Table 4 A typical T&M day spent with a lay health worker (LHW)

I (the researcher) arrived at 08:30 at the LHW’s house, and we promptly left for her visits. It was interesting that she covered the stationery and materials from her NGO in a magazine to hide the purpose of her visits from the scrutinizing eyes of neighbours. Her first patient was not at home, a pattern that was repeated three more times that day. As the LHW had to protect the confidentiality of the patient, she could not check with the neighbours on the patient’s whereabouts. She said that she would return later in the week, hoping to find the person at home then.

Each interaction with a patient started off with a conversation about general issues before the LHW asked about the patient’s health. For those who had started treatment recently, she asked specifically about side-effects. A pill count would follow and in one instance much time was spent on educating an illiterate patient to manage her pill box. Each visit concluded with encouraging words to the patient. I was deeply moved by the LHW’s compassion for a 12-year-old living with HIV, and her calming and reassuring interaction with the mother of the child.