An economic evaluation of the winelands health worker programme

Rörich, Eben Eugéne (2002-12)

Thesis (MComm)--Stellenbosch University, 2002.

Thesis

ENGLISH ABSTRACT: Historically health care in South Africa has been an area of great inequity. Health care was inequitable, inadequate and racially based. In order to redress the gap in the delivery of health care services, created by the previous dispensation of separate development, the National Department of Health has adopted a Primary Health Care (PHC) approach as the guiding principle for the reconstruction of the health system in South Africa. One of the pillars of this approach is the empowerment of communities to participate, thus moving from facility based- to community based health care. The aim of the National Health System (NRS) is to promote health and health knowledge, to provide an equitable, accessible, and appropriate health service, and to empower people to take greater responsibility for their own health. It is constructed around the belief that health for all cannot be achieved simply by improving the formal health system, but that a holistic and multi-sectoral approach is required. This thesis explores the community health worker (CRW) as a possible cost-effective and efficient supplementary service, to the current formal health system, to bridge the gap in the formal health system through the provision of PHC services in a rural setting. This was done through the economic evaluation of a CHW programme operating in the Winelands are of the Western Cape. The aim of this study was to evaluate and analyse the nature, performance, and costs of the programme and place it in context by comparison to other similar programmes. This comparison focused on physical characteristics, goals, and cost structures. It also aims to measure the direct and indirect impact of this type of intervention on the agribusiness sector as well as the local health authorities. The evaluation proceeded from the premise that the CHW programme, if implemented correctly with proper and appropriate training, and adequate post training support, will be a cost-effective and efficient model for the provision ofPHC services in this rural/farming area. The economic evaluation of this CHW programme required it to be viewed from two perspectives. The first component viewed the implementation of the programme from the perspective of the agribusiness sector. This aspect of the study included both a qualitative as well as a quantitative VIew of the costs, benefits (perceived or otherwise), and perceptions of the CHW intervention. The second component assessed the CHW programme within the context of a resource constrained public sector health budget. Since the implementation of this programme implies certain expenditures on the part of the local health authorities, these cost had to be identified and quantified to gauge the effectiveness of that expenditure.

AFRIKAANSE OPSOMMING: Geskikte en doeltreffende gesondheidsdienste in Suid-Afrika se onlangse geskiedenis was nog gereserveer vir 'n uitgesoekte groep mense. Die gesondheidstelsel was ontoereikend, onvoldoende en gebaseer op ras. Daar het 'n gaping ontstaan tussen die dienste wat gelewer is en die werklike behoeftes van die mense wat dit moes gebruik. Ten einde hierdie gaping aan te spreek het die Nasionale Departement van Gesondheid besluit om 'n Primêre Gesondheidsorg (PRe) benadering te volg wat klem plaas op die bemagtiging van plaaslike gemeenskappe deur deelname. Dit was 'n duidelike skuifvanaffasiliteit- na gemeenskap gebaseerde gesondheidsdienste. Die oorkoepelende doel van hierdie verskuiwing in fokus was om voorheen benadeelde gemeenskappe voldoende toegang te gee tot gesondheidsdienste en ook om hierdie dienste aan te pas by die behoeftes van sodanige gemeenskappe. Hierdie tesis ondersoek die Wynland distriksraad se Gemeenskap Gesondheidswerker Program as 'n moontlike koste-effektiewe stelsel vir die lewering van toepaslike primêre gesondheidsdienste in landelike areas. Die doel van die studie was die sistematiese ontleding van die werking en omvang van, en die kostes verbonde aan die implementering en onderhoud van hierdie program. Die studie poog om die impak van hierdie program op die formele landbou sektor asook die plaaslike gesondheidsowerhede te identifiseer en, waar moontlik en prakties wenslik, te kwantifiseer. Die ondersoek sluit in die stelselmatige ontleding van kostes en voordele vir die formele landbou sektor sowel as die plaaslike gesondheidsowerhede. Die kostes asook die kliniese uitkomste geassosieer met die implementasie van die Gesondheidswerker program sal dan in konteks geplaas word deur dit te vergelyk met ander soortgelyke programme wat in die verlede aangepak is. Die vergelyking sal fokus op die fisiese eienskappe, koste struktuur, bronne van ondersteuning en die primêre doel van die intervensie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/52664
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