An Audit of Community Health Workers in the Districts of the North West Province

73 Pages·2011·3.74 MB·English

2011

An Audit of Community Health Workers in

the Districts of the North West Province

In collaboration with the AP
Catherine Ogunmefun and Rhulane Madale
Project Team (cid:884) Muzi Matse,
Waasila Jassat, Tumelo Mampe,

Frank Tlamama, and Mzikazi

Masuku

DDeeppaarrttmmeenntt ooff HHeeaalltthh
An it Audof ity nuommC Health rsWorkein e thts Districf oe htN orth stWe
erovincP
e erinathCefumngunO , e lanuRhaleMad , zi Mu Matse, Waasila ssJaat,elo mTu
uMasukazi Mzik dana amTlamk Fran e,pMam

sts TruSysm teybHealth edlishbuP e,EssTerracex 34
Tel: [phone] [0] 7 +2 stWe 3036ville
][317 +2Fax : [phone] , rbanDu
eerinathcail: Em .st.za@horg Af ricaSothu
[email protected]
:bWe .t.ozargs//www.tt:hph

1120er, bmteSep

y b eddwasfuny dis stuTh icAtlant hiesilantrophP .

itation:c stedSugge
nefumnguO , C Madale R, Matse M, ssat Ja W, e pMam T, a amTlam F dan
uMasukM. An it Audof ity nuommCHe althrsWor kein e thts Districof t e h
e.vincroPst WeN orth t;ss TruSysm teHealth ,rbanDu 1102

SBIN:
e Thation inform edtainoncin is thtion ulicapbay me bly free dteuistribdand
, edcurodrepas glonas e th sorceus i, dowgeledknac danit s i sedufor onn -
rposes.uial percommc

