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Performance of Community Health Workers: Optimizing the benefits of their unique position between communities and the health sector

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Keynote speech given by Maryse Kok at the Kampala Symposium on Community Health Workers.

Published in: Health & Medicine
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Performance of Community Health Workers: Optimizing the benefits of their unique position between communities and the health sector

  1. 1. Optimizing the benefits of their unique position between communities and the health sector PERFORMANCE OF COMMUNITY HEALTH WORKERS Maryse Kok, PhD
  2. 2. Performance of Community Health Workers CommunityHealth Sector CHW !?!
  3. 3. Health systems are complex, social institutions Source: Sheikh et al. (2011)
  4. 4. An example from Malawi
  5. 5. Influencers of Community Health Worker performance “Hardware” • Supervision structure • Training • Supplies “Software” • Relationships • Trust • Power Source: 1mCHW campaign
  6. 6. Mechanisms related to trusting or weak relationships • Feelings of self-fulfillment • Feelings of being supported • Perception that CHWs serve in their interest • Recognition • Respect • Credibility Feelings of connectedness and serving the same goals Feelings of familiarity and free discussion Misunderstandings related to lack of communication • Disrespect • Doubts about CHWs’ competencies • Feelings of disconnectedness • Feelings of unfamiliarity • Feelings of not being supported • Lack of confidence in upper level • Perceptions of dishonesty and unfairness to upper level • Fear for lack of confidentiality • Doubts about CHWs’ competencies • Perceptions of dishonesty (towards CHW) • Perception that CHWs do not serve in their interest • Confused or disappointed feelings Health sector CHW Community
  7. 7. Broader context ‘In a context where...’ Programme context ‘and…,’ Mechanism Outcome ‘,leading to…’ Community participation is promoted by the government CHWs are recruited from their area of origin and/or selected with involvement of the community, and thus share the same socio-cultural attributes as their clients Communities and CHWs feel connected to and familiar with each other and communities feel that the CHWs serve in their interest Trusting relationships between CHWs and their communities There is a history and value of volunteerism Volunteering is an official element of the CHW programme CHWs and volunteers feel connected and serving the same goals through their teamwork There is a history and value of traditional leadership Traditional leaders are involved in the CHW programme Communities have more respect for and credibility towards CHWs Source: Kok et al. (2016)
  8. 8. Broader context Programme context ‘and…,’ Mechanism Outcome ‘,leading to…’ Constrained human resources for health Tasks shifted to CHWs and supplies are available Enhanced respect for and recognition of CHWs; CHWs have increased feelings of self-fulfilment Trusting relationships between CHWs and their communities Tasks shifted to CHWs and supplies lacking and/or roles and responsibilities of CHWs are unclear to communities CHWs feel stressed because of being unable to fulfil communities’ expectations and communities feel disappointed and/or confused Weak relationships between CHWs and their communities Tasks shifted to CHWs and programmes have clear professional support structures CHWs and health professional feel connected and serving the same goals through their teamwork Trusting relationships between CHWs and actors in the health sector Tasks shifted to CHWs, but roles and responsibilities of CHWs are unclear to health professionals and/or clear professional support structures for CHWs are lacking CHWs feel disrespected by health professionals and health professionals doubt about CHWs’ competence Weak relationships between CHWs and actors in the health sector Source: Kok et al. (2016)
  9. 9. Gender
  10. 10. Training and Supervision Source: supervision curriculum REACHOUT
  11. 11. Performance of Community Health Workers CommunityHealth Sector CHW !?!
  12. 12. Realities of intermediate position "Neither does the health services system hold our hand, nor do they leave our hand“ (ASHA India) “We would like it very much if officials from the ministry of health visit us and listen to our concerns as some problems cannot be solved by our coordinators.” (VHT Uganda) Source: HIFA
  13. 13. Discussion & recommendations “Hardware” “Software” Optimal performance Maryse.kok@kit.nl Twitter: @marysekok

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