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Supporting community health workers in fragile settings from a gender perspective: a qualitative study.
Raven, Joanna; Wurie, Haja; Baba, Amuda; Bah, Abdulai Jawo; Dean, Laura; Hawkins, Kate; Idriss, Ayesha; Kollie, Karsor; Nallo, Gartee E; Steege, Rosie; Theobald, Sally.
  • Raven J; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK joanna.raven@lstmed.ac.uk.
  • Wurie H; Department of Nursing, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
  • Baba A; Institut Panafricain de Santé Communautaire et Medecine Tropicale, Bunia, Democratic Republic of the Congo.
  • Bah AJ; Department of Pharmacology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
  • Dean L; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK.
  • Hawkins K; Pamoja Communications, Brighton, UK.
  • Idriss A; Department of Pharmacology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
  • Kollie K; Neglected Tropical Disease Program, Ministry of Health, Monrovia, Liberia.
  • Nallo GE; University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Liberia.
  • Steege R; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK.
  • Theobald S; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK.
BMJ Open ; 12(2): e052577, 2022 02 04.
Article in English | MEDLINE | ID: covidwho-1673431
ABSTRACT

OBJECTIVE:

To explore how gender influences the way community health workers (CHWs) are managed and supported and the effects on their work experiences.

SETTING:

Two districts in three fragile countries. Sierra Leone-Kenema and Bonthe districts; Liberia-two districts in Grand Bassa county one with international support for CHW activities and one without Democratic Republic of Congo (DRC)-Aru and Bunia districts in Ituri Province. PARTICIPANTS AND

METHODS:

Qualitative interviews with decision-makers and managers working in community health programmes and managing CHWs (n=36); life history interviews and photovoice with CHWs (n=15, in Sierra Leone only).

RESULTS:

While policies were put in place in Sierra Leone and Liberia to attract women to the newly paid position of CHW after the Ebola outbreak, these good intentions evaporated in practice. Gender norms at the community level, literacy levels and patriarchal expectations surrounding paid work meant that fewer women than imagined took up the role. Only in DRC, there were more women than men working as CHWs. Gender roles, norms and expectations in all contexts also affected retention and progression as well as safety, security and travel (over long distance and at night). Women CHWs also juggle between household and childcare responsibilities. Despite this, they were more likely to retain their position while men were more likely to leave and seek better paid employment. CHWs demonstrated agency in negotiating and challenging gender norms within their work and interactions supporting families.

CONCLUSIONS:

Gender roles and relations shape CHW experiences across multiple levels of the health system. Health systems need to develop gender transformative human resource management strategies to address gender inequities and restrictive gender norms for this critical interface cadre.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Community Health Workers / Hemorrhagic Fever, Ebola Type of study: Observational study / Prognostic study / Qualitative research Limits: Child / Female / Humans / Male Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-052577

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Community Health Workers / Hemorrhagic Fever, Ebola Type of study: Observational study / Prognostic study / Qualitative research Limits: Child / Female / Humans / Male Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-052577