, Limpopo province, South Africa. RESULTS: The CHW programme operates across these contexts, each associated with its own set of challenges and opportunities. CONCLUSIONS: While these challenges may be interrelated, a contextual analysis provides a useful means of understanding the programme’s implementation as part of ongoing decision-making processes.The American people through the US President’s Emergency Plan for AIDS Relief through the US Agency for International Development (USAID) under cooperative agreement 674-A-12-00015 to the Anova Health Institute. This research project was supported by a postgraduate training scholarship from the Fogarty International Center and National Institute of Allergy and Infectious Diseases (NIAID), the University of North Carolina–University of the Witwatersrand (UNC-Wits) AIDS Implementation Science and Cohort Analyses Training Grant (5D43TW009774-02).https://academic.oup.com/inthealthpm2021Medical Microbiolog