DDeeppaarrttmmeenntt ooff HHeeaalltthh
1
Table of Contents
1. onctitrouInd ................................ ................................ ................................ ................................ .. 12
2. eweviture RLitera ................................ ................................ ................................ .......................... 14
2.1 ostrief hiA b in SAmeramropgW the CHof ry ................................ ................................ ....... 14
2.2 icaoth Afrum Ses minra progof CHWes Experienc ............... ................. ................................ 16
2.2.1 meramogW rpCH te h occefssesSu ................................ ................................ ............... 16
2.2.2 memoragW rp te hCHres ouilfFa ................................ ................................ .................. 17
2.2.3 meramgo CHW prof tees hengallCh ................................ ................................ ............. 18
3. erocvPinst th We Norof tee hProfil .... ............................ ................................ ............................... 21
3.1 yhorapg Tdoanptio Lnoca ................................ ................................ ................................ ..... 21
3.2 onmatio infricmhoDrapeg ............... ................. ................................ ................................ ..... 21
3.3 ct distries erpitiealth facilH ................................ ................................ ................................ ... 22
3.4 itiosodnn cSocial ................................ ................................ ................................ ................... 23
3.5 ty vPero torsicadin ................................ ................................ ................................ ................. 24
4. oygoodlMeth ............... ................. ................................ ................................ ................................ . 25
4.1 vesectij Omb andAi ................................ ................................ ................................ ............... 25
4.2 tS nesigyd Du ................................ ................................ ................................ .......................... 25
4.3 gnmlip Sao andnPlatioup ................................ ................................ ................................ ...... 25
4.4 oTolsctio noeDlloata Cf ent ompvelDe ................................ ................................ ................. 26
4.5 onctioeDllata C ................................ ................................ ................................ ...................... 26
4.6 salysi An andgnturiapData C ................................ ................................ ................................ . 26
4.7 eriato crin Exclusisio andncluIn ............... ................. ................................ ............................. 27
4.8 osneratiosidn cicalEth ................................ ................................ ................................ ........... 27
4.9 atiosnLimit ................................ ................................ ................................ ............................. 28
5. esuve RtitatinQua lts ............... ................. ................................ ................................ ...................... 29
5.1 cevino NW Pr in the CHWso onftiuDistrib ................................ ................................ ............ 29
5.2 Wse CHcvPinro NW cs oferistiact CharicmhoDrapeg ................................ ........................... 31
5.2.1 erGend ................................ ................................ ................................ .......................... 31
5.2.2 tiounribe DAgist ................................ ................................ ................................ ............ 32
5.2.3 tiosnficaali QuemAcadic ..................... ........... ................................ ................................ 32
5.2.4 StatusendStip ................................ ................................ ................................ ............... 33
5.3 ts)Patienes ari(ci Beefin andvicesW SerCH ................................ ................................ ........... 33
5.3.1 vicesW SerCH ................................ ................................ ................................ ................ 33
5.3.2 soput GrW eTargCH ................................ ................................ ................................ ...... 34
5.3.3 s Hosehoduldn atients P oafmerubW NCH ................................ ................................ ... 35
5.4 ginW TrainCH ................................ ................................ ................................ ........................ 37
5.5 msteE) SyM&atio (vnalu E andgorinoitW nMCH ................................ ................................ .. 42
5.6 onDssiiscu .......................... ...... ................................ ................................ .............................. 45
5.6.1 cevino NW Pr in the CHWso onftiuDistrib ................................ ................................ .... 45
5.6.2 cenvPiroW te hN CHWs incs oferistiact CharicmhoDrapeg ................................ ......... 46
5.6.3 ts)Patienes ari(ci Beefin andvicesW SerCH ................................ ................................ ... 46
5.6.4 ginW TrainCH ................................ ................................ ................................ ................ 47
5.6.5 &EW MCH emystS ................................ ................................ ................................ ......... 47
6. esultse RtativliQua ................................ ................................ ................................ ........................ 49
6.1 WsCHyb te hered endes rervicoTyf Se p .... ............................ ................................ ............... 49
6.2 ()CBSvicesed ser basitymonum cof tehsio nvi prooer ths force fDgrivin ............................. 52
6.3 )ties cili(HFFath HealdOs anPen Netbweoprt p Sudantio noCoabrall ............... ................. .. 53
6.3.1 te FohHmt fropr te hhsupwit atisfiedere os wts nwhespondm reoents mfrmCo ....... 53
6.3.2 supwith teh tisfiedess saere ol wts nwhespondm reoents mfrmCo FHthe m frooprt 54
2
6.4 NPOsdanics e clinm toho fr and ttternsRefel parra ................................ ............................. 54
6.5 memorag CHW prof teoh nativalu E andgorinMoitn .... ............................ ............................ 56
6.5.1 tioonrmafsed initymn baum cogtinoecollf co dMeth ................................ ................... 56
6.5.2 geportinof Ros dMeth ................................ ................................ ................................ ... 58
6.5.3 ersmagan by atiofoned inrmy basmitmonouf cUse .......................... ...... ..................... 59
6.6 esvice ser based carmeo of hvoisin proveeffecti er thed hines thatengallCh ...................... 59
6.6.1 esengall chisatioalnanrgThe o .......... ...................... ................................ ....................... 59
6.6.2 esengallte chd relaPatient ................................ ................................ ............................ 62
6.6.3 tyciliFa - esengllchaased b ................................ ................................ .............................. 63
6.7 sgind fino onfDssiiscu ............... ................. ................................ ................................ ............ 64
7. os natimendmolts, Recuese Rtivtaali Qude anitativtthe Qanuof tio nCoasodnli onsi Codclunan 67
7.1 ltsuese Rtivtaali Qude anitativtthe Qanuof tio nCoasodnli ................................ .................. 67
7.2 osnatimoendmRec ................................ ................................ ................................ ................ 68
7.3 sioConclun ................................ ................................ ................................ ............................. 69
8. cesReferen ................................ ................................ ................................ ................................ .... 70

