BACKGROUND : Lesotho adopted primary health care in 1979, and community health workers
(CHWs) were included in the programme to focus on health promotion, particularly to reach
people in underserved rural areas. Although the CHW programme has been successful, the
heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from
health promotion to home-based care.
AIM : The study explored the lived experience of CHWs in conducting health promotion
activities in Lesotho.
SETTING : The study was conducted in four health centres in Berea district, Lesotho.
METHODS : A qualitative study was conducted using an interviewer guide translated from
English into Sesotho for four CHW focus group discussions, four individual interviews of key
informants and four semi-structured interviews with the health centre nurses.
RESULTS : The roles of CHWs in health promotion ranged from offering basic first aid and
home-based care to increasing access to health care services by taking patients to the facilities
and promoting behaviour change through health education. Their perceived successes
included increased access to health care services and reduced mortality rates. CHW challenges
involved their demotivation to carry out their work because of lack of or inconsistent financial
incentives and supplies, work overload which compromises quality of their work and limited
CONCLUSION : This study concludes that CHWs are beneficial to health promotion and its
various activities. They had a clear understanding of their roles and responsibilities, although
they did not fully comprehend that what they were describing was, in fact, health promotion.
When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part
of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably
because of changes in disease burden. This is affecting their ability to practise other health
promotion activities which focus on disease prevention.