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

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    Date
    2016
    Publisher
    © 2016 Elsevier Ltd
    Author
    Kane, Sumit
    Kok, Maryse
    Ormel, Hermen
    Otiso, Lilian
    Sidat, Mohsin
    Namakhoma, Ireen
    Nasir, Sudirman
    Gemechu, Daniel
    Rashid, Sabina Faiz
    Taegtmeyer, Miriam
    Theobald, Sally
    Koning, Korrie de
    Metadata
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    URI
    http://hdl.handle.net/10361/7252
    Citation
    Kane, S., Kok, M., Ormel, H., Otiso, L., Sidat, M., Namakhoma, I., . . . de Koning, K. (2016). Limits and opportunities to community health worker empowerment: A multi-country comparative study. Social Science and Medicine, 164, 27-34. doi:10.1016/j.socscimed.2016.07.019
    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.
    Keywords
    Agents of social change; Community health workers; Empowerment; Performance
     
    Description
    This article was published in Social Science and Medicine [© 2016 Elsevier Ltd.] and the definite version is available at: https://www.ncbi.nlm.nih.gov/pubmed/27459022
    Publisher Link
    https://www.ncbi.nlm.nih.gov/pubmed/27459022
    DOI
    http://doi.org/10.1016/j.socscimed.2016.07.019
    Department
    James P Grant School of Public Health, BRAC University
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