Western Cape Government increases Community-based Services for Rural Communities

The Western Cape government has re-aligned its community-based services to deliver quality care to the people of the Western Cape in rural communities.
 
Western Cape Government Health’s Rural Districts have shifted their focus of services rendered at community level to align with the Department of Health wellness initiatives. 
 
Community care workers, now known as community health workers (CHW), were previously only tasked with supporting the members of the community through regular (often daily) home visits. Their focus was on giving adherence support, health promotion, prevention and home-based care. 
 
Community health workers now form part of Home- and Community-based Care (HCBC) services, which promote good health and the prevention of ill health by rendering quality home-based healthcare. There is also now a range of other services focusing on increasing wellness, such as:

• Promotion of wellness and health: CHW will conduct door-to-door visits during which they will educate members of the family on various health topics
• Health screening and referral where needed to the nearest Primary Healthcare (PHC) facility: During their door-to-door visits, the CHW offers education on preventative services on a range of issues such as TB, diarrhoea, diabetes, and if needed, will make the necessary referral to the nearest primary health facility for further management
• Self-management of chronic diseases: Clients with diagnosed chronic conditions will be assisted by the CHW in terms of information as well as lifestyle changes. This includes education on how and when to take the medication, as well as how clients can better their health by giving advice on healthy living and healthy eating
• Empowering relatives/families/friends to look after clients who require care: Where in the past the main focus of the community care worker was to take care of the ill, he or she will now train the primary caregiver on how to care for the client in their own homes
• Follow-up of known clients referred from the PHC facility: The CHW will do follow-up visits when the facility  provides them with the clients who have compromised functional status requiring supported self-care, treatment adherence and support needs, and end-of-life care needs, whom the CHWs need to assist. It is here when they will also take up the opportunity to advise clients on how to improve their wellness and how to live healthy.  

The CHW will screen clients at houses and crèches and will visit clients at least once a year using a screening tool, concentrating on:

1. Child health – reviewing the immunisation status and making referrals to have the scheduled immunisations received at the primary healthcare facility, as well as growth monitoring, infant feeding, HIV-exposed infant or child, developmental screening, oral health, danger signs
2. Women’s health – family planning advice, healthy pregnancy and safe delivery education, Pap smear education, breast examination education
3. HIV/AIDS, Tuberculosis, STI screening
4. Chronic disease education
5. Men’s health advice and medical male circumcision mobilisation
6. Mental health – signs and symptoms of depression, substance abuse, self-inflicted harm, etc.

Where needed, the CHW will educate and refer the client for further evaluation and treatment to the nearest health facility/clinic.  
Several community health workers have been appointed and are currently trained in the different rural districts.
Overberg District: 249 
Cape Winelands District: 369
Eden District: 404 
West Coast District: 318 
Central Karoo District: 77 
Home- and Community-based Care (HCBC) services in the Metro District

The Metro District works within municipal wards and has re-alignied the current services in line with municipal ward boundaries. Non –profit Organisations(NPO) will now take responsibility for the health of the community in its designated area.  Each NPO is linked to a Primary Health Care (PHC) facility for support and joint planning of outreach campaigns.