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dc.contributor.authorKane, Sumit
dc.contributor.authorKok, Maryse
dc.contributor.authorOrmel, Hermen
dc.contributor.authorOtiso, Lilian
dc.contributor.authorSidat, Mohsin
dc.contributor.authorNamakhoma, Ireen
dc.contributor.authorNasir, Sudirman
dc.contributor.authorGemechu, Daniel
dc.contributor.authorRashid, Sabina Faiz
dc.contributor.authorTaegtmeyer, Miriam
dc.contributor.authorTheobald, Sally
dc.contributor.authorKoning, Korrie de
dc.identifier.citationKane, 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
dc.descriptionThis article was published in Social Science and Medicine [© 2016 Elsevier Ltd.] and the definite version is available at:
dc.description.abstractBackground 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.en_US
dc.publisher© 2016 Elsevier Ltden_US
dc.subjectAgents of social changeen_US
dc.subjectCommunity health workersen_US
dc.titleLimits and opportunities to community health worker empowerment: a multi-country comparative studyen_US
dc.contributor.departmentJames P Grant School of Public Health, BRAC University

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