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

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Kane, Sumit, Kok, Maryse, Ormel, Hermen, Otiso, Lilian, Sidat, Mohsin, Namakhoma, Ireen, Nasir, Sudirman, Gemechu, Daniel, Rashid, Sabina, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X and de Koning, Korrie (2016) 'Limits and opportunities to community health worker empowerment: A multi-country comparative study.'. Social science & medicine (1982), Vol 164, pp. 27-34.

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Abstract

BACKGROUND
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.

METHODS
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.

RESULTS
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.

CONCLUSIONS
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.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WA Public Health > Health Administration and Organization > WA 590 Health education, Health communication
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.socscimed.2016.07.019
Depositing User: Rachel Dominguez
Date Deposited: 05 Aug 2016 08:43
Last Modified: 06 Feb 2018 13:13
URI: http://archive.lstmed.ac.uk/id/eprint/6043

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