Abstract
The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two ‘blocks’, purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women’s collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the explanatory framework may provide general lessons for programmes in similar contexts.
Highlights
The Commission on Social Determinants of Health (CSDH 2008), convened by the World Health Organization (WHO) in 2005, reiterated the need to address the social, economic and political determinants of health alongside healthcare provision
As Lehmann and Sanders (2007, p. 5) write, ‘the early literature emphasizes the role of the village health workers (VHWs), which was the term most commonly used at the time, as a healthcare provider, and as an advocate for the community and an agent of social change, functioning as a community mouthpiece to fight against inequities and advocate community rights and needs to government structures: in David Werner’s famous words, the health worker as ‘‘liberator’’ rather than ‘‘lackey’’ (Werner 1981)’
A case was defined as action by a Community health workers (CHWs) (Mitanin) or team of CHWs (Mitanins) on nutrition or violence against women, which has resulted in a positive change in the particular social determinant of health in the context of the village/cluster of villages for which the CHW/s are responsible
Summary
The social determinants of health may be defined as ‘the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics’ (WHO undated). 5) write, ‘the early literature emphasizes the role of the village health workers (VHWs), which was the term most commonly used at the time, as (and possibly not even primarily) a healthcare provider, and as an advocate for the community and an agent of social change, functioning as a community mouthpiece to fight against inequities and advocate community rights and needs to government structures: in David Werner’s famous words, the health worker as ‘‘liberator’’ rather than ‘‘lackey’’ (Werner 1981)’ As Lehmann and Sanders (2007, p. 5) write, ‘the early literature emphasizes the role of the village health workers (VHWs), which was the term most commonly used at the time, as (and possibly not even primarily) a healthcare provider, and as an advocate for the community and an agent of social change, functioning as a community mouthpiece to fight against inequities and advocate community rights and needs to government structures: in David Werner’s famous words, the health worker as ‘‘liberator’’ rather than ‘‘lackey’’ (Werner 1981)’
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
