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What does trust have to do with the
Sustainable
Development Goals?
Exploring the multiple relationships shaping
Community Health Workers’
experiences and performance
Health systems are
complex, social
institutions
Source: Sheikh et al. (2011)
Trust
“The optimistic acceptance of a vulnerable situation in which the
trustor believes the trustee will care for the trustor’s interest”
(Hall et al. 2001)
Trusting relationships
“Respectful, fair and cooperative interactions between individuals”
(Gilson 2003; Okello and Gilson 2015)
Lessons from six countries
Indonesia:
decentralization of the
health system
strengthens role of
community structures
and “software”
Kenya: guidelines and
curricula that are
developed with
communities and CHWs
lead to better
performance
Bangladesh: informal
health providers are an
important part of the
health system, and are
part of system
“hardware” and
“software”
Mozambique: lack of
performance of CHWs or
health system as a whole
leads to lack of trust:
“software” problems
Ethiopia: Health
development Army is a
vehicle for enhanced
relationships between
communities and CHWs
Malawi: incentive
structure leads to
mistrust between
different actors,
impeding CHW
performance

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What does trust have to do with the Sustainable Development Goals? Exploring the multiple relationships shaping Community Health Workers’ experiences and performance

  • 1. What does trust have to do with the Sustainable Development Goals? Exploring the multiple relationships shaping Community Health Workers’ experiences and performance
  • 2. Health systems are complex, social institutions Source: Sheikh et al. (2011)
  • 3. Trust “The optimistic acceptance of a vulnerable situation in which the trustor believes the trustee will care for the trustor’s interest” (Hall et al. 2001) Trusting relationships “Respectful, fair and cooperative interactions between individuals” (Gilson 2003; Okello and Gilson 2015)
  • 4. Lessons from six countries Indonesia: decentralization of the health system strengthens role of community structures and “software” Kenya: guidelines and curricula that are developed with communities and CHWs lead to better performance Bangladesh: informal health providers are an important part of the health system, and are part of system “hardware” and “software” Mozambique: lack of performance of CHWs or health system as a whole leads to lack of trust: “software” problems Ethiopia: Health development Army is a vehicle for enhanced relationships between communities and CHWs Malawi: incentive structure leads to mistrust between different actors, impeding CHW performance

Editor's Notes

  1. Health system, health worker and CHW performance: strategies to improve these should consider health systems as complex, social institutions. This framework, presented in a paper some years back of Sheikh et al. focuses on health systems as social institutions. The health system is made up of hardware and software. The hardware corresponds to the health system building blocks: human resources, finance, medicines and technology, organizational structure, service infrastructure and information systems. The software are the ideas and interests, relationships and power and values and norms of all actors in and outside the health system. Looking at this software, every health worker is part of social interactions and environments, which, together with available resources, shape their performance. Performance can be seen as a transactional social process.
  2. Definition of trust Trust could be built by personal behaviours and organizational practices that provide space for engagement and open dialogue (Gilson 2006). Factors that have been found to influence trust of health workers are perceived organizational support, communication, procedural justice and feedback from upper levels (Albrecht and Travaglione 2003; Nyhan 2000). Trust is an important factor affecting interpersonal relationships. Definition trusting relationships. Thus, understanding the factors that influence trust and HSAs’ interpersonal relationships with different actors in the community and health sector is important in order to analyse and improve CHW performance.
  3. Point to hard and software, and that there are interlinked. They both influence CHW performance The broader context does play a role In the REACHOUT countries, we have seen examples of how different contextual, hard and software elements influence CHWs in conducting their work. For this panel, we would like to focus of trust and relationships, as this was such a profound issue coming out of our studies.