Table 2 Thematic analysis on ‘Capacity’ domain: resources and capacity to use them
(i) Pre-intervention | (ii) Post-intervention | ||
|---|---|---|---|
Sub-themes | Quotes (barriers) | Sub-themes | Quotes (enablers, impacts) |
Barriers • Lack of training | “For someone who had never worked at the clinic before, I wish I had proper training … That is what they promised us when we got to the clinic, but they didn’t deliver, we are even promised a full COVID-19 training but we are still waiting.” Participant, clinic 1 | Enablers • Structured/certified process by Wits/DoH • Co-designed process: practical, acceptable and locally relevant • Inclusive ‘safe to fail’ learning spaces • Principles of collective knowledge and action regularly revisited and appraised | “The VAPAR training has filled a lot of gaps that I had before I joined the training. The first one is public speaking, I was so shy when I joined but the training helped me overcome the challenge, now I can talk in front of people”. Participant, clinic 1 |
“I do not have challenges at the community but at the clinic, I feel like the clinic does not care about us. They do not care about our training needs, salaries, and other things. I wish they can start to recognise us more and treat us like we are also professional health workers.” Participant, clinic 1 | |||
“I need training on report writing because I still have challenges with it.” Participant, clinic 3 | “The VAPAR training helped me with ways of prioritising, …This will often create tension because each one of us want to be heard but now I have learnt about … systems that allow everyone to have an equal voice and enable us to reach an agreement without undermining each other.” Participant, clinic 1 | ||
“We want to be trained so that we qualify as assistant nurse.” Participant, clinic 2 | Impacts • Improved communication and mutual respect (CHWs, DHS actors and communities) • Collective mindsets built • Competencies built in community mobilisation • Competencies built in public speaking • Competencies built in data analysis • Competencies built in peer relationships • Competencies built in alliance building | “I will use the facilitation skills I obtained during the training when we have meetings at the clinic and when conducting support groups.” Participant, clinic 3 | |
Barriers • Insufficient equipment and supplies | “We do not have enough equipment; most challenging now is inadequate transportation, we either have to walk very long-distance crossing rivers to access our patients or even use our own money to pay for transport, and this affects our work negatively.” Participant, clinic 3 | Enablers • Platform enabled logistical challenges to be referred to OMs/systems actors | “The training taught me ways of identifying challenges and addressing them, I understand challenges better than I used to. I'm confident that now I know even how to identify people who can assist us in dealing with various issues” Participant, Clinic 1 |
Barriers • Inadequate remuneration | “We are still waiting about the COVID money that they promised to pay us when we were done with COVID-19 screening…. Now they made us risk our lives to do registrations for COVID-19 vaccines, but they are not going to pay us at the end.” Participant, clinic 3 | Enablers • Reimbursement for time in training • Forum for dialogue on pay/conditions Impacts • Requests for more training programmes | “DoH can support by increasing our salaries and for VAPAR to continue giving us training.” Participant, clinic 3 |
“My wish is for the government to recognise our value and the effort we put in saving the lives of people in our communities” Participant, clinic 1 | |||
Barriers • Poor employment and career development | “It is frustrating to see our community suffering while we know we can help them, but we cannot because we are not allowed to work.” Participant, clinic 2 | Enablers • Forum for dialogue on employment and career development | “I know that VAPAR does not have the capacity to employ us, but if they can motivate for us or negotiate with DoH on our behalf we would really appreciate.” Participant, clinic 2 |
“Maybe VAPAR can convince the department on our behalf, I desperately need to go back to work because I feel like my patients will default their medications because they have no one to help them.” Participant, clinic 2 |