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