Using community health workers:

Abstract

In this article, we use semistructured interviews and documents produced by Ethiopian government officials and international health donors to examine two key features of the nation's community health worker (CHW) program: (1) the process and criteria of selecting community health workers; and (2) policies, rhetoric, and experiences of payment and empowerment. We examine these from the varied perspectives of district health officials, Health Extension Workers, and leaders and members within Ethiopia's so‐called Women's Development Army, whom we interviewed during 2012–14. According to national policymakers and policy documents, the goals of the Women's Development Army are twofold: first, to reduce mortality and second, to produce “model” women, who discipline themselves and their neighbors to enact healthy behaviors. The Army is supposed to simultaneously “empower” these women to be more autonomous from husbands and more active in development‐oriented work. Yet one of the key criteria sought by district‐level health officials—willingness to “accept what we teach them and implement what we tell them”—highlights that Army leaders are to remain subordinate to government health officials. Many female members of the Women's Development Army expressed ambivalence about their selection, particularly as the position was unpaid. Some questioned why women were expected to volunteer when men had previously been paid to do similar work. These data emphasize the differences in goals, aims, and experiences among various actors involved in CHW programs, and the need for researchers to address whether or not respondents are comfortable to express perspectives that might question dominant goals and discourses.

The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies

“…As a whole, these non-specialists were effective when delivering psychological treatments for adults [ 26 ] and other mental health services for children and adults [ 44 , 49 ]. Reflecting wider concerns in global health [ 115 , 116 , 117 ], three of the reviews called for more attention to low motivation among non-specialists, potential harms associated with non-specialist delivered care, and the potential burden to non-specialists, particularly among women [ 26 , 32 , 49 ]. The WPA has raised the issue of resistance among professionals and practitioners to community-oriented care [ 11 , 12 ], but this was not addressed in the reviews.…”

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations

“…With increasing distribution of tasks to community health workers, there is growing concern about the economic burden, lack of compensation, and contribution to personal physical and mental health problems. 156157 This is especially problematic given that the majority of community health workers are women and thus bear the greatest burden of uncompensated or undercompensated labour. 158159 …”

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

“…For example, HEWs were viewed as a trusted source of information about health, and an access point to obtain basic services or referrals to higher levels of the health system, which has also been reported elsewhere in Ethiopia [ 24 – 27 ]. Others, however, have highlighted the top-down nature of Ethiopia’s Health Extension Program, and questioned the extent to which local health workers are expected to remain subordinate [ 28 ]. Indeed, social desirability tendencies and the complexity of situating health interventions within specific local cultural and social forces remain important considerations that further support the need for contemporary, context-specific research.…”