The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh

Mahbubur Rahman,Farzana Begum,Stephen P Luby,Khobair Hossain,Fosiul Alam Nizame,Leanne Unicomb,Anika Jain,Mosammot Mobashara,Farzana Yeasmin,Peter J Winch,Rezwana Hossain,Elli Leontsini,Tania Jahir,Rizwana Khan

doi:10.3390/ijerph18073389

Abstract

Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the trial, to aid future recruitment, training and retention of CHWs. Nine focus groups and 18 in-depth interviews were conducted with CHWs. Focus groups and interviews were transcribed and thematic content analysis performed to summarize the results. All CHWs described experiencing positive working conditions and many benefits both socially and financially; these contributed to their retention and job satisfaction. Their honorarium was commonly applied towards their children’s education and invested for income generation. CHWs gained self-confidence as women, to move unaccompanied in the community and speak in public. They earned respect from the community and their family members who helped them manage their family obligations during work and were viewed as a resource for advice on health and social issues. Many participated in family decision-making from which they were previously excluded. Health programs should foster a positive experience among their CHWs to aid the recruitment, retention and development of this important human resource.

Highlights

We present findings on the lived experiences of female Community health workers (CHWs) serving in the WASH-Benefits Bangladesh trial to inform how future community-based health interventions should employ, support and supervise CHWs
If other studies working with CHWs with similar responsibilities, training, incentives and supervision, adopt the approaches we describe in this paper, it is possible that the CHWs may perform their duties well or better
There are many studies that seek to understand how CHWs engage in delivering health programs and devise methods to improve CHW attrition, retention and motivation

Summary

Introduction

Community health workers (CHWs) are essential in implementing community-based health interventions and promoting preventive behaviors. The term CHW refers to all cadres of community-based workers including community health promoters, community health advocates, community outreach workers, lady health workers, community health volunteers, village health workers and auxiliary health workers [1,2]. Their descriptions and roles are generally similar in that they provide services to promote a healthy lifestyle and prevent diseases, mobilize and encourage community members to utilize health services and facilitate access to facility-based healthcare, as noted by a systematic review [3]. The World Health Organization defines CHWs as “members of

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Conclusion