Community Health Workers- change agents and mobilisers

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The American Public Health Association defines a community worker as: “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery”. Non-profits working towards improvement of vulnerable population rely on the work of these individuals, to achieve the organization’s mission.

Community health workers (CHW) are therefore fundamental for implementing field-level programming by engaging the community and the beneficiaries through participatory efforts. Carrying out initial work in the community through surveys, house-listing, community mapping, corner meetings, micro-planning etc. are crucial tasks in establishing first contact with the community. Initial community engagement activities carried by CHW(s) include identification of eligible beneficiaries, enrolling them for the sessions, services and trainings. They also mobilize community to participate in group education events and campaigns. Carrying out interventions in the community through group formation, group/community meetings, counselling, information sharing, capacity building, paying home visits, conducting growth monitoring health camps and vociferously following up with individual cases are significant activities carried by them. An important skill that they have mastered over their engagement with the community is customizing the information delivery based on the requirements of the beneficiary. Case management and referrals are other vital tasks carried by them to reach out to the beneficiaries.

A critical area of SNEHA’s research involved analyzing the motivations of these frontline workers, to both take up as well as sustain in this challenging role. As such, a study was created in order to gain insight into the perception of roles and responsibilities by CHWs as well as motivations and challenges they faced. The study comprised of in-depth interviews of the health workers from four NGOs namely: SNEHA, Apnalaya, Foundation for Mother and Child and Shelter Associates, to tap into areas, from background information and training, to personal and organizational factors.

Many themes emerged as to why CHWs decided to join the non-profit sector to begin with. Narratives expressed a desire to contribute to purposeful work, as well as to increase one’s knowledge base from a personal growth perspective. Others expressed support from supervisors as contributing factors to making the decision to join the organization. Another narrative offered willingness to try out work in a new field, and an opportunity to return to the workforce following marriage and motherhood as motivation behind initial association.

Community Health Workers also reported having a positive impact on beneficiaries who engage with trained staff during a critical phase in their growth and development. This, CHWs stated, gave rise to a capacity for self-reflection, increase in knowledge and discernible behavior modification, promotion of healthy relationships through candid conversations between beneficiaries and their parents, and added value through incentivized vocational courses, such as computer literacy and English speaking for beneficiaries. Most importantly, confidence and a personal connection and rapport is built in beneficiaries, and changes seen in youth that push forward that they will go on to produce an equitable society free from gender based or domestic violence.

As for their perceived role, many CHWs believe they served as teachers as well as resource personnel. However, they also believed their responsibilities and scope of influence transcended programming and campaign initiatives. They served as confidants and guides to youth and adolescents by providing them with a safe space, to share their experiences and voice their opinions.

Self-reported characteristics of an ideal CHW included: a strong work ethic, exceptional communication skills, and the ability to generate goodwill through intensive rapport-building efforts in communities. Many front line workers left feeling their own exposure to topics during training left them having not only gained knowledge but also triggering introspection and empowerment within them themselves.

Most CHWs reported having a positive and supportive environment at work and were well satisfied with provisions offered by the organization, including training, timely salaries, flexibility with schedules, as well as staff support and real time feedback.

As for challenges that arose within their work, CHWs expressed the need to juggle multiple responsibilities, thus risking being overstretched. Financial situations also posed a challenge, as did organizational factors.

Perhaps one of the most moving aspects of the study was the participants’ personal account on the changes they had witnessed within themselves, having been part of the organization. While their role was believed to be multifaceted to include serving as a teacher, confidant and guide to the beneficiaries, a significant element that emerged from their personal journey with the NGO was their own process of self-reflection. This manifested in an internalization of knowledge within participants such that through their evolving understanding of themes, empowerment emerged. Affection and respect for working with interacting with children arose as well, contributing to a positive learning environment. Participants also expressed an increase in topical knowledge; skill based competencies, as well as improvements in communication skills and self-confidence. Most importantly, participants saw themselves community resources persons, with one expressing the view of being a change agents, with the ability to empower people in the community.

 

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