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The importance of gender transformative policies for CHW programmes


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This presentation was given at the Inspiring Communities in Global Health conference on the 12 June 2017

Published in: Health & Medicine
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The importance of gender transformative policies for CHW programmes

  1. 1. Gender & policy in Community Health Worker programmes Rosie Steege 12th June 2017 Matatcha CHW Moamba, Mozambique
  2. 2. Contents • Why is gender important? • Gender challenges in context of policies and guidelines • Future of CHW programme policies
  3. 3. Introduction • IMAGE OF CHW Meskerem and Tezeru – Health Extension Workers, Sidama Zone, Ethiopia
  4. 4. • “My challenge is the communities couldn’t accept what I told about health facility delivery. The pregnant woman wanted to deliver at home because her husband didn’t permit her to deliver in the health facility.” CHW, Indonesia (REACHOUT context analysis)
  5. 5. Arminda, APE with mothers from her community Manhiça, Mozambique
  6. 6. Palmina APE with her daughter in Manhica Mozambique
  7. 7. Contents • Why is gender important? • Gender challenges in context of policies and guidelines • Future of CHW programme policies
  8. 8. Key informant interviews
  9. 9. Training “where women were nominated they were sent to this training institution they are away from their family for you know, up to a year and it was very difficult because we have a couple instances where some women arrived, didn't know that they were pregnant, found out that they were pregnant and had to drop out which was hard for them because they were so excited and wanted to do this and then another issue was men, if you will, just asking them to come back, they didn't feel comfortable with their wife being you know in a far off place, with a bunch of people that they didn't know. ” Zambia
  10. 10. Mobility “the supervisors go out into the community and this is really difficult terrain, sometimes you are going through jungle and going on hikes and these sorts of things, and we use motorbikes to get there and what we found is that a lot of the women, who are the supervisors going out are petite, and actually getting them on a bike and having them actually be able to ride the bike through all this muddy terrain and navigate all of this sometimes its just impossible… So [we send] out another person with them and usually its a man but again, this is all stuff that at the national level it hasn't really been thought through how we are going to navigate some of these points but they are real life implementation challenges, that have a funny gender dynamic.” Liberia
  11. 11. Contents • Why is gender important? • Gender challenges in context of policies and guidelines • Future of CHW programme policies
  12. 12. Current challenges • Funding / sustainability • Education levels by gender – (especially in conflict affected settings) Gender bias in the health sector – Larger systems issue  How can we support CHWs to bring their voice, perspective and leadership into health systems – Supportive supervision and space for reflection
  13. 13. Current opportunities • Natural researchers (Perez & Martinez, 2008) – CHWs have untapped insights around gender, equity and power  should be harnessed to build more responsive health systems • Representation from Gender dept. and women’s groups needed • HMIS data for CHWs disaggregated by gender should be used to support decision making Mehret Lamiso, Becha Kabele, Ethiopia
  14. 14. Case study – ASHA programme – National policy adapted by each state – Female nodal officers bringing gender issues to table • Safe spaces, harrassment – Modular training • Residential • Childcare on site • Female only facilitators
  15. 15. Safety “So you have to have a programme that sensitizes every service provider male and female above the ASHA to gender - that hasn't happened and that’s terrible because the ASHA can be as aware of gender issues as you care to make her and then she goes into this person's house and gets raped.” India
  16. 16. Conclusion • Gender impacts CHWs in a multitude of ways • Current CHW policies do not acknowledge the complexity gender plays ‘supply side’ – missed opportunity to promote gender transformative approaches at all levels of the health system – Bottom up approach needed • Implementation approaches on the ground are often governed by gender but not by policy – Responsive policy inclusive of gender governing the implementation at community level Leopoldina, APE Moamba Mozambique
  17. 17. Acknowledgements • CHWs and key informants from all genders that participated in the research • REACHOUT consortium family • PhD supervisors - Sally Theobald (LSTM) and Miriam Taegtmeyer (LSTM)
  18. 18. Thank you Email: Twitter: @rjsteege Joel, community leader with his community in Manhica Mozambique
  19. 19. References • Theobald, S. MacPherson, E. McCollum, R. Tolhurst, R. (2015) Close to community health providers post 2015: Realising their role in responsive health systems and addressing gendered social determinants of health REACHOUT BMC Proceedings. 9(Suppl 10):S8 (18 December 2015) • Gomez, W. (2015) A literature review exploring how the gender of a community health worker impacts provision of healthcare services in low and middle income countries. LSTM, unpublished, cited with permission. • Jackson, R. Kilsby, D. (2015) We are dying while giving life: Gender and the role of Health Extension Workers in rural Ethiopia .84p. Accessed 5 Feb 2016. Available from: • Saprii, L., Richards, E., Kokho, P. and Theobald, S. (2015) 'Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles', Human Resources for Health, 13(1), pp. 1-13. • Najafizada, S. A., Labonte, R. and Bourgeault, I. L. (2014) 'Community health workers of Afghanistan: a qualitative study of a national program', Confl Health, 8, pp. 26. • Mumtaz, Z. (2012) 'Gender and social geography: Impact on Lady Health Workers Mobility in Pakistan', BMC Health Services Research, 12, pp. 360-360. • Uzondu, C. A., Doctor, H. V., Findley, S. E., Afenyadu, G. Y. and Ager, A. (2015) 'Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria', Glob Health Sci Pract, 3(1), pp. 97-108. • Razee, H., Whittaker, M., Jayasuriya, R., Yap, L. and Brentnall, L. (2012) 'Listening to the rural health workers in Papua New Guinea - the social factors that influence their motivation to work', Social Science & Medicine (1982), 75(5), pp. 828-835. • Fotso, J. C., Higgins-Steele, A. and Mohanty, S. (2015) 'Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India', BMC Health Serv Res, 15 Suppl 1, pp. S5.