Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review

Patient Educ Couns. 2014 May;95(2):201-10. doi: 10.1016/j.pec.2014.02.001. Epub 2014 Feb 12.


Objective: To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts.

Method: A qualitative systematic review of the literature on lay counsellor services in South Africa.

Results: Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support.

Conclusion: Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level.

Practice implications: Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling.

Keywords: Chronic care; Lay counsellors; South Africa; Systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Chronic Disease / psychology
  • Chronic Disease / therapy*
  • Community Health Workers*
  • Counseling*
  • Humans
  • Long-Term Care
  • Primary Health Care / organization & administration*
  • Qualitative Research
  • South Africa