The quest for diffusible community health worker projects and the pitfalls of scaling culture

Abstract

ABSTRACT Researchers of community health worker (CHW) models in many countries are looking for ways to scale without losing one of their main advantages, their context-sensitivity. This paper looks at one research strategy to make CHW projects scalable, namely by developing a generic notion of culture-sensitivity. Based on in-depth qualitative analysis, we reconstruct how ‘culture’ has been enshrined in a US-based CHW project and specifically in the artefact of a binder with teaching materials for vulnerable mothers. The inscription of generalized, culture-sensitive spaces into the binder did allow the Project to comply with standards of evidence-based medicine while respecting community self-determination and made space for creative and competent CHW practices. Yet at the same time, it took away from more substantive conceptions of community engagement and from community empowerment through CHWs. Our analysis highlights how the focus on culture can invisibilise and displace the importance of competent CHW practice and processes of community engagement.