For Love of Money: Rewards of Care for India’s Women Community Health Workers

2021 ◽  
Author(s):  
Vrinda Marwah
Keyword(s):  
Community Health ◽  
Health Workers ◽  
Care Work ◽  
Extrinsic Rewards ◽  
Private Hospitals ◽  
Community Health Volunteers ◽  
Ethnographic Fieldwork ◽  
Frontline Health Workers ◽  
Love Of Money ◽  
Skill Building

Abstract What are the rewards of paid care work for frontline health workers? I focus on India’s women community health volunteers, the largest such workforce in the world. Appointed since 2007 and numbering one million, these women are paid per-case incentives to connect the poor and marginalized to government-run health services. Using 14 months of ethnographic fieldwork in Delhi and Punjab, including 80 interviews, I find that women community health volunteers (called Accredited Social Health Activists or ASHAs) experience extrinsic rewards in paid care work. ASHAs earn not only from their official wages, but also from two unofficial streams: a) a boost of income from non-ASHA work and b) commissions from private hospitals. I also find that the intrinsic rewards ASHAs report—emotional gratification, relative autonomy, and skill-building—are co-constituted with extrinsic rewards; that is, they are tied to their earnings. This calls into question the “Love versus Money” binary, used to frame much of the discussion on care work. I argue instead for a “Love of Money” framing—that is, money as a reward and money as begetting other rewards. My findings highlight the significance of globalizing the empirical research on paid care work.

scholarly journals Intimate Labor at Biomedical Frontlines: Situated Knowledges of Female Community Health Workers in the Management of COVID-19 in India

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sanghamitra Das ◽  
Samhita Das
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Medical Knowledge ◽  
Healthcare Services ◽  
Care Work ◽  
Professional Status ◽  
Public Healthcare ◽  
The Public ◽  
Female Community

Media reports of the COVID-19 pandemic in India have highlighted the important role that India’s female community health workers, the Accredited Social Health Activists (ASHAs), have played in managing COVID infections in India. This paper explores the epistemic basis of ASHA work to understand the significance of their role. Through a discourse analysis of textual media articles, we show that the ASHAs’ routine and COVID-related caregiving practices are a form of embodied, intimate labor rooted in their situated, community-oriented knowledge. This labor is devalued as emotional and feminized care work, which denies the ASHAs professional status in the public healthcare system of India and, in turn, reflects a hierarchy among health practitioners that stems from the status of objectivity/disembodiment in biomedicine. We find that, despite their low status in the public health system, ASHA workers develop a self-concept that enables them to self-identify as healthcare professionals, motivating them to continue providing essential healthcare services during the pandemic. We argue that an official recognition of the epistemic value of ASHA work would help to overcome the age-old nature/culture dichotomy that informs what counts as valuable, legitimate, formal medical knowledge. Furthermore, our analysis provides a critique of the gendered devaluation of care work within a political economy of health increasingly dictated by a neoliberal logic.

scholarly journals Working towards universal health coverage: a qualitative study to identify strategies for improving student enrolment for the pre-service training of nurses, midwives and community health workers in Nigerian health training institutions

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ekechi Okereke ◽  
Babatunde Ahonsi
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Health Coverage ◽  
Health Training ◽  
Frontline Health Workers ◽  
Service Training ◽  
Student Enrolment ◽  
Training Institutions ◽  
Training Programmes

Abstract Background Student enrolment processes and practices can affect the quality of pre-service training programmes. These processes and practices may have serious implications for the quality and quantity of students within health training institutions, the quality of education for prospective health workers and consequently health workforce performance. This study assessed current student enrolment processes and practices for nurses, midwives and community health workers within health training institutions in two Nigerian states, so as to identify strategies for improving student enrolment for these key cadres of frontline health workers. Methods This study was carried out in Bauchi and Cross-River States, which are the two Human Resources for Health (HRH) project focal states in Nigeria. Utilizing a qualitative research design, 55 in-depth interviews and 13 focus group discussions were conducted with key stakeholders including students and tutors from pre-service health training institutions as well as policy-makers and public sector decision-makers from Ministries of Health, Government Agencies and Regulatory Bodies. Study participants were purposively sampled and the qualitative data were audio-recorded, transcribed and then thematically analysed. Results Study participants broadly described the application process to include the purchase, completion and submission of application forms by prospective students prior to participation in entrance examinations and oral interviews. The use of ‘weeding examinations’ during the student enrolment process, especially in Bauchi state, was identified as a useful quality assurance mechanism for the pre-service training programmes of frontline health workers. Other strategies identified by stakeholders to address challenges with student enrolment include sustained advocacy to counter-cultural norms and gender stereotypes vis-à-vis certain professions, provision of scholarships for trainee frontline health workers and ultimately the development as well as effective implementation of national and state-specific policy and implementation guidelines for the student enrolment of key frontline health workers. Conclusion While there are challenges which currently affect student enrolment for nurses, midwives and community health workers in Nigeria, this study has proposed key strategies which if carefully considered and implemented can substantially improve the status quo. These will probably have far-reaching implications for improving health workforce performance, population health outcomes and efforts to achieve universal health coverage.

