Skip navigation

Not knowing enough, not having enough, not feeling wanted: challenges of community health workers providing maternal and newborn services in Africa and Asia

Not knowing enough, not having enough, not feeling wanted: challenges of community health workers providing maternal and newborn services in Africa and Asia

Olaniran, Abimbola, Banke-Thomas, Aduragbemi ORCID: 0000-0002-4449-0131, Bar-Zee, Sarah and Madaj, Barbara (2022) Not knowing enough, not having enough, not feeling wanted: challenges of community health workers providing maternal and newborn services in Africa and Asia. PLoS ONE, 17 (9):e0274110. ISSN 1932-6203 (Online) (doi:https://doi.org/10.1371/journal. pone.0274110)

[img]
Preview
PDF (Publisher VoR)
37546_BANKE_THOMAS_Not_knowing_enough_not_having_enough.pdf - Published Version
Available under License Creative Commons Attribution.

Download (481kB) | Preview

Abstract

Background
Community health workers (CHWs) have been identified as a critical bridge to reaching many communities with essential health services based on their social and geographical proximity to community residents. However, various challenges limit their performance, especially in low-and middle-income countries. With the view to guiding global and local stakeholders on how best to support CHWs, this study explored common challenges of different CHW cadres in various contexts.
Methods
We conducted 36 focus group discussions and 131 key informant interviews in Bangladesh, India, Kenya, Malawi, and Nigeria. The study covered 10 CHW cadres grouped into Level 1 and Level 2 health paraprofessionals based on education and training duration, with the latter having a longer engagement. Data were analysed using thematic analysis.
Results
We identified three critical challenges of CHWs. First, inadequate knowledge affected service delivery and raised questions about the quality of CHW services. CHWs’ insufficient knowledge was partly explained by inadequate training opportunities and the inability to apply new knowledge due to equipment unavailability. Second, their capacity for service coverage was limited by a low level of infrastructural support, including lack of accommodation for Level 2 paraprofessional CHWs, inadequate supplies, and lack of transportation facilities to convey women in labour. Third, the social dimension relating to the acceptance of CHWs’ services was not guaranteed due to local socio-cultural beliefs, CHW demographic characteristics such as sex, and time conflict between CHWs’ health activities and community members’ daily routines.
Conclusion
To optimise the performance of CHWs in LMICs, pertinent stakeholders, including from the public and third sectors, require a holistic approach that addresses health system challenges relating to training and structural support while meaningfully engaging the community to implement social interventions that enhance acceptance of CHWs and their services.

Item Type: Article
Uncontrolled Keywords: community health workers; maternal health
Subjects: H Social Sciences > HT Communities. Classes. Races
R Medicine > RG Gynecology and obstetrics
R Medicine > RT Nursing
Faculty / School / Research Centre / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development
Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families
Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified: 28 Sep 2022 12:15
URI: http://gala.gre.ac.uk/id/eprint/37546

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics