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

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 nation...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Social science & medicine (1982) Jg. 164; S. 27 - 34
Hauptverfasser: Kane, Sumit, Kok, Maryse, Ormel, Hermen, Otiso, Lilian, Sidat, Mohsin, Namakhoma, Ireen, Nasir, Sudirman, Gemechu, Daniel, Rashid, Sabina, Taegtmeyer, Miriam, Theobald, Sally, de Koning, Korrie
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 01.09.2016
Pergamon Press Inc
Schlagworte:
Access
Agents of social change
Alienation
Attitude of Health Personnel
Bangladesh
Case studies
Clinical Competence - standards
Community health workers
Community Health Workers - psychology
Community involvement
Comparative analysis
Comparative studies
Emotions
Empowerment
Ethiopia
Health education
Health problems
Health promotion
Health Promotion - manpower
Health Promotion - methods
Health services
Health Services Accessibility - standards
Health services utilization
Humans
Indonesia
International comparisons
Kenya
Literature reviews
Locus of control
Malawi
Medical personnel
Medical workers
Medicine
Motivation
Mozambique
Power (Psychology)
Professional Autonomy
Program Development - methods
Program Development - standards
Qualitative Research
Self determination
Sense of control
Social change
Systematic review
Work environment
Workers
Working conditions
Workplace control
Bangladesh
Kenya
Malawi
Ethiopia
Indonesia
Agents of social change
Performance
Community health workers
Empowerment
ISSN:0277-9536, 1873-5347, 1873-5347
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung: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. 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. 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. 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. •Community health workers are a key bridge between communities and the health system.•For them to be able to empower communities, they must themselves be empowered.•Involvement with health services empowers community health workers in many ways.•However, many community health worker program aspects undermine this empowerment.•Community health workers need to be better supported by the health services.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ObjectType-Undefined-3
ISSN:0277-9536
1873-5347
1873-5347
DOI:10.1016/j.socscimed.2016.07.019