Supporting Community Health Workers in Fragile Settings from a Gender Perspective: A Qualitative Study
This article was originally published here
BMJ open. 2022 Feb 4;12(2):e052577. doi: 10.1136/bmjopen-2021-052577.
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 programs and managing CHWs (n=36); life story and photovoice interviews 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. Community-level gender norms, literacy levels, and patriarchal expectations surrounding paid work meant that fewer women than imagined took on this role. Only in the DRC, there were more women than men working as CHWs. Gender roles, norms and expectations in all settings also affected retention and progression as well as safety, security and travel (long distance and at night). Female CHWs also juggle household responsibilities and childcare. Despite this, they were more likely to stay in their jobs while men were more likely to leave and seek better paying jobs. CHWs have shown agency in negotiating and challenging gender norms in their work and interactions with families.
CONCLUSIONS: Gender roles and relations shape the experiences of CHWs at multiple levels of the health system. Health systems must develop gender-transformative human resource management strategies to address gender inequalities and restrictive gender norms for this critical interface framework.