Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers

Ranking ninth in the world for its contribution to the global burden of tuberculosis (TB), South Africa continues to battle the disease. Within the framework of the World Health Organisation's Directly Observed Treatment Short Course (DOTS) strategy, attempts have been made to utilize lay health workers (LHWs) as TB treatment supporters. Previous research has highlighted the benefits and difficulties associated with such an approach, but little attention has been paid to the perceptions of LHWs themselves. A randomised control trial of a LHW intervention in TB treatment in the farming areas of the Western Cape, South Africa has shown a 19% improvement in TB treatment outcomes. This paper describes the experiences of those LHWs drawing on data collected through focus groups with incumbents. The data has shown that once trained, respondents were engaged in a wide range of activities, well beyond simple health care. In the majority LHWs were women. Becoming LHWs opened up their worlds, creating opportunities they would otherwise not have had. But while doing so, it also added extra responsibilities and stresses, which were not easy to manage. Respondents sustained themselves through support from each other, the intervention team, their employers and contact with the public health system. The question this study raises is given the obvious need for LHWs, how can they be motivated to participate in primary health care in such a way that maximises their access to resources while minimising their experience of the role as burdensome?