Description
PROJECT PLANNING 
10% Take burden of disease in consideration when doing planning e.g., chronic disease area needs less service than an identified TB hotspot area

• Use strengths and weaknesses of team when placing them e.g., a specific CHW can be excellent providing adherence support whilst another is better with demand creation
• Professional Nurses must submit a monthly programme with the estimated kilometres to the Project Coordinator
• Professional Nurse for Community Based Service Team must take the following in consideration when planning the month programme;
• Coordinates basic care (1st and follow up visits) rendered by the CHW – who is doing the basic care, number of basic care per area, how many CHW’s allocated, frequency of the visits and due date for review (6 weeks)
• Alternative Distribution Sites – when and where are these sites, how many CHW’s with home-based care experience and CHW’s with lay counsellor experience needed
• Creche visits (registered and unregistered) – who are the creches, how many children, frequency of visits i.e., visiting unregistered creches more often than registered creches, how many CHW’s to allocate to the visit
• Number of household assessments per month per catchment area and CHW allocation
• Allocate days for CHW with lay counsellor experience in the facility and community and ensure that health talks will continue as per planned roster
• For Wellness Services and Community Based Services as part of the COPC approach, the team must take the following in consideration when planning the month programme
• Outreaches / wellness events / youth and workplace activities / focus on adherence groups – take events calendar in consideration and Departmental / stakeholder request, will it be during working hours, after-hours or weekends / Public Holidays, logistics with regards transport, staffing requirement, equipment, and time-off in lieu should team be required to work overtime
• Different types of services can be delivered in different settings e.g., adherence support in a community, school or church hall, screening and testing at a taxi rank, and health education on the grounds of a sports club and plan accordingly
• Include community health workers with home based care experience as well as community health worker with lay counsellor experience
• Alternative distribution sites – to allocate a community health worker with lay counsellor experience whose strength it is to work with non-adherent clients
• Compile a roster with Operational Manager for CHW with lay counsellor experience to determine the days in the community and those in the facility
• Attend to the service components: Community engagement and household assessment, Maternal and Newborn health, Child and Adolescent Health, Sexual Reproductive Health, Healthy Ageing
• Focus on preventative, promotive, curative, rehabilitative and palliation activities
• Focus on key populations and vulnerable communities as stipulated in the workplan
• Specific to wellness services: 
• The services must be as convenient as possible to people in community and their living spaces with the
• Professional Nurse must source spaces available that can be within the working, living, learning and social spaces of the community should the service be delivered at a fixed site or by using the mobile unit
• The service must be free and accessible, not appointment based and be adequately marketed to target groups and / or key populations within the community
• Focus on flexibility to respond to the needs and circumstances for individuals and groups of people
• Schedule the RtC mobile unit to access hard-to-reach communities
• RtC fixed Wellness Sites must ensure an (i) appropriate waiting area (ii) private and safe working environment (iii) adequate counselling space to ensure confidentiality (iv) sufficient space to conduct the test privately, and a safe environment for patient access according to all OHAS specifications
• Link the NPO Wellness Centre to the HTA project ensuring an accessible service that suits the client’s working conditions / hours
• Compile Annual Leave Planner CLINICAL CARE

40%Strengthen the clinical preventative activities within a community-based setting in working with the Wellness PN in COPC focus areas

• Administration of immunisation in the community and ensure proper cold chain management
• Administration of Vit A and deworming
• Provision of Sexual Reproductive Health e.g., family planning
• Men’s Health Screening and referral
• Perform cervical screening and breast examination in an appropriate community venue
• Take bedridden patient’s blood e.g., liver functions
• Conduct on-the-spot HIV testing when needed
• Support all health campaigns including visits to schools and creches and administering vaccinations e.g., measles, HPV, influenza, COVID19, when necessary BASIC CARE AND REHABILITATION 

10% Assessment all referred clients within 3 days (72 hours) after referral

• Determine type of nursing care such as bed wash, wound care, pressure sores, ulcer management, catheter care, feeding
• Provide nursing care plan with interventions and treatments with an outcomes-based discharge plan
• Allocated CHW’s to the client in the catchment area
• Maintain a file of all patients referred to HCBS for Basic and Transitional Care
• Accurate recordkeeping of patient progress, interventions and treatment with regards the outcomes- based nursing plan
• Professional Nurse should provide CHW with relevant records for follow up visits
• Record client on HCBS register
• Professional monitoring and review of patients’ needs should take place at intervals no longer than six weeks and frequently as little as two weeks if possible
• Treat client with dignity and respect
• Ensure a safe, clean and secure working environment taking patient safety in consideration
• Ensure that clinical records are stored in an appropriate safe lockable area
• Ensure patient safety in the community such as storage of medicines and the procedure for medical waste management are applied to – educate CHW’s
• Involve primary caregiver in the household and train primary caregiver to provide basic care to the client at home
• Follow the Wound Care Guideline – 2021 – Assessment and care of the “hole within the whole”; all complicated wounds should be referred HEALTH PROMOTION AND WELLNESS 

