HIV counsellors: Lay more on
A patient satisfaction survey in 266 clinics in three health districts in the Eastern Cape (Amathole, OR Tambo and Chris Hani) highlighted the role of lay counsellors as frontline workers in combating the HIV pandemic in South Africa.
The report says, in a country where HIV/AIDS has reached hyper-endemic proportions, community health worker initiatives are seen as a way of addressing the crisis in many low- and middle-income settings.
Given that this is a relatively new role in healthcare, and has no formal status in a professional hierarchy, lack of attention is paid to the organisational issues facing lay counsellors.
Although researchers have previously noted the need for adequate support and supervision to help lay counsellors cope, they were not as clear on how this should be provided. Also, lack of information on lay counsellors’ involvement in the prevention of mother-to-child transmission (PMTCT) in South Africa, among others, necessitated this study’s focus on their experiences, in order to better identify the country’s potential HIV-counselling needs.
Results from 74 lay counsellors in Cacadu district health facilities in the Eastern Cape indicated that they experienced medium to high job stress but, with relatively high job satisfaction, almost all respondents felt they could always or often help their clients.
Inadequate remuneration (less than the minimum wage for full-time work) ranked as the most important challenge when it came to providing PMTCT-related services, followed by poor working environment; lack of training; too many patients; inadequate transport for clients; staff shortages; security; inadequate facilities, insufficient time to do the job; demoralised staff; lack of feedback on job performance; lack of supervision; and people not making use of the facility.
In addition, workers were ill equipped to provide HIV-counselling services, and the need for improved training, together with systematic support and supervision was identified. Also, their role in the HIV-counselling process should be more clarified and formalised, and their career structure with improved benefits strengthened.
The report, Baseline Patient Satisfaction Survey in 266 clinics located in three Health Districts of the Eastern Cape: Amathole, OR Tambo and Chris Hani, is available on www.hsrc.ac.za
The South African government has developed strong policies for vulnerable children, some of which have been taken up in other African countries and other parts of the world. But in spite of the excellent policy environment, implementation continues to lag behind, failing to reach many of the country’s most vulnerable children.
This is one of the conclusions reached in the first comprehensive review of government-funded programmes and services to protect vulnerable children in South Africa, released this month. The review is intended to enhance understanding of how government, working with civil society, can improve the situation of vulnerable children. It lays out the relevant policies, legislation, and provisions for programmes and services by all government departments with one or more responsibilities for the protection of children. It also identifies, in each area, key policy, services and resource gaps.
These departments include Agriculture, Forestry and Fisheries, Basic Education, Energy, Health, Home Affairs, Human Settlements, Justice and Constitutional Development, Police and the National Prosecuting Authority, Social Development, and Water Affairs.
The review was commissioned as part of a larger five-year study looking at the effects of grants and services in enabling families to protect and care for their children under the joint burden of poverty and HIV/AIDS. The study is a collaborative project of the HSRC and New York University, with support from UNICEF, the department of social development, and others. The review finds that social protection – particularly social grants paid to the poorest families in communities affected by HIV/AIDS – provides solid assistance to families. However it is not yet known to what extent social security helps families to access formal services and community networks in providing for their children.
The main author of the review, Patricia Martin, points to a number of structural barriers in South Africa that prevent people living in poverty, especially in rural areas, from improving their conditions through infrastructural development, access to social protection and other means of escaping poverty. These include very poor roads and transport facilities, inadequate communication and illiteracy; all of which make it difficult for South Africans to use those services to which they have a right.
‘Not enough is being done to remove these barriers. For example, there is no plan to remedy transport facilities and there are no effective national, provincial or local communication strategies that target rural communities,’ Martin says.
‘Poor sanitation and infant and childhood malnutrition are two of the biggest contributors to childhood mortality, illness and poor development. Yet there is no enforceable sanitation policy in South Africa and we have no nutrition policy that addresses food security and hunger so as to effectively prevent malnutrition.’
Martin points to early childhood development as another area that can help families ensure that their children reach their full potential, but there is no policy in place to provide guaranteed early childhood development services that are not centre-based, especially in rural areas.
‘Rural areas – where families and children are poorer, where infrastructure lags behind, where services are the least developed, and where the challenges are the biggest – are largely left to be serviced by civil society organisations and community groups. Government, at all levels, does not assume responsibility and accountability for delivery of services provided for in national policies,’ says Martin.
‘Under these conditions, civil society is left to tackle the hardest problems with insufficient, inappropriate and erratic funding. There is an urgent need for consistent, reliable, sustainable and coherent funding frameworks to sustain service delivery by non-governmental organisations and community groups.
‘Another challenge highlighted by the review is that prevention and early intervention are poorly addressed in policy, and few resources are allocated to them. Although the Children’s Act and other provisions address this policy gap to some extent, the resource gap and accountability for comprehensive delivery at acceptable levels of quality remains a problem.
Martin hopes that this publication ‘will encourage better service delivery of policy provisions, as well as stronger accountability at provincial and local levels, so that already under-served groups are not further marginalised by inequitable access to services’.
The full report, Martin P (2010) Government funded programmes and services for vulnerable children in South Africa is available on www.hsrc.ac.za and on www.unicef.org/southafrica.
A review of progress towards the Millennium Development Goals (MDGs) in four southern African countries has been undertaken by the HSRC. As the target year of 2015 comes in sight there is increasing interest in, and concern over, whether these countries (Botswana, Malawi, Tanzania and South Africa) will meet the minimum targets for social progress.
Among researchers in the field there is a wide range of opinions about the application of MDGs to the African context. While some feel that Africa is ‘being set up for failure’ as the MDG targets are too ambitious, others feel that more progress is being made than anticipated, as in the case of maternal mortality.
To add to this, governments find it difficult to acknowledge complications in progress towards the targets. The differing views beg a common approach and methodology rather than more intense debate.
The HSRC has been conducting research in this field, with the purpose of producing a research brief to engage the SADC and governments in research initiatives to support regional initiatives to spur interventions to bring the MDGs to realisation in 2015. This forms part of a series of research and policy briefs produced by the HSRC in partnership with George Washington University, with the purpose of highlighting research findings to the widest set of interested parties.
This research brief captures key issues in improving the lives of people in southern Africa through implementing the MDGs in these four countries.
The need for change, identified in progress towards key MDGs, is most urgent in southern Africa, but there are also the greatest opportunities for improvement.
‘There is a mixture of hope and realism as the target date of 2015 approaches. If resources could be mobilised strategically in the region, much more progress could be made and the SADC instrument of the Regional Indicative Strategic Development Plan (RISDP) is explored to this end’, says Dr David Hemson, of the Democracy, Governance and Service Delivery programme at the HSRC.
The research B rief concludes that in a number of targets the MDGs are being approached but that the pace of change in others is too slow. In a minority of targets no progress is being made.
The full research brief is available on www.hsrc.ac.za