Skip to main content

Table 5 Change in this study using Lewin’s three-stage model

From: Implementing without guidelines, learning at the coalface: a case study of health promoters in an era of community health workers in South Africa

Stage

Organisational action that occurred

Factors for or against working together

Facilitators

Barriers

Unfreeze

Policy-makers introduce rPHC and the HP policy and launch the new reform

• Health promoters know communities well

• Limited re-alignment of HPPs for new roles:

 ◦ job descriptions

 ◦ re-training

Change

HPPs and CHWs/WBOTs experiment on how to work together on the ground

• HPPs as forerunners of the CHW programme

• Role overlap

• More attention and resources towards CHWs

• Anxiety and trepidation among HPPs

Refreeze

Some HPPs institutionalise new change into their practice culture

• HPPs train CHWs

• Working at part of one WBOT

• Two cadres, and their management structures, working in parallel

  1. CHW community health worker, HP health promotion, HPP health promotion practitioner, rPHC re-engineering of primary healthcare, WBOT Ward-Based Outreach Team