Lay health workers and HIV programmes: implications for health systems
- 1 July 2010
- journal article
- conference paper
- Published by Taylor & Francis Ltd in AIDS Care
- Vol. 22 (up1), 60-67
- https://doi.org/10.1080/09540120903483042
Abstract
One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.Keywords
This publication has 15 references indexed in Scilit:
- An assessment of interactions between global health initiatives and country health systemsThe Lancet, 2009
- Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?PLoS Medicine, 2009
- Producing effective knowledge agents in a pluralistic environment: What future for community health workers?Social Science & Medicine (1982), 2008
- Community health workers and the response to HIV/AIDS in South Africa: tensions and prospectsHealth Policy and Planning, 2008
- Adherence as therapeutic citizenship: impact of the history of access to antiretroviral drugs on adherence to treatmentAIDS, 2007
- Gendered home-based care in South Africa: more trouble for the troubledAfrican Journal of AIDS Research, 2006
- Expanding the care continuum for HIV/AIDS: bringing carers into focusHealth Policy and Planning, 2006
- Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workersHealth Policy, 2005
- ‘What I've noticed what they need is the stats’: Lay HIV counsellors’ reports of working in a task-orientated health care systemAIDS Care, 2005
- Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994.American Journal of Public Health, 1996