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Supporting community health workers in fragile settings from a gender perspective: a qualitative study

Raven, Joanna ORCID:, Wurie, Haja, Baba, Amuda, Bah, Abdulai Jawo, Dean, Laura ORCID:, Hawkins, Kate, Idriss, Ayesha, Kollie, Karsor, Nallo, Gartee E, Steege, Rosie and Theobald, Sally ORCID: (2022) 'Supporting community health workers in fragile settings from a gender perspective: a qualitative study'. BMJ Open, Vol 12, e052577.

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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 programmes and managing CHWs (n=36); life history interviews and photovoice 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. Gender norms at the community level, literacy levels and patriarchal expectations surrounding paid work meant that fewer women than imagined took up the role. Only in DRC, there were more women than men working as CHWs. Gender roles, norms and expectations in all contexts also affected retention and progression as well as safety, security and travel (over long distance and at night). Women CHWs also juggle between household and childcare responsibilities. Despite this, they were more likely to retain their position while men were more likely to leave and seek better paid employment. CHWs demonstrated agency in negotiating and challenging gender norms within their work and interactions supporting families.

Conclusions Gender roles and relations shape CHW experiences across multiple levels of the health system. Health systems need to develop gender transformative human resource management strategies to address gender inequities and restrictive gender norms for this critical interface cadre.

Item Type: Article
Subjects: 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
WX Hospitals and Other Health Facilities > WX 100 General works
WY Nursing > WY 106 Community health nursing
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Daisy Byrne
Date Deposited: 10 Mar 2022 13:23
Last Modified: 10 Mar 2022 13:23


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