Sustaining the National Health Insurance Scheme in South Africa: The Roles and Challenges of Community Health Workers

Takalani G. Tshitangano, Foluke C. Olaniyi*
Department of Public Health, School of Health Sciences, University of Venda, South Africa



The provision of universal health coverage is acknowledged as a priority goal for healthcare systems globally. In South Africa, the National Health Insurance system has been endorsed as a funding model for the provision of universal health coverage for South Africans. Community Health Workers have contributed to better universal health coverage outcomes in many countries. A study in India revealed that coverage of health care practices is positively correlated with the knowledge level of Community Health Workers. In South Africa, there is a difference in the duration of training of Community Health Workers in different provinces, especially in Vhembe District.


This study aimed to assess Community Health Workers’ knowledge regarding their roles and describe their challenges within the context of National Health Insurance.


Qualitative design was used to collect data from 33 participants who formed five focus groups comprising six to eight members each. Ethical principles of research such as permission, informed consent, voluntary participation and anonymity were observed. Data was analysed using thematic data analysis technique guided by Tesch open coding method.


The findings revealed that Community Health Workers lack adequate knowledge regarding the roles they are expected to play within Ward Based Outreach teams. Some of the challenges they face include transportation to clients’ homes and poor reception in households.


A review of the South African Qualification Authority health promoter unit standards is recommended coupled with the mentorship of Community Health Workers by retired nurses to help them understand their roles better.

Keywords: Community health workers, National Health Insurance, Roles, Knowledge, Challenges, South Africa.

Abstract Information

Identifiers and Pagination:

Year: 2018
Volume: 11
Publisher Item Identifier: EA-TOPHJ-2018-37

Article History:

Received Date: 26/6/2018
Revision Received Date: 24/10/2018
Acceptance Date: 30/10/2018
Electronic publication date: 15/11/2018
Collection year: 2018

© 2018 Tshitangano and Olaniyi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Public Health, School of Health Sciences, University of Venda, South Africa, Tel: +27612177991; E-mail: