title: Community health workers, recipients' experiences and constraints to care in South Africa - a pathway to trust.
abstract: Community health workers (CHWs) affiliated with community-based organisations are central to the implementation of primary health care in district health services in South Africa. Here, we explore factors that affect the provision of and access to care in two provinces - Gauteng and Eastern Cape. Drawing on narratives of care recipients and the CHWs who support them, we illustrate the complex issues surrounding health maintenance and primary care outreach in poor communities, and describe how the intimate interactions between providers and recipients work to build trust. In the study we report here, householders in Gauteng Province had poor access to health care and other services, complicating the impoverished circumstances of their everyday lives. The limited resources available to CHWs hindered their ability to meet householders' needs and for householders to benefit from existing services. CHWs in the Eastern Cape were better able to address the needs of poor householders because of the organisational support available to them. Based on an ethos of integrated and holistic care, this enabled the CHWs to address the recipients' context-related needs, and health and medical needs, while building greater levels of trust with their clients.
authors.affiliation: a Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg.
authors.forename: Nonhlanhla
authors.initials: N
authors.lastname: Nxumalo
authors.affiliation: a Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg.
authors.forename: Jane
authors.initials: J
authors.lastname: Goudge
authors.affiliation: b School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg.
authors.forename: Lenore
authors.initials: L
authors.lastname: Manderson
mesh_terms: D003153:Community Health Services; D003150:Community Health Workers; D003159:Community-Institutional Relations; D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009938:Organizations / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D064890:Social Determinants of Health; D013019:South Africa; D035502:Trust; D000078329:Workforce
keywords: Barriers to care; South Africa; community health workers; integrated care; policy; primary health care; social determinants of health