Community health volunteers and their role in health system strengthening in peri-urban areas: A qualitative study of Epworth, Zimbabwe

ABSTRACT

Background: Community health volunteers remain an increasingly important resource through which to address the global health workforce crisis, in pursuing health system strengthening in low and middle-income areas. The aim of this study was to provide more research attention on community health workers and their role in the pursuit of universal health coverage in resource-limited peri-urban areas, the focus of which was Epworth, Zimbabwe.

Methods: A cross-sectional research design was used for an exploratory qualitative study within which data were collected through a documentary search, key informant interviews, focus group discussions and non-participant observation. Data were transcribed into narratives that were then subjected to interpretive thematic analysis.

Results: Two main categories of Community Health Volunteers, namely Community Health Workers/Village Health Workers and Peer Educators were reported by key informants and focus group discussion participants. Community Health Workers helped mitigate healthcare worker shortages by performing outreach work whilst Peer Educators did the same at clinics by helping onsite. Findings also revealed that health volunteers were a source of local knowledge, helped navigate the local physical terrain and cultural practices in facilitating the uptake of healthcare interventions in all parts of the community. Local health volunteers were also an important link between local clinics and the community and facilitated beneficial interaction in healthcare.

Conclusions: Community health volunteers are an important resource in strengthening health systems in resource-limited peri-urban areas. The sustainability of local health voluntary work in peri-urban communities is however undermined by capacity constraints which in turn undermines progress towards universal health coverage in low-income peri-urban areas.

KEYWORDS:

• Community
• volunteers
• role
• health
• strengthening
• peri-urban

Disclosure statement

No potential conflict of interest was reported by the author.

Ethical and institutional clearance

Institutional and ethical clearance for this study was granted by the Ministry of Health (MOH) in Zimbabwe, Health Services Board (HSB), the Provincial Medical Office of Mashonaland East (PMOME), Seke District Medical Office (SDMO), Epworth Local Board (ELB), and the Zimbabwe Republic Police (ZRP). The study was also approved by the Academic Advisory Committee (AAC) of the University of Pretoria (UP). Ethical clearance was granted by the Research Ethics Committee (REC) [Reference number 413/2014] of the Faculty of Health Sciences, University of Pretoria, and the Medical Research Council of Zimbabwe (MRCZ) [Approval Number MRCZ/A/1941]. Written informed consent to participate and for publication was sought and granted by all participants.

Additional information

Funding

I am most grateful to the African Doctoral Dissertation Research Fellowship Award (ADDRF 2015-2017 ADF 002) awarded by the African Population and Health Research Centre in partnership with the International Development Research Centre (IDRC), and the University of Pretoria Postgraduate Research Bursary (10443925) which helped finance this study.

Notes on contributors

Bernard Hope Taderera

Bernard Hope Taderera is a Public Health Researcher. His research focuses on Health Policy and Management, Human Resources for Health Decision Space Analysis and Health Systems Strengthening. Bernard is a Senior Lecturer of Public Health (Health Policy and Management Track) at the University of Johannesburg.