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Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique’s community health workforce

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Steege, Rosie, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Ndima, Sozinho, Give, Celso, Sidat, Mohsin, Ferrão, Clara and Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X (2020) 'Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique’s community health workforce'. Human Resources for Health, Vol 18, Issue 37.

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Abstract

Background: Mozambique’s community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). The government of Mozambique is aiming to increase the proportion of females to constitute 60% to improve maternal and child health outcomes. To understand the imbalance, this study explored current recruitment processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience, and retention of APEs in Maputo province, Mozambique.

Methods: We employed qualitative methods with APEs, APE supervisors, community leaders, and a government official in two districts within Maputo province. Interviews were recorded, transcribed and translated. A coding framework was developed in accordance with thematic analysis to synthesise findings.

Findings: In-depth interviews (n=30), key informant interviews (n=1) and focus group discussions (n=3) captured experiences and perceptions of employment processes. Intra-household decision-making structures mean women may experience additional barriers to join the APE programme, often requiring their husband’s consent. Training programmes outside of the community were viewed positively, as an opportunity to build a cohort. However, women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with higher salary. Age and geographic location were also important intersecting factors: younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain.

Conclusion: Gender norms, roles and power dynamics intersect with other axes of inequity such as marital status, age and geographic location to impact recruitment and retention of APEs in Maputo province, Mozambique. Responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.

Resumo
O programa de saúde comunitária de Moçambique tem um número desproporcional de agentes comunitários de saúde – Agentes Polivalentes Elementares (APEs) – do sexo masculino. O governo pretende aumentar a proporção de mulheres para 60%, para melhorar indicadores de saúde materna e infantil. Este estudo explora os processos de recrutamento dos APEs e como estes são moldados por normas de gênero; e como os papéis e relações de gênero influenciam a experiência e retenção dos APEs na província de Maputo, Sul de Moçambique.

Recorreu-se a métodos qualitativos para selecionar de forma propositada APEs, supervisores dos APE e líderes comunitários. As entrevistas foram gravadas, transcritas e traduzidas. Uma grelha de codificação foi desenvolvida de acordo com a análise temática para sintetizar os resultados.

Realizamos entrevistas em profundidade (n=30), informante chave (n=1) e discussões em grupos focais (n=3) para captar as experiências e percepções dos processos de recrutamento. As estruturas decisórias intrafamiliares, implicam que as mulheres podem experienciar barreiras na adesão ao programa dos APE, exigindo frequentemente anuência dos esposos. Os treinamentos fora das comunidades representam aprendizagem em ambiente diferente, todavia, as mulheres relataram dificuldades em deixar as suas responsabilidades familiares, e os homens desafios em prover assistência as suas famílias. Estas dinâmicas agudizaram-se para mães solteiras com o papel de provedoras e de principais cuidadoras. A atracão do programa por gênero revelou que as mulheres tendem a abandonar o programa quando se casam, e os homens a abandonarem quando são oferecidos melhores empregos. A idade e a localização geográfica demonstram que os APEs mais jovens buscam oportunidades de emprego na vizinha África do Sul, e os mais velhos tendem permanecer no programa.

Sugerimos que as normas de gênero e a dinâmica de poder se cruzam com outros eixos de desigualdade, como estado civil, idade e localização geográfica, para influenciarem o recrutamento e a retenção dos trabalhadores comunitários de saúde. O fortalecimento dos sistemas de saúde requer políticas mais equitativas e sensíveis para apoiarem a equidade de gênero nos processos de recrutamento e manter dos APEs.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
W General Medicine. Health Professions > W 21 Medicine as a profession.
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 525 General works
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12960-020-00476-w
Depositing User: Rachel Dominguez
Date Deposited: 14 May 2020 12:38
Last Modified: 27 May 2020 14:04
URI: https://archive.lstmed.ac.uk/id/eprint/14446

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