scholarly journals Feasibility and acceptability of computer based online certifcation program for frontline community health workers of Wardha district, India

2017 ◽  
Vol 8 (2) ◽  
pp. 82-85
Author(s):  
Manoj S Patil ◽  
Abhay M Gaidhane ◽  
Shital Telrandhe ◽  
Quazi Syed Zahiruddin ◽  
Navnita Jadhav
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Community Outreach ◽  
Medical Sciences ◽  
Frontline Workers ◽  
Frontline Health Workers ◽  
Computer Based ◽  
Health Experts ◽  
Strong Agreement

Background: In India, different types of Frontline Community Health Workers are recruited under different departments and health programmes. These include Anganwadi Workers (AWW) under ICDS, ASHA and ANMs under NRHM and health services. Training and recruitment of this staff cadre is an ongoing process. Most of the trainings are aimed at improving the knowledge and skills. A set of test is needed to assess the post training knowledge of trainees which should be feasible, acceptable and easy to administer. Team of Health Experts from DMIMSU, Wardha has developed such specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted to assess the feasibility and acceptability of these tests.Aims and Objectives: Team of Health Experts from DMIMSU,Wardha has developed specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted -1] To assess the feasibility and acceptability of Computer based online certifcation tests for frontline workers. 2] To assess the scope for generalization of these tests to entire frontline health cadre of the district.Materials and Methods: Data was collected from 30 randomly selected Frontline Health Workers who were engaged in Community Outreach Activities/Projects of DMIMS and had undergone trainings and Online Certifcation tests. Questionnaire with Likert type scoring scale was administered. Data was compiled in MS Excel and Weighted Means and proportions of responses towards agreement and disagreement were calculated.Results: Average Weighted Mean was 4.07 showing Strong Agreement towards the feasibility and acceptability. Only 10.3% participants showed disagreement towards the feasibility and acceptability of this test whereas 89.7% participants showed agreement and among them, 47.67% showed strong agreement towards the feasibility and acceptability of this test.Conclusion: These tests were found quite feasible and well accepted by Frontline Health Workers. Similar tests should be made compulsory for all Frontline Health Workers Cadre and their performance in tests should be linked to provisions of incentives and seniority benefits.Asian Journal of Medical Sciences Vol.8(2) 2017 82-85 

scholarly journals Challenges and prospects for implementation of community health volunteers’ digital health solutions in Kenya: a qualitative study

2020 ◽  
Author(s):  
Pauline Bakibinga ◽  
Eva Kamande ◽  
Lyagamula Kisia ◽  
Milka Omuya ◽  
Dennis J Matanda ◽  
...  
Keyword(s):  
Health Care ◽  
Community Health ◽  
Information And Communication Technologies ◽  
Health Workers ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Health Technologies ◽  
Community Health Volunteers ◽  
Barriers To Use ◽  
Health Managers

