Original Research

Skills2Care: An innovative, cooperative learning programme for community health workers in South Africa

Therese M. Boulle, Paul Cromhout, Khuzwayo August, Dave Woods
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a2922 | DOI: https://doi.org/10.4102/phcfm.v13i1.2922 | © 2021 Therese Marie Boulle, Paul Cromhout, Khuzwayo August, Dave Woods | This work is licensed under CC Attribution 4.0
Submitted: 28 January 2021 | Published: 21 October 2021

About the author(s)

Therese M. Boulle, Small Projects Foundation, East London, South Africa
Paul Cromhout, Small Projects Foundation, East London, South Africa
Khuzwayo August, Small Projects Foundation, East London, South Africa
Dave Woods, Bettercare, Cape Town, South Africa


Background: Community health workers (CHWs) hold potential to support universal health coverage and better health for vulnerable communities. They are integral to the re-engineered Primary Health Care (PHC) strategy, introduced in South Africa in 2011. This study focussed on how to train CHWs in large numbers, especially in resource-limited, rural settings. Skills2Care, a method of cooperative learning for CHWS, has been pioneered in the Eastern Cape of South Africa.

Aim: To determine whether Skills2Care could improve the cognitive knowledge of CHWs; to understand their response and attitude to the programme; to explore factors that enabled and inhibited learning and to consider its viability as a training method.

Setting: Research was conducted in 2019 in the Ngqeleni subdistrict of the O.R. Tambo district, in rural Eastern Cape.

Methods: A group-learning model using specifically tailored study modules in booklet format, addressing mother and baby care, was used. A facilitator promoted learning. Knowledge assessment was conducted by pre- and post-study testing using multiple choice questions. Focus group discussions and interviews explored the appropriateness and acceptability of this method, and factors enabling and inhibiting the learning.

Results: This method of peer group cooperative learning can significantly increase the cognitive knowledge of CHWs. Test scores indicated a significant (13%) improvement. Focus group discussions indicated that participants valued this method as it increased knowledge and boosted their confidence.

Conclusion: This innovative approach to district-based, continuing education suggests that CHWs could be trained in large numbers without the need for additional resources.


community health worker; community health worker training; community health worker programmes; lay health worker; maternal and child health; access to health care; village health worker; community care worker


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