List of Figures
re 1ugFi idmyra Platioonu Pp: – thoNr -7002ce vinot PrWes ................................ ................................ . 22
CHWso onftiuDistribtrict Dre 2uis:gFi ................................ ................................ ................................ . 29
st by Disof CHWo on Lcatire 3u:gFi rict ................................ ................................ ................................ .. 30
Wsof CHatio nnsig Dre 4ue:gFi ................................ ................................ ................................ ............. 31
WsCHof er Gedre n5u:gFi .......................... ...... ................................ ................................ ..................... 31
f CHWso ontiuDistribe Agre 6u:gFi ................................ ................................ ................................ ...... 32
of CHWsios ncatfiestalih Qu Higre 7u:gFi ................................ ................................ ............................. 32
WsCH of Statusend Stipre 8u:gFi ................................ ................................ ................................ ......... 33
sPoatientf mer b CHW Nure 9u:gFi ................................ ................................ ................................ ....... 35
ossehoHuld ofmerb Nu:re CHW1u0gFi ................................ ................................ ............................... 36
y Date perd visiossehoHuld ofmerb Nu:re CHW1u1gFi ................................ ................................ ...... 36
ginainroC Tf AHth Leng:re 1u2gFi ................................ ................................ ................................ ........ 38
nrai Tof CHWth Leng:re 1u3gFi gin ................................ ................................ ................................ ....... 38
ginTraino f HCBCth Leng:re 1u4gFi ................................ ................................ ................................ ...... 39
ginnTS TraiO Dof TBth Leng:re 1u5gFi ................................ ................................ ................................ . 39
ginain Trof VCTth Leng:re 1u6gFi ................................ ................................ ................................ ......... 40
ginT TrainTCPoMf th Leng:re 1u7gFi .... ............................ ................................ ................................ .... 40
raiCI Tof IMth Leng:re 1u8gFi ginn .......... ...................... ................................ ................................ ........ 41
ginon Tnraitritiouf Nth Leng:re 1u9gFi ................................ ................................ ................................ 41
ginn TraiCHMNof th Leng:re 2u0gFi ..................... ........... ................................ ................................ ..... 42
Officer ogrtin Rep:re CHW2u1gFi ................................ ................................ ................................ ........ 42
eservices/SActivitiof co Rerd:re CHW2u2gFi ................................ ................................ ...................... 43
co Re:re CHW2u3gFi onmatifo InrPsoatient'f rd ................................ ................................ .................. 43
cer Offigtinmbit Su:re CHW2u4gFi .... ............................ ................................ ................................ ....... 44
tionrmaos Infatient' P of Usage:re CHW2u5gFi ................................ ................................ ................... 44
ic StaffnCli witheet M:re CHW2u6gFi ............... ................. ................................ ................................ .. 45

