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Supporting community health workers in fragile settings from a gender perspective: a qualitative study
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 i...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819829/ https://www.ncbi.nlm.nih.gov/pubmed/35121601 http://dx.doi.org/10.1136/bmjopen-2021-052577 |
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author | Raven, Joanna Wurie, Haja Baba, Amuda Bah, Abdulai Jawo Dean, Laura Hawkins, Kate Idriss, Ayesha Kollie, Karsor Nallo, Gartee E Steege, Rosie Theobald, Sally |
author_facet | Raven, Joanna Wurie, Haja Baba, Amuda Bah, Abdulai Jawo Dean, Laura Hawkins, Kate Idriss, Ayesha Kollie, Karsor Nallo, Gartee E Steege, Rosie Theobald, Sally |
author_sort | Raven, Joanna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8819829 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-88198292022-02-08 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 BMJ Open Health Services Research 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. BMJ Publishing Group 2022-02-04 /pmc/articles/PMC8819829/ /pubmed/35121601 http://dx.doi.org/10.1136/bmjopen-2021-052577 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Health Services Research Raven, Joanna Wurie, Haja Baba, Amuda Bah, Abdulai Jawo Dean, Laura Hawkins, Kate Idriss, Ayesha Kollie, Karsor Nallo, Gartee E Steege, Rosie Theobald, Sally Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title | Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title_full | Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title_fullStr | Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title_full_unstemmed | Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title_short | Supporting community health workers in fragile settings from a gender perspective: a qualitative study |
title_sort | supporting community health workers in fragile settings from a gender perspective: a qualitative study |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819829/ https://www.ncbi.nlm.nih.gov/pubmed/35121601 http://dx.doi.org/10.1136/bmjopen-2021-052577 |
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