An economic evaluation of the winelands health worker programme

[摘要] ENGLISH ABSTRACT: Historically health care in South Africa has been an area of great inequity. Healthcare was inequitable, inadequate and racially based. In order to redress the gap in thedelivery of health care services, created by the previous dispensation of separatedevelopment, the National Department of Health has adopted a Primary Health Care(PHC) approach as the guiding principle for the reconstruction of the health system inSouth Africa. One of the pillars of this approach is the empowerment of communitiesto participate, thus moving from facility based- to community based health care.The aim of the National Health System (NRS) is to promote health and healthknowledge, to provide an equitable, accessible, and appropriate health service, and toempower people to take greater responsibility for their own health. It is constructedaround the belief that health for all cannot be achieved simply by improving theformal health system, but that a holistic and multi-sectoral approach is required.This thesis explores the community health worker (CRW) as a possible cost-effectiveand efficient supplementary service, to the current formal health system, to bridge thegap in the formal health system through the provision of PHC services in a ruralsetting. This was done through the economic evaluation of a CHW programmeoperating in the Winelands are of the Western Cape.The aim of this study was to evaluate and analyse the nature, performance, and costsof the programme and place it in context by comparison to other similar programmes.This comparison focused on physical characteristics, goals, and cost structures. Italso aims to measure the direct and indirect impact of this type of intervention on theagribusiness sector as well as the local health authorities. The evaluation proceededfrom the premise that the CHW programme, if implemented correctly with proper andappropriate training, and adequate post training support, will be a cost-effective andefficient model for the provision ofPHC services in this rural/farming area.The economic evaluation of this CHW programme required it to be viewed from twoperspectives. The first component viewed the implementation of the programme fromthe perspective of the agribusiness sector. This aspect of the study included both aqualitative as well as a quantitative VIew of the costs, benefits (perceived orotherwise), and perceptions of the CHW intervention. The second componentassessed the CHW programme within the context of a resource constrained publicsector health budget. Since the implementation of this programme implies certainexpenditures on the part of the local health authorities, these cost had to be identifiedand quantified to gauge the effectiveness of that expenditure.

[发布机构] Stellenbosch University