3
List of Tables
: e 1Tabl lationuo7 Pp0200 1 and0e 2ocvPinrest th Woe NrTh testimaEs ................................ ............ 21
11/)102P0 (W te nhN ict distries erpitiealth facil h ofmerubal no:t Te 2Tabl ................................ ...... 22
: e 3Tabl atorsictyd Ino MrtaliKey ................................ ................................ ................................ .......... 23
:b Sue 4Tabl -of CHWstio untrib Disistrictd ................................ ................................ ........................... 29
yb CHWsered es rendvic: Sere 5Tabl ................................ ................................ ................................ .... 34
WsHof Cs Gropuet arg: Te 6Tabl .... ............................ ................................ ................................ ........... 34
yb CHWsved receiginnrai: Te 7Tabl ................................ ................................ ................................ ..... 37
4
Abbreviations
ARI sonectiofry Inatespirte RAcu
DSAI ImireduAcq meorcyd SynenDeficie mnu
CHA Careary ealthHcillAn
PA iesthropanPilhtic nAtla
BoD seDen oiseardf Bu
PB muPlatin Boalajan
CBOs atiosnizned Orgay BasmitmnCou
CsCH esth Centry HealmitmnCou
FsCH ymitcomnu - ors tatciliased Fab
WsCH eorkth Wy HealmitmnCou s r
sGCC vers e Giy CarmitmnCou
WCC erorke Wy CarmitmnCou
SC sCensu
DoH Health t omfenDtepar
DOTS tnmeeatved TrObsertly Direc
DBH eterm Barot ealthHDistric
DISH mSysteo nmatifo Inrt ealthHDistric
P DT ertussis Ps, andxotoids Tetanutheria, hDip
Dr KK Dr adKaunet hennK
MDr RS tiomaMpotsi megoD Sr Ruth
DSD entompelev Dcial Sot omfenDtepar
PEPW me ramgoPrrks Woc lied PbduExpan
GETC e CecatrtifiginnTrai tio andncau EdGeneral
AASH ica th Afr Sou ofciationsooce HAsspi
CBCH edy Basmitmonu Cde oanHm Care
FH stieliealth FaciH
IVH sruViy eficiencomndum ImuanH
PSAHCA icath Afrof Soo unociatiss Care AvePiatialloce Hspi
RH esorcum ReuansH
STH tms Tsteruealth SysH
PIA tioounllPodor Inr Ai
IMCI soeshno Illldd Chi omfenteagManrated tegIn
sMDG Mlenil Gomalsent opvelDem iun
EM & onativalu E andgorinMoitn
celMS Ex celt oExsoMficr
ordMS W ordt oWsoMficr
DOHN alth Het omfenDteparatioal nN
MMN mao Mleoiriaka MdgN
GON atio niztal Organmenvo GoernNn
CHMN Healthld Chi andMalatern
PON anOrgoofit PNnr o nisati
oWDHN Health ofent tmDeparest oNrth W
WN estoNrth W
WPN eocvPinrest oNrth W
QFN kwomre Fratiosnficaliatioal QuanN
PCH eealth carry HPrima
TCTPM onsm Tdranissiilho Cer toothf Mo nventiPre
5
WHAPL AIDSdanV w HIgithvinole liPpe
STIs lySexual iosnectftted InsmTrani
WSETAH TA) (WSEoHhrityt AuginTrain catio andEdunor ectelfare S Wdealth anH
WHO tionisaan OrgalthWo Herld
QASA ythoorits AunficatiliQua icanth AfrSou
TS SASTA ca i Soth AfruStatistics
TASTA e packagStatistical
TB oerculsiTub s
VCT gestinT andgselinConutaryn Volu

6
Acknowledgements
The ers archreseof the itdua were Dr e erinCath mnefunugO danMs e lanRhuale, Mad ine clos
k me, e, onm atio MpMwith Damda Mr ni Ms mr silaanor MatscozaelTlaassat,aaburDllJFrWaaTu Ms
asi MikazMz ku.u

The it daumtea woldue klio t kthan thee thre atad turers,cap thatis, Mr ert bRoeManopru , sM
e lThemisib Mafu danMs le eziFe anbugNo wh wetne httra ex meilo tt eg theit dua esestairuionqn
turedcaposly. muetiWe eally rciate repapor uym tea rit spi dang oo de dattitu grinudthe aatd
ss. procegnturicap

t. ojece rr thpos fdn te hfuginvidos for preithropanPilhtic tlank the Athanoke to li alswoldWeu

The it dauteam olduw kelito exress peir theeestdp reciatio pnapo t allthe t artmpenDeof ealthH
s ocialffia t the atioal, nno cialvinrp danlocal els levoh wassisted with the it dauof the Ws CH inthe
oNrth t Wese. cvPinro In, plararticuwe olduwkeli tok thanMr mganMoras atiunIge, oaranSh sM
oloo ognLetlhothatDi , Mr ie Ronn tie, oHt s M we Lencia dClauoSehle, danMs tsoKoke eataliN - ol Car
Cwaile , woit hdste e udteamthassia e inti trict. Wothooe D gtsi Mmmr RuthaDpis soare Seeful alratg
to Ms. ela Na oagjanM, . Mse elaidAdela, ShMs. anAnoa, MtsiouhM r. oThabwei, dgnMaM r. ymsRa
mSekoei,M r.o Thab o,SellM r.,goisandK Ms e Lizslono,Pri who ed vidorpstance assio te thit dau
m tea in the Dret hennKa dKaunct. DistriWe dwolukeli o t oewledgcknae thce anassistof the
wingfoolls cialoffi inthe aka gN oiridMma eMolctDistri - r M Gleni, oapgMMr si oogtMM e, okor Ms
e oJycsSethai o, r Mo Kei, oapgMMs y llSai, Mipp Mslvia Si, Serair MoMh poei, nMMs ahnoanJh
, TaljaardMs ezel Lis, umErasMr ens Stevoe, onkMMr oe rgGe, gntluTlhohaMs o eDinwa, tDin Ms
o Leseg, oognlapM Mrreck dadSh oere,nMs Myne oEbe, MerMs eneIr, sameKaitMs oatsLeny
gN weyna, Ms vla umoN, oybeLegMs to Lerao,Leep dan Mr gKganBogjan . Initio, dnade w olduw ekli
to k than Ms et habEliz oMh p oe, anorM Mr dviDa se, Rakga Mr o nmSi i, ishashM Mr sMarcu
o, mathMakgaMr es Moswa, engMosMs Kea be hMats danMr ObakengecubN , who sisted as thwi
t.Districm Pualalatinanj Bos in theocesit prthe aud
We e aro alsl furateg tos ST'Hoprt sup ersoelnnp foreir hte cassistan grinudthe t, ropjec in,lararticup
es.e issuistrativinmadother s andemgentranel artrav w ithsistedwho asva, anweMagwa Miss Ydan
y, allnFithe it daum tea olduwkeli to k than allthe y mitmnCouealth Hrs eorkW(CHWs) dan PON
ers magan who deatarticipp inthe it dauy b goinvidrp atiofonrmino ntheir rvices,es gintrain dan
itymn. umotheir c do in theyoe rk hwo t tgnertainissues pother i

