South Africa had timely and decisive action in response to COVID-19. Most significant was the lockdown, delaying spread and preventing surge. Community-based public health has been a major focus: 28,000 CHWs were deployed across the country for community screening and door-to-door testing and contract-tracing. CHWs are a key part of South Africa’s COVID-19 response. There are approximately 70,000 CHWs in the country employed by over 3,000 non-governmental organisations (NGOs). As part of commitments to National Health Insurance (NHI), Ward-Based Primary Healthcare Outreach Teams (WBPHCOTs) were introduced in 2011 as part of a significant primary health care (PHC) revival connecting people with services.
Despite significant government efforts to formalise and integrate CHWs into the public health system, however, multiple obstacles exist. Implementation of WBPHCOTs has been slow and uneven and there is low coverage. By 2017, only 42% of the required teams had been established, with many inadequately staffed. There is also relatively low awareness of the expanded CHW roles and functions in communities. Moreover, despite recognition of the potential for WBPHCOTs to promote local action on the social determinants of health, these roles are not well-defined, valued or supported.