Research for stronger health systems during and after crisis

Community Health Workers and Gender

Posted on Tuesday, 17 Jul 2018

A reflection on gender issues across programmes in Liberia, Sierra Leone and Democratic Republic of Congo

By Georgina Zawolo (below, fourth from the right), University of Liberia Pacific Institute for Research and Evaluation, Liberia

The findings of the ReBUILD Community Health Worker (CHW) project from three fragile and conflict-affected African countries were shared and discussed at a one-day dissemination meeting in Freetown, Sierra Leone recently. The ReBUILD research, led by Joanna Raven (below, second left) from Liverpool School of Tropical Medicine (in collaboration with RinGs), used a gender lens to try to identify how CHW cadres in Liberia, Sierra Leone and the Democratic Republic of Congo can be better supported to play an effective and long-term role in broader health systems in fragile contexts. During each country’s presentation sensitive issues surrounding gender surfaced and are reflected on here.

 Row of smiling Africa and European men and women


Country presentations

The presenter from College of Medicine and Allied Health Sciences in Sierra Leone, Haja Wurie (below), described how social cultural norms and the potential earning power presented by the new CHW policy meant that men came forward to become community health worker while women were influenced by gender norms, eg they had to care for their homes, some were shy, while others had to obtain approval from their husbands. Also, men in Sierra Leone are more literate then women, and so reading and writing CHW reports posed challenges for some women. Another issue for some women was the amount of time required by CHW duties and how they balanced this with their other duties.

The Liberian presenter, Gartee E Nallo (above, fifth from right) from University of Liberia Pacific Institute for Research and Evaluation, emphasised the roles of CHWs in health promotion, health campaigns, and in the treatment of illnesses in children aged under five. As in Sierra Leone, most females find it difficult to travel long distances and are unable ride a motor bike.  Community preferences also play a role here and women were uncomfortable to explain their health problems to a male.

An African woman with a red top talking in front og an image of an African village

In the Democratic Republic of Congo, the CHW situation is slightly different to that of Liberia and Sierra Leone. According to Amuda Baba (above, far left) of Institut Panafricain de Santé Communautaire et Medecine Tropicale, there are more women working as CHWs but they still need to obtain consent from their husbands. When it comes to community development, women are fully engaged. He demonstrated this through images showing women CHWs themselves transforming dirt into bricks to build a new maternity centre.  

There are some similarities across the three countries; more men than women are literate and this, as well as  gender norms, shapes selection. There are also some inspiring practices here, eg in Grand Bassa county in Liberia the community level adult literacy programme has given women the confidence to put themselves forward as CHWs or community health assistants.

 Four smiling African men and women

Community health workers from Sierra Leone - (left to right) Dauda Rogers (Bonthe district), Hawa Kamara (Kenema district), Mohamed Koroma (Kenema district) & Bernadette Thomas (Bonthe district)

Lessons learnt

My learning from the meeting, and from being part of the research in Liberia, is on the importance of gender when researching human resources for health, not just with CHWs but at all levels of the health system.

In terms of methods and approaches, I was really interested in the photovoice approach because the photos provided a really clear overview of CHWs’ own experiences at the community level. We really saw through their eyes.  Strategies to encourage both women and men to become CHWs and be supported by the health system are important.

There’s more on ReBUILD’s CHW research here, and check out some of the tweets from the session.