Abstract
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver.This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January–September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework.We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities.Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.
Highlights
Close-to-community (CTC) providers' play an important role in health service provision carrying out promotional, preventive, and/or curative health services and they are often the first point of contact to the health system for community members
This paper aims to add to current literature, as well as provide a critical synthesis of the existing knowledge around gender and CTC health service provision
The results from the critical interpretive synthesis and the primary data collection are presented together according to the themes that emerged, and in relation to the individual CTC provider level, the community level, and health systems level
Summary
Close-to-community (CTC) providers' play an important role in health service provision carrying out promotional, preventive, and/or curative health services and they are often the first point of contact to the health system for community members. They can be based in the Abbreviations. CTC providers include a variety of different types, roles and designations of health workers, with Community Health Workers (CHWs) constituting the largest group (Theobald et al, 2015). It is advocated that CHWs should be members of, and selected by the communities they serve (Lehmann and Sanders, 2007)
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