Evaluating community health workers’ capacity to deliver ‘lifestyle Africa’ in Cape Town, South Africa: adaptation of the diabetes prevention programme for a middle-income country

Abstract

Background and rationale: There is a growing burden of Non-Communicable Diseases (NCDs), such as Type 2 Diabetes, globally and in particular in low- and middle-income countries (LMICs). LMICs face the added challenge of curbing the syndemics of NCDs and infectious diseases, such as HIV and TB, and more recently COVID-19. These diseases pose a growing threat to health systems, communities, and development, which will ultimately affect the goal of reaching Universal Health Coverage and Sustainable Development Goals (SDGs). These challenges require new and comprehensive models of service delivery and more efficient resource use. Task shifting to community health workers (CHW) is a strategy promoted in LMICs to ease burdens on human resources for health. However, there is limited evidence in the literature on the impacts and sustainability of holistic NCD management in LMICs with a need for contextually adapted and “socially valid” strategies to match the resources and existing capacity of health and other sectoral systems. This thesis examines the roles and capacity of CHWs in the prevention and management of Type 2 Diabetes.