7
Eecxutive Summary
Introduction
The ary rimpealth hre caC) HP(ro pachapwas ed otadp inth Soua ricAft oabuwo tecades do, ags a an
eal idvcle ehior fthe ery velidof le itabequ dantyali uqealth he carto its ;latioon upp, voerweh the
cotrynues uotinnco tep ormrf oorlyp inealth he omotcuorsicatdin t nmetepar(Dof ealth, H ;102a0
t 1xum)alo0N1e, 2al. e. Th e dlule pthe mruce esoadoinguotinealth oq testc uor hotuptribfactonhrsc
en rdBuof ase Dise D(Bo) gosistinncof IVH danB, Tonn - le icabmnumco, easesisd highma l ernat dan
ldchity, mortali dance olenvi danries; juinthe nmuahresorces uor fealth his; cris danemasis hp on
ative curealth hcare adtes(inof tivme orop dantativen verepealth h). careAs a t resulof e thee nd ot
ress dadthese ors, ctfare theas hee bna enrec t ftshitowards the re - gnerieinengof PC H in thSou
rica Af hgthrouthe o onvisirp ofyitmonumc - ased bPC Hes rvicse ybity monumCth ealH ersorkW
(CHWs) ment tepar(Dof ealth, H); 102b0s thie itiativin wolduont oly ne ba pstetowards gvinoimrp
tes ubmcoealth othu 5. 0y1 2DGs) bMoals (ent GompvelDem iuenn Mlil teevhgchiino aals
ent och mmf PsC ois oe The ishe Htreahtetablnouaf tes o osed e r tesrohegippfrestrat - ogeefrinineng
rise opf mwill com ch teaC oHtreauPEach ica. Soth AfrPC inuH e erago avn ruoal nnofessioe rnp se dan
six WsCH ( ginependd one hto nlatiouppesiz ) . The t menishstablef oth e PCHch otreau msteawill
itate facilitymn umcoment vveolin dano natiticiparp ni gentifyinidealth hs, eatthrle erabvlnu sopurg
danals ividudin dante riapropap tiosnventerin for gressindade thest nemDtepar( ofealtH ,h 0). b012
Initio, dnad itaym te itaacilfe thtio noecllc ofationloupp - ased bealth ha, atd which olduc lead to
mes.ootcu health etbter
The oNrth West eocvinrpof th Sourica Af as hed ostratemndoor pceanormerfp on me os thealh
es. omotcuFor e, stancin al aternmorm y talit is still y ativelrel high(see gvSainothers M0520 - ).0720
Even hoguththe ata dm ofrthe t Districealth Ho nmatiorfInm eSyst) (DISHws oshthat e th irthstillb
dan atal erinp ty mortali ates r e avh ed remain rly fai static in t recen years (see strict Di thealH
er metBaro) (DBH9), 0/0820ost maths ed curoctside ouealth hsitiefacil ence hthey e arerdnu -
ed report dan are ontte nduoacc for inthe ityacilf - sed ab DISHaatd ,PCHMN(; 0802 MD,CCEN8)002 .
The th oNrest Wceovinrp )WP(N as h oretheref neeb chosenyb e thtealH h myssteSTrust T),(HS
tic nAtlaoies pthranPilh) P(A danthe ment Dteparof ealth H(DOH) as ane libeligsite r fo ogprtinsup
istrictd s dansub - ts istricdto vemropient emaganmacitycap inw vieof e thC HPre - geerinineng
itiative. This inis oe that esurnt allal osed ed o ciently rcesroely ffiuwo andcatctivldfresutilieeulbeffe
the eryelivdof yitmnumco - ased bmary ripealth hre ca ) (PCH es, vicserly specialese thot tha olduw
t resul in vedmropi al, nterma al eonatn dan ldchi ealth h ( CHMN ) esomotcu (and ther o altheh
otu e.rocpvin in themeoramgtreach pruoPC H te h ofationlempentme i thh troghues)o,mc

The rent cury studis anit duaof WCH s in allts istricdof the W Ne ocvinrp inoer rdo ty entifid eth
e coeragv dans apg inthe gintrain danropvo isin ofyitcomnum - ased b ealthh es servicas we ll sa
entify idthe Ws oCH whfit e htents iremrequof the w enoel dmof the PC Hch eame. ramorotrpguThe
ts resulm ofre th itdauwill also eidug the t nmeshliestabof PCH treachou mstea inthe WN ecvinrop
ica.th Afrof Sou

Aim and Objectives
The st yd ums ait o e vidrope aselinbo nmatiforinyb ctingudnoc anit dauof the e coeragv dan tyaliuq
s apg inthe gintrain dano onvisirpof mnumco ity - deasbealth hes ervicsyb WsCH in all the istrictsdf o
e.ocvPinrest th Wthe Nor e:ves arctie hojebT
 a profct uoTodn c cevino NW prof tes hct distri teWs hinof CHe il
8
 To ess assthe o onvisirp ofyitcomnum - ased bs viceseryb Ws CH inthe istrictsdof the WN
erocpvin
 eocvin NW prof tectsh tri in the dis ogf CHWsinaintr in the sap te hgsessTo as
 it teho fWs whthe CHtify To iden ms Theaeactr Ouof PCel Hmoewn dthe omf entsireequr
Methodology
The y stud seu d a edmix - odmeth s o, achrpapthat , sia atiomninboc of ativetitanuq dan vetatialiuq
esuiqtechn . A etivtitaanuqe estairuionqn wased poveled to ectcollata dm ofrthe Ws.CH or Fthe
q tativeali uent, moponca emis - ctured rustw vieterine idugwas sed uto ct uodncin - epth dwtervinie s
erag man NPOected selwith teh s .

