Report on the Think-in on Community Health Worker Voice, Power, and Citizens’ Right to Health  

Date: January 2018
Authors: Marta Schaaf, Caitlin Warthin, Amy Manning, Stephanie Topp
Publication type: Learning Exchange Report
Published by: Accountability Research Center and Averting Maternal Death and Disability

Community health workers (CHWs) are increasingly put forward as a remedy for lack of health system capacity, including addressing challenges associated with low health service coverage and with low community engagement in the health system. CHWs are often explicitly mandated or implicitly expected to enhance or embody health system accountability to the populations they serve.

While definitions vary, CHWs are generally community-based workers who: are members of the communities where they work; are (at least in part) selected by the communities they serve; and are required to represent and/or deliver health services (WHO, 2007). CHWs are also commonly envisioned as being answerable to the community for their activities, and they often perform a linking function between communities and the health system (WHO, 2007).

In June of 2017, thirty researchers, health advocates, and program implementers from eight countries attended a two-day ‘think-in’ at American University. While many country experiences were discussed, the meeting focused in particular on the experiences of Brazil, India, South Africa, and the United States. These countries were selected because, with the exception of the United States, they have large, scaled-up CHW programs where there have been at least some instances of CHWs facilitating—or demanding—greater health system accountability.

Marta Schaaf

Marta is the Deputy Director of the Averting Maternal Death and Disability (AMDD) Program at the Mailman School of Public Health, Columbia University. She works on the “Accountability on the Frontlines” project developing program research and implementation to promote accountability for health programs. Marta has conducted research and policy analysis and implemented programs on minority health, health and social exclusion, tuberculosis, and health systems for the World Lung Foundation, HealthRight, the Open Society Foundation, and the WHO. Marta has lived in Burkina Faso, Kosovo, and Macedonia. She has a Masters in International Affairs and an MPH from Columbia University, and a BA from Smith College. She is currently pursuing a doctorate in public health at Columbia University.

Caitlin Warthin

Caitlin is a Program Officer at the AMDD Program at the Mailman School of Public Health, Columbia University. Her work focuses on measuring and improving the availability and quality of maternal health care. She also contributes to AMDD’s work on accountability in health systems and emergency obstetric care (EmOC). Caitlin previously worked in monitoring and evaluation for reproductive health programs in the Philippines and global EmOC programming for USAID. She holds an MPH in Population and Family Health from Columbia University and a BA in Economics from Williams College.

Amy Manning

Amy is the Program Assistant of the AMDD Program at the Mailman School of Public Health, Columbia University. She provides support including desk research, report writing, and communications across all of AMDD’s research projects. Amy graduated from American University in 2015 with a Bachelor’s degree in International Studies. Prior to joining AMDD, she interned with the German Marshall Fund of the United States, the Wilson Center, and the U.S. Department of State.

Stephanie Topp

Stephanie has a background in politics, sociology and medical anthropology. She is a Senior Lecturer at James Cook University, Australia. Steph’s research interests include health policy analysis and exploration of the way social accountability and trust shape primary health service delivery and uptake. Steph has worked in Zambia, South Africa, India and Papua New Guinea. She was lead investigator on a four-year program to strengthen the Zambian prison health system and is a member of the Partners for Tropical Health consortia building health systems research capacity in a cluster of Pacific Island countries. Steph is an Associate Editor for the journal BMJ Global Health. She has a PhD from the University of Melbourne, a Masters in Development Studies from Oxford University and a Masters in International Public Health from the University of Sydney.

Community Health Worker Voice, Power, and Citizens’ Right to Health: Meeting Brief for “Think-In” to Develop a Research Agenda

Caitlin Warthin, Amy Manning and Marta Schaaf

This brief is intended to provide background to participants of the meeting on Community Health Worker Voice, Power, and Citizen’s Right to Health. The guiding questions for the meeting are as follows: What factors promote or undermine community health workers as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? The text below provides a basic overview on community health workers and accountability, as well as a non-exhaustive discussion of some of the kinds of issues that will likely arise during the meeting.
Read more

“Lackeys or liberators” revisited: Community health workers and health system accountability

June 2017

Kerry Scott, Stephanie Topp and Marta Schaaf

International Health Policies

Earlier this week, a group of 30 researchers, program implementers, and activists met in Washington, DC, to develop a research agenda on “community health worker voice, power, and citizens’ right to health.” The meeting was convened by Columbia University’s Averting Maternal Death and Disability Program and American University’s Accountability Research Centre. Participants drew from social accountability theory and CHW experiences in India, South Africa, Brazil, Guatemala, Pakistan, Ethiopia, Malawi, Peru, and the USA to explore the factors that can promote or undermine community health workers’ ability and interest in fostering health system accountability to the community.
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Community health workers and accountability: reflections from an international “think-in”

May 2018

Marta Schaaf, Jonathan Fox, Stephanie M. Topp, Caitlin Warthin, Lynn P. Freedman, Rachel Sullivan Robinson, Sundararaman Thiagarajan, Kerry Scott, Thoko Maboe, Margareth Zanchetta, Ana Lorena Ruano, Maryse Kok and Svea Closser

International Journal for Equity in Health

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.

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“We are everything to everyone”: a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system

May 2018

Stephanie M. Topp, Alexandra Edelman and Sean Taylor

International Journal for Equity in Health

Health policy in Australia positions Aboriginal and Torres Strait Islander Health Workers (AHWs) as central to improving Aboriginal and Torres Strait Islander peoples’ health, with high expectations of their contribution to closing the gap between Indigenous and non-Indigenous health outcomes. Understanding how AHWs’ governance and accountability relationships influence their ability to address such health inequities has policy, programme and ethical significance. We sought to map the evidence of AHWs’ experiences of accountability in the Australian health system.

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