Abstract Background: The value of digital health technologies in delivering vital health care interventions, especially in low resource settings is increasingly appreciated. We co-developed and tested a decision support mobile health (m-Health) application (app);with some of the forms used by Community Health Volunteers (CHVs) in Kenya to collect data and connected to health facilities. This paper explores the experiences of CHVs, health workers and members of Sub-County Health Management Teams following implementation of the project.Methods: Data were collected in December 2017 through in-depth interviews and focus group discussions with CHVs and key informant interviews with health care workers and health managers in Kamukunji sub-County of Nairobi, Kenya. Data coding and analysis was performed in NVivo 12.Results: Regarding users and health managers’ perceptions towards the system; three main themes were identified: 1) variations in use, 2) barriers to use and 3) recommendations to improve use. Health workers at the private facility and some CHVs used the system more than health workers at the public facilities. Four sub-themes under barriers to use were socio-political environment, attitudes and behaviour, issues related to the system and poor infrastructure. A prolonged health workers’ strike, the contentious presidential election in the year of implementation, interrupted electricity supply and lack of basic electric fixtures were major barriers to use. Suggestions to improve usage were: 1) integration of the system with others in use and making it available on users’ regular phones, and 2) explore sustainable motivation models to users as well as performance based remuneration. Conclusions: The findings reveal the importance of considering the readiness of information and communication technologies (ICT) users before rollout of ICT solutions. The political and sociocultural environment in which the innovation is to be implemented and integration of new solutions into existing ones is critical for success. As more healthcare delivery models are developed, harnessing the potential of digital technologies, strengthening health systems is critical as this provides the backbone on which such innovations draw support.

scholarly journals Adaptation and performance of a mobile application for early detection of cutaneous leishmaniasis

2021 ◽  
Vol 15 (2) ◽  
pp. e0008989
Author(s):  
Luisa Rubiano ◽  
Neal D. E. Alexander ◽  
Ruth Mabel Castillo ◽  
Álvaro José Martínez ◽  
Jonny Alejandro García Luna ◽  
...  
Keyword(s):  
Health Services ◽  
Community Health ◽  
Cutaneous Leishmaniasis ◽  
Mobile Application ◽  
Health Workers ◽  
Prediction Rule ◽  
Case Detection ◽  
Access To Health Services ◽  
Community Health Volunteers ◽  
Access To Health

Background Detection and management of neglected tropical diseases such as cutaneous leishmaniasis present unmet challenges stemming from their prevalence in remote, rural, resource constrained areas having limited access to health services. These challenges are frequently compounded by armed conflict or illicit extractive industries. The use of mobile health technologies has shown promise in such settings, yet data on outcomes in the field remain scarce. Methods We adapted a validated prediction rule for the presumptive diagnosis of CL to create a mobile application for use by community health volunteers. We used human-centered design practices and agile development for app iteration. We tested the application in three rural areas where cutaneous leishmaniasis is endemic and an urban setting where patients seek medical attention in the municipality of Tumaco, Colombia. The application was assessed for usability, sensitivity and inter-rater reliability (kappa) when used by community health volunteers (CHV), health workers and a general practitioner, study physician. Results The application was readily used and understood. Among 122 screened cases with cutaneous ulcers, sensitivity to detect parasitologically proven CL was >95%. The proportion of participants with parasitologically confirmed CL was high (88%), precluding evaluation of specificity, and driving a high level of crude agreement between the app and parasitological diagnosis. The chance-adjusted agreement (kappa) varied across the components of the risk score. Time to diagnosis was reduced significantly, from 8 to 4 weeks on average when CHV conducted active case detection using the application, compared to passive case detection by health facility-based personnel. Conclusions Translating a validated prediction rule to a mHealth technology has shown the potential to improve the capacity of community health workers and healthcare personnel to provide opportune care, and access to health services for underserved populations. These findings support the use of mHealth tools for NTD research and healthcare.

scholarly journals Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e045455
Author(s):  
Parveen K Parmar ◽  
Fatma Rawashdah ◽  
Nahla Al-Ali ◽  
Raeda Abu Al Rub ◽  
Muhammad Fawad ◽  
...  
Keyword(s):  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Communicable Disease ◽  
Blood Pressure Measurement ◽  
Syrian Refugees ◽  
Loop Analysis ◽  
Causal Loop ◽  
Community Health Volunteers ◽  
Management Of Complications

ObjectivesGlobally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies.Setting and participantsA participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan.Primary outcomeThis causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan.ResultsDuring the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring.ConclusionsCHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.

scholarly journals Challenges and prospects for implementation of community health volunteers’ digital health solutions in Kenya: a qualitative study

