Abstract
BackgroundAlthough many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation.MethodThe study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys.Results and discussionWe explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role.ConclusionIt is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.
Highlights
The declaration of Alma-Ata highlighted the importance of primary health care and the community’s “full participation” to bring health care close to the ground [1]
We explored the emic logic of participation in a malaria elimination trial and found that Village Health Workers (VHWs) played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits to the community
We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role
Summary
The declaration of Alma-Ata highlighted the importance of primary health care and the community’s “full participation” to bring health care close to the ground [1]. A lay health worker is “a member of the community who has received some training to promote health or to carry out some health-care services, but is not a health-care professional” p.919 [5]. They are expected to take medical and social roles: the medical role handles biomedical tasks such as delivering diagnostic and treatment services; and the social role mainly involves mobilising and communicating with the population [6]. Many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. We shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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.
