Listening to Community Health Workers: How Ethnographic Research Can Inform Positive Relationships Among Community Health Workers, Health Institutions, and Communities

Abstract

Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs' desires for alleviation of their own and others' economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions.

Community health workers and social change:

“…Collectively they promote and maintain a willingness to pay attention to and sit down with people in their multilayered political, economic, social, and moral contexts (Biehl ). Such research, coupled with engagement in productive discussion and collaboration with various actors in the global health industry, can hopefully help shift policy and practice to more productive and pro‐active modes, in which multiple actors work toward an explicit goal of maintaining solid working relationships among CHWs, the people they serve, and the individuals and institutions that supervise and deploy them (Maes et al ).…”

Gender exploitative and gender transformative aspects of employing Health Extension Workers under Ethiopia's Health Extension Program

“…Task shifting to Community Health Workers (CHWs) to address critical health worker shortages in sub-Saharan Africa and South East Asia [1][2][3][4] has resulted in CHWs being recruited and trained to perform essential health services and to link rural communities with the formal healthcare sector [5][6][7][8][9][10][11]. CHWs are generally women selected from their local community as their presence is more likely to be acceptable in providing reproductive, maternal, newborn and child health (RMNCH) services [7,[12][13][14][15][16][17].…”

“Volunteers Are Not Paid Because They Are Priceless”: Community Health Worker Capacities and Values in an AIDS Treatment Intervention in Urban Ethiopia

“…For global health bodies that deploy CHWs within poor neighborhoods and districts, a central challenge is ensuring their efficacy, often conceived in terms of preventing unhealthy behaviors, improving adherence to drugs and other biomedical technologies, and lowering morbidity and mortality rates (Lehmann and Sanders 2007;Singh 2011;Standing and Chowdhury 2008). Anthropologists and others have recently brought critical attention to this vision of CHW efficacy that prioritizes their ability to act as professional mediators of biomedical technologies and as models and monitors of healthy behaviors (Kalofonos 2014;Nading 2013). This vision may sideline CHWs' agency in reducing poverty, enhancing social solidarity, and improving well-being, a key element of their role envisioned within the Alma Ata Declaration of 1978 (Arvey and Fernandez 2012;Balcazar et al 2011;Pérez and Martinez 2008;Sabo et al 2013).…”

“…The case that I present below, of a CHW-mediated antiretroviral therapy program in Addis Ababa, stands in contrast to a norm-appraised in much recent medical anthropological literature-of global health institutions largely ignoring quality of life and care and focusing on quantitative outcomes like the number of lives saved or rates of adherence to biomedical prescriptions (Biehl 2011;Kalofonos 2014;Marsland and Prince 2012;Nading 2013;Prince 2012). The NGOs and government health institutions involved in this AIDS treatment program highly valued CHWs' capacities for empathic care in that they devoted considerable attention to encouraging and using them to improve the quality of peoples' lives through the reduction of poverty-and HIV-related stigmatization, despair, and strife.…”