2020 ◽  
Author(s):  
Pauline Bakibinga ◽  
Eva Kamande ◽  
Lyagamula Kisia ◽  
Milka Omuya ◽  
Dennis J Matanda ◽  
...  
Keyword(s):  
Health Care ◽  
Community Health ◽  
Information And Communication Technologies ◽  
Health Workers ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Health Technologies ◽  
Community Health Volunteers ◽  
Barriers To Use ◽  
Health Managers

Abstract Background The value of digital health technologies in delivering vital health care interventions, especially in low resource settings is increasingly appreciated. We co-developed and tested a decision support mobile health (m-Health) application (app);with some of the forms used by Community Health Volunteers (CHVs) in Kenya to collect data and connected to health facilities. This paper explores the experiences of CHVs, health workers and members of Sub-County Health Management Teams following implementation of the project. Methods Data were collected in December 2017 through in-depth interviews and focus group discussions with CHVs and key informant interviews with health care workers and health managers in Kamukunji sub-County of Nairobi, Kenya. Data coding and analysis was performed in NVivo 12. Results Regarding users and health managers’ perceptions towards the system; three main themes were identified: 1) variations in use, 2) barriers to use and 3) recommendations to improve use. Health workers at the private facility and some CHVs used the system more than health workers at the public facilities. Four sub-themes under barriers to use were socio-political environment, attitudes and behaviour, issues related to the system and poor infrastructure. A prolonged health workers’ strike, the contentious presidential election in the year of implementation, interrupted electricity supply and lack of basic electric fixtures were major barriers to use. Suggestions to improve usage were: 1) integration of the system with others in use and making it available on users’ regular phones, and 2) explore sustainable motivation models to users as well as performance based remuneration. Conclusions The findings reveal the importance of considering the readiness of information and communication technologies (ICT) users before rollout of ICT solutions. The political and sociocultural environment in which the innovation is to be implemented and integration of new solutions into existing ones is critical for success. As more healthcare delivery models are developed, harnessing the potential of digital technologies, strengthening health systems is critical as this provides the backbone on which such innovations draw support.

scholarly journals Challenges and prospects for implementation of community health volunteers’ digital health solutions in Kenya: a qualitative study

2020 ◽  
Author(s):  
Pauline Bakibinga ◽  
Eva Kamande ◽  
Lyagamula Kisia ◽  
Milka Omuya ◽  
Dennis J Matanda ◽  
...  
Keyword(s):  
Health Care ◽  
Community Health ◽  
Information And Communication Technologies ◽  
Health Workers ◽  
Digital Health ◽  
Mobile App ◽  
Health Technologies ◽  
Community Health Volunteers ◽  
Barriers To Use ◽  
Health Managers

Abstract Background: The value of digital health technologies in delivering vital health care interventions, especially in low resource settings is increasingly appreciated. We co-developed and tested a decision support mobile health (m-Health) application (app); an integrated data capture tool running as a mobile app with selected reporting forms for Community Health Volunteers (CHVs) in Kenya and connected to health facilities. This paper explores the experiences of CHVs, health workers and members of Sub-County Health Management Teams following implementation of the project.Methods: Data were collected in December 2017 through in-depth interviews and focus group discussions with CHVs, and key informant interviews with health care workers and health managers in Kamukunji sub-County of Nairobi, Kenya. Data coding and analysis was performed in NVivo 12.Results: Regarding users and health managers’ perceptions towards the system; three main themes were identified: 1) variations in use, 2) barriers to use and 3) recommendations to improve use. Health workers at the private facility and some CHVs used the system more than health workers at the public facilities. Four sub-themes under barriers to use were socio-political environment, attitudes and behaviour, issues related to the system and poor infrastructure. A prolonged health workers’ strike, the contentious presidential election in the year of implementation, interrupted electricity supply and lack of basic electric fixtures were major barriers to use. Suggestions to improve usage were: 1) integration of the system with others in use and making it available on users’ regular phones, and 2) explore sustainable motivation models to users as well as performance based remuneration. Conclusions: The findings reveal the importance of considering the readiness of information and communication technologies (ICT) users before rollout of ICT solutions. The political and sociocultural environment in which the innovation is to be implemented and integration of new solutions into existing ones is critical for success. As more healthcare delivery models are developed, harnessing the potential of digital technologies, strengthening health systems is critical as this provides the backbone on which such innovations draw support.

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