Women Community Health Workers Research Articles

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH).

Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours. A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components. Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities. MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

Community health workers as rights defenders: the Mitanin experience in India

ABSTRACT Women community health workers from a government-run program in India have been uncommonly successful in combining rights-based advocacy (accountability to their communities) with (nominal) paid work on healthcare tasks by the state. Over two decades, 70,000 Indigenous women Mitanins or community health workers have advanced community health and gender rights of the broader communities they are part of, and their own labour rights. Being able to strategically advocate for both types of rights is an experience unmatched by their global counterparts. This Note focuses on two elements of the Mitanin pre-emptive learning strategy, the movement-building approach of a government run program to empower frontline community health workers , and the role of a hybrid agency in prioritising social mobilisation by these workers to improve healthcare delivery.

Liminality as wage penalty for India's women community health workers

AbstractIn this paper, I analyze the experiences of the world's largest all‐women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers' experiences of being in‐between established structures and roles in varying degrees, times, and/or places. India's ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state's health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task‐based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs' liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue that we need to consider not just how much women are paid, but how the payment is structured, and how that places marginalized women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive.

Supporting community health workers in fragile settings from a gender perspective: a qualitative study

ObjectiveTo explore how gender influences the way community health workers (CHWs) are managed and supported and the effects on their work experiences.SettingTwo districts in three fragile countries. Sierra Leone—Kenema and...

For Love of Money: Rewards of Care for India’s Women Community Health Workers

Abstract What are the rewards of paid care work for frontline health workers? I focus on India’s women community health volunteers, the largest such workforce in the world. Appointed since 2007 and numbering one million, these women are paid per-case incentives to connect the poor and marginalized to government-run health services. Using 14 months of ethnographic fieldwork in Delhi and Punjab, including 80 interviews, I find that women community health volunteers (called Accredited Social Health Activists or ASHAs) experience extrinsic rewards in paid care work. ASHAs earn not only from their official wages, but also from two unofficial streams: a) a boost of income from non-ASHA work and b) commissions from private hospitals. I also find that the intrinsic rewards ASHAs report—emotional gratification, relative autonomy, and skill-building—are co-constituted with extrinsic rewards; that is, they are tied to their earnings. This calls into question the “Love versus Money” binary, used to frame much of the discussion on care work. I argue instead for a “Love of Money” framing—that is, money as a reward and money as begetting other rewards. My findings highlight the significance of globalizing the empirical research on paid care work.

Promissory Capital: State Legitimacy among Women Community Health Workers in India

Promissory Capital: State Legitimacy among Women Community Health Workers in India

Promoting Health in Rural India: Enhancing Job Performance of Lay Health Care Activists

The health of people in a nation is a potential indicator of its development. Over and above that, the job performance of people involved in the delivery and facilitation of health care services within a nation reflects the actual health conditions in it. In developing countries, where a large chunk of the population lives in rural areas, the job performance of grass-roots health care workers gains significant importance in order to ensure effective and efficient delivery of health care services to the masses and marginalized communities. The present study takes the case of Accredited Social Health Activists (ASHAs) in difficult rural areas of India to identify factors that affect their job performance and suggests interventions through which it could be enhanced. Fifty-five ASHAs were interviewed and five focused group discussions (FGDs) were conducted. Additionally, triangulation was done by interviewing other stakeholders, while studying relevant documents. Through content analysis of these interviews and documents, this study identifies the demands, resources and stressors that affect the job performance of these important intermediaries in the health care supply chain (in the Indian context). The study also suggests policy-level decisions that could help in enhancing job performance of ASHAs by managing demands, increasing resources and reducing stressors. Key Messages We have developed a model that delineates the demands, resources and stressors that affect job performance of women workers in rural India. We have studied Accredited Social Health Activists (ASHAs) who are part of community health care sector. However, our findings are applicable to a wider set of similar job roles. We have studied the nuances of factors affecting job performance for a category of community health care workers who are not full-time employees, have received minimal training and work in close proximity of their residence in a closely knit society. We have looked at job performance of ASHAs who are women community health workers, with low educational qualifications, based in rural setting of a developing country. We have recommended policy implications that would aid in enhancing the performance of ASHAs and thus improve the health care situation in rural India.

