The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis

Soc Sci Med. 2010 Sep;71(6):1110-8. doi: 10.1016/j.socscimed.2010.06.009. Epub 2010 Jun 23.


There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s-1994) - a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care. Thirteen oral history interviews and eight witness seminars were conducted in South Africa in April 2008 with founders and CHWs from these earlier programmes. These data were triangulated with written primary sources and analysed using thematic content analysis. The study suggests that 1970s-1990s CHW programmes were seen as innovative, responsive, comprehensive and empowering for staff and communities, a focus which respondents felt was lost within current programmes. The growth of these earlier projects was underpinned by the struggle against apartheid. Respondents felt that the more technical focus of current CHW programmes under-utilise a valuable human resource which previously had a much wider social and health impact. These prior experiences and lessons learned could usefully inform policy-making frameworks for CHWs in South Africa today.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Health Workers / history*
  • HIV Infections
  • Health Policy
  • History, 20th Century
  • Humans
  • Interviews as Topic
  • Politics*
  • Primary Health Care / history*
  • Professional Role / history*
  • South Africa
  • Workforce