University of KwaZulu-Natal, Discipline of Public Health Medicine, School of Nursing & Public Health, Howard College Campus, Durban, South Africa.
Health Research & Knowledge Management Unit; KwaZulu-Natal Department of Health, 330 Langalibalele Street, Pietermaritzburg, South Africa.
BMC Health Serv Res. 2022 Mar 11;22(1):326. doi: 10.1186/s12913-022-07707-x.
The South African Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that the distribution of community health workers (CHWs) should be proportional to levels of poverty and disease within the population. We aimed to describe the spatial distribution of CHWs in relation to the prevalence of the Human Immunodeficiency Virus (HIV) which has itself been associated with poverty in previous studies.
This was a descriptive, cross-sectional study in which secondary data was used for geospatial analysis. Based on the extrapolation from the norm of one WBPHCOT per 6000 individuals, we utilized geographic information system (GIS) methods to visualize the distribution of CHWs in relation to the prevalence of HIV in KwaZulu-Natal (KZN). Dot density mapping was used to visualize the random distribution of CHWs in relation to HIV prevalence and population in the districts. The districts' HIV prevalence, number of PLWH, ratio of CHW: people living with HIV (PLWH), ratio of CHW: population and poverty scores were mapped using choropleth mapping. MapInfo Pro 17.0 was used to map geospatial presentation of the data.
Overall, KZN province showed under allocation of CHWs with a CHW: people ratio of 1: 1156 compared to the estimated norm of 1: 600-1000. At district level, only two of 11 districts met the suggested norm of CHW: PLWH (1: 109-181). This indicates shortages and misallocation of CHWs in the nine remaining districts. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution of CHWs. There was no relationship between CHW distribution and HIV prevalence or poverty scores in the districts.
This study shows inequality in the distribution of CHWs which may be associated with inequalities in the provision of HIV related services. It is critical to strengthen the response to the HIV epidemic through the appropriate distribution of CHWs especially in those districts with high levels of HIV prevalence and poverty.
南非基于病房的初级卫生保健外展团队（WBPHCOT）政策框架规定，社区卫生工作者（CHW）的分布应与人口中的贫困和疾病水平成正比。我们旨在描述 CHW 与艾滋病毒（HIV）流行率的空间分布情况，因为在之前的研究中，HIV 本身与贫困有关。
这是一项描述性的横断面研究，其中使用了二次数据进行地理空间分析。根据从每 6000 人一个 WBPHCOT 的规范中推断出来的，我们利用地理信息系统（GIS）方法来可视化 CHW 的分布与夸祖鲁-纳塔尔省（KZN）HIV 流行率的关系。点密度映射用于可视化 CHW 与 HIV 流行率和人口的随机分布关系。使用专题地图法绘制了各地区的 HIV 流行率、PLWH 人数、CHW:PLWH 比值、CHW:人口比值和贫困评分。使用 MapInfo Pro 17.0 映射数据的地理空间呈现。
总体而言，KZN 省的 CHW 分配不足，CHW:人口比为 1:1156，而估计的规范为 1:600-1000。在地区一级，只有 11 个地区中的两个达到了 CHW:PLWH（1:109-181）的建议标准。这表明在其余九个地区存在 CHW 短缺和分配不当的情况。此外，我们的研究结果显示出广泛的地理空间异质性，CHW 的分布没有明显的模式。在各地区，CHW 的分布与 HIV 流行率或贫困评分之间没有关系。
本研究表明 CHW 的分布存在不平等，这可能与 HIV 相关服务提供的不平等有关。通过适当分配 CHW，特别是在 HIV 流行率和贫困程度较高的地区，加强对 HIV 流行的应对至关重要。
