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How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework.

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Steege, Rosalind, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, McCollum, Rosalind, Hawkins, Kate, Ormel, Hermen, Kok, Maryse, Rashid, Sabina, Otiso, Lilian, Sidat, Mohsin, Chikaphupha, Kingsley, Datiko, Daniel Gemechu, Ahmed, Rukhsana, Tolhurst, Rachel, Gomez, Woedem and Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X (2018) 'How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework.'. Social Science & Medicine, Vol 209, pp. 1-13.

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Abstract

Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January-September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.

Item Type: Article
Subjects: WA Public Health > WA 100 General works
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.socscimed.2018.05.002
Depositing User: Stacy Murtagh
Date Deposited: 30 May 2018 15:52
Last Modified: 22 Jun 2018 14:13
URI: https://archive.lstmed.ac.uk/id/eprint/8703

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