The gnmlipsamefra inis thy studwas all the s WCH dan their PO Ns ermagan inthe WPN . A
ence enicovn gnmlipsatho demwas sed uas the Ws CHe wer allcte dexepo tene covn ina central
ot pinto er stregias art pof the W Ne's rocpval inunanes ropcessof gatinvdalithe mer ubnof Ws CH in
the ce. ropvoin nmatiforInte dcoecllom fre thWs CHwas sed ufor e thtitaanuq ve timoent poncof the
y. stud it. in the audatedps partici7 CHW165 oof talA t

A total of 9 2PO Nrs emaganwere ed ectsel gsinua cence ovneni gnmlipsao dmethto e atarticipp in
the ve tatialioent unqmcopof they. studThe tio nelecswas asedbo ntytheir li ivabail aas wellas eirth
engnwilli cess.it prod te haugrinute daop particiss t

Key Findings
As icated dine, oabv 7165,Ws CH atedarticipp in theit. dauThe ority maj) %90(of the s WCH are
es femal dany thee morely klio te b donuf inthe ralruareas of the e ocvinrpre ewhtheir es ervicse ar
eend ed t. mos In msterof the o ntiuistribdof the Ws, CH they joritmaof e thWs CHare sed ab in eth
N aka g M oirid M ma oleM(NM) t istricd8%)(2, ed woollfyb the B oalajan P m ulatin(BP) t istricd 6%)(2
danDr K th eenn K a dnaur D(KK) rict istd%), 25(e whilDr R th u S tmooeg si M ati mpo(Dr RSM) istrictd
%)(2 1as hthe st leaer mubnof Ws. CHe Tha osanMatlsub - istrict das hthe esth ighmer ubn%) 13( of
brivier suenget Klg teheWs whilCH -.Wsof CH%) (1mer nubwestothe lt as histricd
rther Fualysis an ws shot thathe ratio of W CHo toupp lationfor P Bis 1: 8;9 3e whilDr RSM is :1 ;223
K Dis 1; and:5r KDM:7Mr N 5 is 1 estatio is in Dlonr te whratioom oleans that po6uf CHW t5p. This 6
ited.de auwerWs CHer obf meast nu te hlwhereRSM,
The ata dfrom the it dau so als showthat a er high roopprtio n( %) 32of the WsCHis etbween 31 dan
ears. 7 y 3P isthe NW Ws inCHe ogf aanedi m tehs andy4ear0
Interms f omic eacadficatio, naliuq2% 3of the Ws CHave he radtric gm2a/1e whil% 43assed p esradg
8 - 1. ts t 1esThis gthaat east% 7sugo5f lP e Ws theCHWthNarin e;rate myerat ed anuctiotnnalllienfu
ore therefthe y oritmajof the WsCH met themu mimino ntericri for onectiselof Ws CH otin PCH
ms. ch teaotreau
One e tivojecobf ythe studis to assess e vo isironthypf oitcomnum - ased es bealth servhyicb Ws CHin
the W Nrp e. ocvinData wsho s that the Ws CHe vidropa e granof es servic suchas H ome - B sed a C era ,
s anhOrp dan V le erablnu C ren dilh(OVC) , ealth ho, norotipm dan s oerculsiTuby Directl vedObser
mentTreat( TB TSDO ) ces; er, ervevios weir sehthvicare sered ke woswardstthe p o nrovisiof BC H dan
TB DOTS s. viceserThe y studts hglihighthat there is a apg inthe ropvo isinof er othes servicthat are
core to the PC Her - gerineinengy, strateg suchas I MCI danschool th ealhs. viceserThere is oreerefth
a ee ndfor ma e m raroopgtacicap tate Ws CH inthe W Ne rocpvinwith the sary cesens skillo t evidrop
es.rvic secialcruthese
9