Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.

INTRODUCTION:As South Africa embarks on the implementation of the community health care worker (CHW) 2018 policy, quantifying the resource requirements to effectively manage the programme across different geographical communities is essential. This study was conducted to quantify and compare costs a...

Full description

Bibliographic Details
Main Authors: Donela Besada, Daygan Eagar, Russel Rensburg, Gugu Shabangu, Salamina Hlahane, Emmanuelle Daviaud
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0218682
id doaj-1176013ed54d4b9cb9f3dd70d682f0c7
record_format Article
spelling doaj-1176013ed54d4b9cb9f3dd70d682f0c72021-03-03T21:20:37ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e021868210.1371/journal.pone.0218682Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.Donela BesadaDaygan EagarRussel RensburgGugu ShabanguSalamina HlahaneEmmanuelle DaviaudINTRODUCTION:As South Africa embarks on the implementation of the community health care worker (CHW) 2018 policy, quantifying the resource requirements to effectively manage the programme across different geographical communities is essential. This study was conducted to quantify and compare costs associated with travel and service delivery demands on CHWs between area types in two districts. METHODS:This economic analysis adopted a provider perspective to cost CHW services between January and November 2016. A total of 221 CHWs completed diaries for 10 days to document their activities. Quintile regression and the Kruskall Wallis test were used to test for differences in time and activities across urban and rural sites. RESULTS:While travel time across rural and urban settings within each district did differ it was not the most significant predictor of differences in time utilization. Time on activities showed more significant differences with overall median time by unit of activity being 15% longer in rural than urban areas in Sedibeng and 10% longer in uMzinyathi respectively. Most CHW time was spent conducting home visits (57% in rural,66% in peri-urban/urban). Median time per home visit in uMzinyathi was 50% longer in deep-rural areas than urban areas and 20% longer in rural than urban areas in Sedibeng. Referrals and number of home visits per capita (0.4 visits in rural and 0.7 in urban/peri-urban areas) were low in both districts. Expenditure on the programme translated to under 4% of PHC expenditure per capita and remains under 5% if despite the new national minimum wage (R3,500/$245). CONCLUSION:Because home visits take longer and CHWs spend a lower share of time on visits, a higher number is required in rural and deep rural areas (33% and 66% respectively) than in urban areas. Effective budget planning will therefore need to recognize the different geographical needs.https://doi.org/10.1371/journal.pone.0218682
collection DOAJ
language English
format Article
sources DOAJ
author Donela Besada
Daygan Eagar
Russel Rensburg
Gugu Shabangu
Salamina Hlahane
Emmanuelle Daviaud
spellingShingle Donela Besada
Daygan Eagar
Russel Rensburg
Gugu Shabangu
Salamina Hlahane
Emmanuelle Daviaud
Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
PLoS ONE
author_facet Donela Besada
Daygan Eagar
Russel Rensburg
Gugu Shabangu
Salamina Hlahane
Emmanuelle Daviaud
author_sort Donela Besada
title Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
title_short Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
title_full Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
title_fullStr Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
title_full_unstemmed Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces.
title_sort resource requirements for community-based care in rural, deep-rural and peri-urban communities in south africa: a comparative analysis in 2 south african provinces.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2020-01-01
description INTRODUCTION:As South Africa embarks on the implementation of the community health care worker (CHW) 2018 policy, quantifying the resource requirements to effectively manage the programme across different geographical communities is essential. This study was conducted to quantify and compare costs associated with travel and service delivery demands on CHWs between area types in two districts. METHODS:This economic analysis adopted a provider perspective to cost CHW services between January and November 2016. A total of 221 CHWs completed diaries for 10 days to document their activities. Quintile regression and the Kruskall Wallis test were used to test for differences in time and activities across urban and rural sites. RESULTS:While travel time across rural and urban settings within each district did differ it was not the most significant predictor of differences in time utilization. Time on activities showed more significant differences with overall median time by unit of activity being 15% longer in rural than urban areas in Sedibeng and 10% longer in uMzinyathi respectively. Most CHW time was spent conducting home visits (57% in rural,66% in peri-urban/urban). Median time per home visit in uMzinyathi was 50% longer in deep-rural areas than urban areas and 20% longer in rural than urban areas in Sedibeng. Referrals and number of home visits per capita (0.4 visits in rural and 0.7 in urban/peri-urban areas) were low in both districts. Expenditure on the programme translated to under 4% of PHC expenditure per capita and remains under 5% if despite the new national minimum wage (R3,500/$245). CONCLUSION:Because home visits take longer and CHWs spend a lower share of time on visits, a higher number is required in rural and deep rural areas (33% and 66% respectively) than in urban areas. Effective budget planning will therefore need to recognize the different geographical needs.
url https://doi.org/10.1371/journal.pone.0218682
work_keys_str_mv AT donelabesada resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
AT dayganeagar resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
AT russelrensburg resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
AT gugushabangu resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
AT salaminahlahane resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
AT emmanuelledaviaud resourcerequirementsforcommunitybasedcareinruraldeepruralandperiurbancommunitiesinsouthafricaacomparativeanalysisin2southafricanprovinces
_version_ 1714817300811481088