Collaborative Care Goes Global

Collaborative Care Goes Global

Donning the mask: effects of emotional labour strategies on burnout and job satisfaction in community healthcare

Emotional labour involves management of one's emotions to match the demands of their roles. This emotion display involves just expression (surface-level emotional labour) or experience in addition to expression (deep-level emotional labour) of the desired emotions. Emotional labour is required in the effective, efficient and successful healthcare service delivery. Burnout associated with emotional labour is an important factor that decides how satisfied frontline service providers with their job are. This empirical study investigates the link between surface and deep-level emotional labour, burnout and job satisfaction in women community health workers from India. Our results from the structural equation modelling of 177 accredited social health activists (ASHAs) indicate a negative relation between surface and deep-level emotional labour, clearly demarcating them as two different strategies for performance of emotional labour in community health care setting. Surface-level emotional labour is associated with higher job satisfaction, and burnout partially mediates this relation. Deep-level emotional labour is associated with lower job satisfaction; burnout fully mediates this relation. Qualitative post hoc analysis based on interviews of 10 ASHAs was done to understand the findings of the quantitative study. Surface-level emotional labour was found to be a more desirable strategy for community health care workers for the effective and efficient performance of their work roles. Our results have a significant contribution to design, redesign, and improvement of employment practices in community healthcare. This study brings forth the neglected issues of emotions and their implications for these healthcare workers in low and middle-income countries who are a vital link that delivers healthcare to weaker section of the society. The findings have relevance not merely for the individual providing this service but the beneficiary and the organization that facilitates this delivery. Interventions based on demographic, community, national and occupational factors have also been presented.

African American and Latina community health workers engagePhotoPARas a resource in a post-disaster context: Katrina at 5 years

This article reports on participatory action and photo elicitation research conducted by community health workers and university-based researchers in post-Katrina New Orleans between August 2007 and 2010. It documents how 11 African American and Latina women community health workers forged ties and developed a model for responding to some of the personal, familial, and community effects of this "unnatural disaster." We identify and analyze two of the health literacies they developed and deployed: (1) intragroup and intergroup empathy skills and (2) capacity to critically analyze structural causes of health inequities. We argue that the participatory processes and outcomes analyzed herein offer one possible model through which local communities and health workers can creatively respond to health disparities in post-disaster contexts.

Can We Talk? Feminist Economists in Dialogue with Social Theorists

Previous articleNext article No AccessCan We Talk? Feminist Economists in Dialogue with Social TheoristsJulie A. Nelson Julie A. NelsonGlobal Development and Environment InstituteTufts University Search for more articles by this author Global Development and Environment InstituteTufts UniversityPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Signs Volume 31, Number 4Summer 2006 Article DOIhttps://doi.org/10.1086/500599 Views: 127Total views on this site Citations: 21Citations are reported from Crossref © 2006 by The University of Chicago. All rights reserved.PDF download Crossref reports the following articles citing this article:Analena B. Bruce, Yetkin Borlu, Leland L. Glenna Assessing the scientific support for U.S. EPA pesticide regulatory policy governing active and inert ingredients, Journal of Environmental Studies and Sciences 44 (Aug 2022).https://doi.org/10.1007/s13412-022-00788-4Michal Plaček, Cristina Del Campo, Vladislav Valentinov, Gabriela Vaceková, Markéta Šumpíková, František Ochrana Gender Heterogeneity and Politics in Decision-Making About Green Public Procurement in the Czech Republic, Politics and Governance 10, no.33 (Jun 2022).https://doi.org/10.17645/pag.v10i3.5408Claudia Roethlisberger, Franziska Gassmann, Wim Groot, Bruno Martorano The contribution of personality traits and social norms to the gender pay gap: A systematic literature review, Journal of Economic Surveys 5 (Mar 2022).https://doi.org/10.1111/joes.12501Antonietta Cosentino, Paola Paoloni Women’s Skills and Aptitudes as Drivers of Organizational Resilience: An Italian Case Study, Administrative Sciences 11, no.44 (Nov 2021): 129.https://doi.org/10.3390/admsci11040129Vrinda Marwah For Love of Money: Rewards of Care for India’s Women Community Health Workers, Social Problems 10 (Sep 2021).https://doi.org/10.1093/socpro/spab062Ariane B. Anderson, Jane Jorgenson , Journal of Organizational Ethnography 8, no.33 ( 2019): 253.https://doi.org/10.1108/JOE-05-2018-0028Leland L. Glenna AFHVS 2017 presidential address, Agriculture and Human Values 34, no.44 (Aug 2017): 1021–1031.https://doi.org/10.1007/s10460-017-9824-6Jessica Andrea Chelekis Risks and strategies of Amazonian households: Retail sales and mass-market consumption among caboclo women, Economic Anthropology 4, no.22 (Jun 2017): 173–185.https://doi.org/10.1002/sea2.12086Joni J. Young (En)gendering sustainability, Critical Perspectives on Accounting 26 (Feb 2015): 67–75.https://doi.org/10.1016/j.cpa.2013.06.002Shelley L. Koch, Joey Sprague Economic Sociology vs. Real Life: The Case of Grocery Shopping, American Journal of Economics and Sociology 73, no.11 (Jan 2014): 237–263.https://doi.org/10.1111/ajes.12065Joni J. Young Devil's Advocate: The Importance of Metaphors, Accounting Horizons 27, no.44 (Dec 2013): 877–886.https://doi.org/10.2308/acch-10369Margarita Le?n A real job? Regulating household work: The case of Spain, European Journal of Women's Studies 20, no.22 (Apr 2013): 170–188.https://doi.org/10.1177/1350506812463910Örn B. Bodvarsson, Hendrik Van den Berg Immigration and Economic Growth: More Fundamental Issues, (Mar 2013): 249–283.https://doi.org/10.1007/978-1-4614-2116-0_10Stephanie Baker Collins, Marge Reitsma-Street, Elaine Porter, Sheila Neysmith Women's community work challenges market citizenship, Community Development 42, no.33 (Oct 2011): 297–313.https://doi.org/10.1080/15575330.2010.505296Maureen Sander-Staudt Care as a Corporate Virtue, (Jul 2011): 259–277.https://doi.org/10.1007/978-90-481-9307-3_14Julie A. Nelson Care Ethics and Markets: A View from Feminist Economics, (Jul 2011): 35–53.https://doi.org/10.1007/978-90-481-9307-3_2Julie A. Nelson Sociology, Economics, and Gender, American Journal of Economics and Sociology 69, no.44 (Oct 2010): 1127–1154.https://doi.org/10.1111/j.1536-7150.2010.00738.x Kate Bedford and Shirin M. Rai Feminists Theorize International Political Economy Bedford and Rai, Signs: Journal of Women in Culture and Society 36, no.11 (Jul 2015): 1–18.https://doi.org/10.1086/652910SHEILA M. NEYSMITH, MARGE REITSMA-STREET, STEPHANIE BAKER-COLLINS, ELAINE PORTER, SANDRA TAM Provisioning Responsibilities: How Relationships Shape the Work that Women Do, Canadian Review of Sociology/Revue canadienne de sociologie 47, no.22 (May 2010): 149–170.https://doi.org/10.1111/j.1755-618X.2010.01228.xJulie A. Nelson Care Ethics and Markets: A View from Feminist Economics, SSRN Electronic Journal (Jan 2010).https://doi.org/10.2139/ssrn.1619938Julie A. Nelson A RESPONSE TO BRUNI AND SUGDEN, Economics and Philosophy 25, no.0202 (Jul 2009): 187.https://doi.org/10.1017/S0266267109990058

