Health and Wellness

Community health workers (CHWs) in the Western Cape are not employed directly by the Western Cape Department of Health and Wellness (WCDHW) but are contracted through funded non-profit organisations (NPOs). This model enables the WCDHW to deliver community-based services in partnership with a wide network of NPOs that provide supervision, support, and structures for CHW engagement.

(a)(i) Measures to ensure that the voices of CHWs are included in policymaking are built into community-oriented primary care structures, multi-disciplinary teams, and ward-based outreach or community-based teams. These models create platforms for CHWs to share their experiences and insights so that provincial health policy reflects the realities of households and communities.

In the Metro, this is supported through geographic nodes linked to primary health care facilities, with CHW teams aligned to these nodes rather than ward-based boundaries. It is important to note that CHWs are contracted through NPOs funded by the WCDHW, and therefore also engage through NPO structures and representation.

(a)(ii) For programme design, CHWs are integrated into geographically based, interdisciplinary teams. Their practical knowledge directly shapes the planning, prioritisation, and delivery of health services, ensuring that programmes are responsive to local needs. Structured engagement processes are used to capture their input into the design and improvement of community-based services. Input is also sought from funded NPO partners, although aligning a wide range of NPOs with differing focus areas to a single vision can be challenging. The WCDHW continues to strengthen mechanisms to ensure that CHW and NPO perspectives are incorporated into programme design.

(b)(i) Grievance redress is provided through established complaints and feedback systems, including independent mechanisms, which allow CHWs to raise concerns in a fair and transparent manner. Grievances that cannot be managed within an NPO can be escalated to the substructure management team responsible for managing NPO contracts. If unresolved at this level, matters may be further escalated to the office of the Chief Director: Metro Health Services / Rural Health Services.

(b)(ii) Participatory decision-making is supported through collaborative governance approaches. CHWs and outreach team leaders participate in area-based teams and community-oriented primary care structures, where they work with other stakeholders to address health system challenges. These forums also include other NPO partners who may contribute resources or expertise, particularly on issues linked to the social determinants of health. This approach, known as “social prescribing,” allows clinicians to refer clients to community partners and resources to ensure holistic care. In addition, quarterly NPO engagements, co-chaired by Metro Health Services and the City of Cape Town, bring together NPO stakeholders and community groups to provide input on priority topics. The WCDHW is also working to strengthen opportunities within these engagements to ensure CHWs’ lived experiences are more directly heard.

(b)(iii) Recognition of the lived experience of CHWs takes place in both practical and symbolic ways. Practically, the WCDHW provides funding via NPOs for stipends, training, and the tools required to support their work. Structured training and mentorship opportunities build skills, improve quality of care, and create career pathways.

Symbolically, the critical role of CHWs in outreach, health promotion, and patient care is consistently acknowledged, affirming their value as trusted figures in communities and essential members of the public health workforce. Their contribution is reflected in measurable system performance, including improvements in maternal and child health, immunisation coverage, patient tracing, and chronic disease management.

Most importantly, CHWs act as a bridge of trust between households and the health system, reinforcing confidence in services and strengthening the relationship between communities and government. Annual engagements with funded NPOs provide a further opportunity to celebrate and acknowledge the contribution of CHWs and their partner organisations.