10%  

• Strengthen the more preventative and promotive health aspects within a community-based setting in working with the Wellness PN in COPC focus areas
• Supervises and assists with wellness campaigns; community health promotion and marketing as well as WoW interventions
• Ensure that the team identify clients in need of Child Health:  Immunisation, Vit A, Deworming and nutrition; Women’s Health:  Family Planning & Cervical Screening and breast examination and refer the non-adherent clients to the professional nurse
• Support all health campaigns including visits to schools and creches e.g., measles, HPV, influenza
• Planning meetings with the Operational Manager, Wellness Professional Nurse and other NGO projects, stakeholders working in the defined geographical area, having targeted interventions focusing on outcomes / impact
• Follow the quarterly events plan according to the four seasons and Health Calendar i.e., April, July, Oct, Jan ADHERENCE SUPPORT 

5% Liaises closely with PHC services in following up referred clients from and / to PHC

• Provide assistance at the Alternative Distribution Sites.
• Ensure the venue, register and medications are ready for the club sessions at the right time
• Measuring and monitoring blood pressure, blood glucose within the scope of practice of a CHW
• Provide information on intake of medication, promotion of physical activity
• Educate patients and their families on the importance of lifestyle changes
• Information on health risks including tobacco use, hazardous use of alcohol, unhealthy eating habits, insufficient physical activity and effective prevention measures
• Assess treatment literacy, support with quality educational tools
• Finding ways to increase compliance with medication HUMAN RESOURCE DEVELOPMENT 

10% Identify training needs and complete an annual in – service training roster and submit to the Project Coordinator

• Coordinates formal CHW training (refresher course) and provide a replacement in the event of CHW absence
• Apply different teaching and mentoring principles to ensure staff competencies and retention of knowledge
• Employee Wellness: Project Coordinator must be informed of the procedure referring and employee to the Company’s Employee Assistance Programme ensuring the emotional, mental health and crisis related needs of staff
• Project Coordinator and Professional Nurse should schedule a quarterly supervision combine with in – service training, WOW activities and feedback on progress made (M&E) to the team
• Performance Management
• Project Coordinator should explain the Annual Employee Performance Management Review to the Professional Nurse and provide in service training in using the prescribed manual that is available
• Discuss individual targets to be achieved to the employee and obtain a signature as acknowledgement thereof
• Conduct quarterly performance reviews focusing on indicators and individual targets to achieve QUALITY ASSURANCE 

5% Applicable to RtC rented sites:

• Professional Nurse and Project Coordinator should ensure that all areas identified by the Occupational Health and Safety Act No 85 of 1993 are in place
• Evacuation Plan well displayed at all exits and control points
• Emergency Plans are documented, up to date and emergency drill is practiced regularly
• Emergency Numbers must be clearly displayed
• Sufficient fire extinguishers and hoses are available, clearly marked and visible and are regularly serviced
• Availability of first aid kits
• Universal precautions are upheld
• Trained and Appointed of Health Safety Officers i.e., Fire Marshall, First Aider, SHE representative
• Monthly site SHE (Safety, Health, Environment) held and minutes submitted to the Provincial Health and Safety Committee
• Submit 1st of the month the SHE Rep, Fire and First Aid Checklist to the Chairperson of the Health and Safety Committee
• Educate staff in infection control from to convey the knowledge to their service users
• Ensure the employees have an adequate understanding on Occupational Exposure to TB – how to apply basic infection prevention and control measures in high risk areas
• Wear the appropriate personal protective equipment such as N95 masks, aprons, gloves
• Ensure that proper hand wash technique applied – reminder that is also a requirement for NCS and the Ideal Clinic that all staff are properly trained in hand wash technique
• Ensure a safe, clean and secure working environment for the team; apply personal infection control measures
• Know in advance when riots will take place and do not allocate staff to the specific areas
• Professional Nurse should do monthly Quality Assurance visits to monitor service delivery (Focusing on equity and efficiency) and evaluate the quality of screening done as well as surveying the clients for quality service rendering
• Professional Nurse should do weekly Quality Assurance on the CHW daily collection tool to prevent fraudulent activities
• Professional Nurse and Project Coordinator should analyse the monthly data and implement a quality improvement plan to improve on targets not reached
• Ensure that the annual client satisfaction survey completed by the end of Sept
• Demonstrate and understand traditional healing practices within the health care user’s belief RECORDKEEPING AND DATA COLLECTION

5%Assess the availability, usage and completeness of standardized forms and applicable registers

• Explain data collection tools and definitions to the community health worker
• Ensure all recordkeeping by Community Health Workers are completed and collated
• Submit verified weekly and monthly data to the identified person responsible for M & E
• Ensure all statistic totals are submitted timeously to the Project Coordinator and DoH
• Compile a monthly report for Project Coordinator ADMINISTRATION

5%

•   Project Coordinator and Professional Nurse must have a good working relationship with the District and Sub District CBS manager and CBS coordinator
• Attend all relevant Departmental meetings
• Implementation of 2-weekly or at least once a month a meeting with PHC facility:
• Has “back referral” as standing point on the agenda in order to measure the impact made by HCBS
• Professional Nurse and Project Coordinator must have a monthly PDR meeting with the team
• Submit annual leave end of June and ensure that all leave forms submitted to the SAGE impersonator
• Monitor stock levels – apply the FIFO principle and ordering of consumables according to the prescribed dates of the PHC facility

Asset Management:

• Ensure that the asset transfer form is completed and submit it to the Provincial Administrative Support who must place the item on the asset register
• Ensure that the equipment is in a working condition and maintenance thereof
• Report all broken and misplaced assets to the Project Coordinator

Requirements

• Grade 12
• Diploma in General Nursing