Translocal and gender dimensions of frame alignment: community mobilization and recruitment processes among women community health workers in Mexico

Translocal and gender dimensions of frame alignment: community mobilization and recruitment processes among women community health workers in Mexico

Translocal and gender dimensions of frame alignment: Community mobilization and recruitment processes among women community health workers in Mexico

The rise of working-class women's organizing, community work around health issues, and non-governmental organizations (NGOs) in Latin America has been attributed to structural and cultural factors. Yet these factors fall short in explaining how women are recruited into community health work and NGOs. In this paper the author argues that the frame alignment is the mediating process that stands between structural and cultural factors and individual women to make community activism in health possible. The frame alignment is an interactive process constituted by the life stories women bring into their activism and the NGO into which they are recruited. Further, the frame alignment is shaped by translocal actors such as state and international institutions as they put frames and financial resources in circulation throughout the Third World, particularly via NGOs. This argument is developd in a case study of women community workers members of a Mexican health-oriented NGO. The author relies on women's and the NGO's narratives to explore how the frame alignment takes place in and through the recruitment of working-class women into community health work within this NGO.

“I was not Invited to be a [CHW] … I asked to be one”: Motives for Community Mobilization among Women Community Health Workers in Mexico

Despite health educators' revitalized interest in community mobilization for health, little attention has been given to participants' motives for mobilizing. The purpose of this article is to contribute to the understanding of community mobilizing by analyzing the motives for mobilization among a group of women community health workers (CHWs), members of a community-based organization in Mexico. The study is guided by critical feminist and social constructivist theories. It aims at identifying the categories of motives used by women CHWs and exploring how these motives are created while presenting women's own voices. Women's motives fall into four categories: getting out, serving, learning, and women's betterment. These motives blend personal andpublic motives. The analysis suggests that mobilization for health may be enhanced by addressing both the personal satisfaction of individuals and the accomplishment of public goods. The study of motives may be useful for the recruitment and retention of participants in community mobilization efforts.