Limits and opportunities to community health worker empowerment: A multi-country comparative study

Autor: Korrie de Koning, Sally Theobald, Hermen Ormel, Daniel Gemechu, Ireen Namakhoma, Sabina Faiz Rashid, Miriam Taegtmeyer, Maryse Kok, Sudirman Nasir, Sumit Kane, Mohsin Sidat, Lilian Otiso
Rok vydání: 2016
Předmět:
Malawi
Health (social science)
Attitude of Health Personnel
Performance
media_common.quotation_subject
Agents of social change
wa_590
Health Promotion
Health Services Accessibility
Health(social science)
03 medical and health sciences
0302 clinical medicine
History and Philosophy of Science
Health care
Humans
Medicine
Professional Autonomy
030212 general & internal medicine
Program Development
10. No inequality
Empowerment
Competence (human resources)
Mozambique
Qualitative Research
Health policy
media_common
Community Health Workers
wa_30
wa_546
Bangladesh
Motivation
HRHIS
business.industry
4. Education
030503 health policy & services
International health
Public relations
Kenya
Health promotion
Indonesia
Community health
Workforce
Clinical Competence
Ethiopia
Power
Psychological
7c0bbdab
0305 other medical science
business
Zdroj: Social Science & Medicine. 164:27-34
ISSN: 0277-9536
1873-5347
Popis: BACKGROUND\ud In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving 'Empowerment of communities'. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW's empowerment experience.\ud \ud METHODS\ud We present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used.\ud \ud RESULTS\ud CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by - the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact.\ud \ud CONCLUSIONS\ud While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters.
Databáze: OpenAIRE
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