Day 1 Speaker Presentation - Rosalind Steege
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This document discusses how gender impacts the working lives of community health workers (CHWs). It identifies several gender-related challenges faced by CHWs, including communities not accepting health advice from female CHWs, difficulties for female CHWs in traveling long distances or being away from home for training, and pressures from husbands for female CHWs to prioritize family responsibilities over work. The document recommends that CHW programs and policies acknowledge these gender issues and promote more gender-transformative approaches to support CHWs and strengthen health systems in a sustainable and equitable manner.
![Mobility
(Community level)
“the supervisors go out into the community and this is really difficult
terrain, sometimes you are going through jungle and going on hikes 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, KII](https://image.slidesharecdn.com/rosalindsteege-genderdimensions-171102100350/85/Day-1-Speaker-Presentation-Rosalind-Steege-9-320.jpg)
Day 1 Speaker Presentation - Rosalind Steege
- 1. How does gender impact the working lives of Community Health Workers? Rosie Steege 23rd October 2017 Matatcha CHW Moamba, Mozambique
- 2. Contents • Why is gender important? • Gender challenges for CHWs • Recommendations for sustainable CHW programmes & policies
- 3. • “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)
- 4. Arminda, APE with mothers from her community Manhiça, Mozambique
- 5. Contents • Why is gender important? • Gender challenges for CHWs • Recommendations for sustainable CHW programmes & policies
- 6. Steege et al. (Manuscript submitted for publication)
- 7. Training (HS level) “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, KII
- 8. Palmina APE with her daughter in Manhica Mozambique
- 9. Mobility (Community level) “the supervisors go out into the community and this is really difficult terrain, sometimes you are going through jungle and going on hikes 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, KII
- 10. Marriage (Individual level) “Agriculture development agents are getting transfer, education. The one who has a certificate level education is becoming diploma level and the diplomas are becoming degree holder. We also have the right to get married. We have to be with our husband as like other sectors doing. There is a provision of government which says ‘the wife and the husband should not separate due to work place’” HEW, Ethiopia
- 11. Contents • Why is gender important? • Gender challenges in context of policies and guidelines • Recommendations for sustainable CHW programmes & policies
- 12. Steege et al. (Manuscript submitted for publication)
- 13. Challenges to change • Funding / sustainability • Education levels by gender – (especially in conflict affected settings) Gender bias in the health sector & women’s leadership – Larger systems issue How can we support CHWs to bring their voice, perspective and leadership into health systems – Supportive supervision and space for reflection Dhatt R, Theobald S, Buzuzi S, Ros B, Vong S, Muraya K, et al. The role of women's leadership and gender equity in leadership and health system strengthening. Global Health, Epidemiology and Genomics. 2017;2. Standing H. Gender – a Missing Dimension in Human Resource Policy And Planning for Health Reforms 2000.
- 14. Introduction • IMAGE OF CHW Meskerem and Tezeru – Health Extension Workers, Sidama Zone, Ethiopia
- 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, KII
- 16. Opportunities for change • 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 Perez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. Am J Public Health. 2008;98(1):11-4.
- 17. Conclusion • Gender impacts CHWs in a multitude of ways • Current CHW programmes & policies do not acknowledge the complexity gender plays ‘supply side’ – missed opportunity to promote gender transformative approaches at all levels of the health system – Recognition of gender influence can help in scale up and sustainability of programmes – Bottom up approach needed • Implementation approaches on the ground are often governed by gender but not policy – Responsive policy inclusive of gender governing the implementation at community level
- 18. Acknowledgements • CHWs and key informants from all genders that participated in the research • PhD supervisors - Sally Theobald (LSTM) and Miriam Taegtmeyer (LSTM) • Kate Hawkins and the wider REACHOUT consortium team for valuable insights on gender
- 19. Contact us • Website: http://www.reachoutconsortium.org/ • Twitter: @REACHOUT_Tweet • Join the Health Systems Global TWG ‘Supporting and strengthening the role of community health workers in health system development’ email: [email protected]
- 20. Interested in Gender? Contact RinGs • Website: http://resyst.lshtm.ac.uk/rings • E-mail: [email protected] • Twitter: @RinGsRPC • Google+: RinGs • Linked In: https://www.linkedin.com/groups/Gender-Health-Health-Systems-Group- 8293050/about Photo Credit: bug_g_membracid
- 21. Thank you [email protected] @rjsteege Joel, community leader Manhica Mozambique
- 22. 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) • 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. • Perez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. Am J Public Health. 2008;98(1):11-4. • Dhatt R, Theobald S, Buzuzi S, Ros B, Vong S, Muraya K, et al. The role of women's leadership and gender equity in leadership and health system strengthening. Global Health, Epidemiology and Genomics. 2017;2. • Standing H. Gender – a Missing Dimension in Human Resource Policy And Planning for Health Reforms 2000. • Steege et al. How does gender impact the working lives of close to community providers? Empirical research, a review and conceptual framework. Manuscript submitted for publication.