Gender and Community Health Worker programmes in fragile and conflict-affected settings. Findings from Sierra Leone, the Democratic Republic of Congo and Liberia
Community health workers (CHWs) extend services to the community and are often relied on in fragile and conflict-affected settings where there is a shortage of formal health workers.While some CHW policies and programmes have an explicit commitment to gender equality this may not have a significant impact at the community level.
Efforts to treat men and women equally may fail to take account of the fact that gender influences male and female CHWs’ ability to perform their role because of the influence of gender norms at programme, community and household level. Policies that appear progressive, or at least aim to do no harm, may not be as neutral as is first perceived.
CHWs work within the same gender norms and power relations that influence the households, communities and societies they serve. Harmful gender norms shape vulnerability to ill health and impact on health seeking behaviour and access to health services in negative ways. Conflict, fragility and disease outbreaks such as Ebola can create and exacerbate gendered vulnerabilities and effect households in profound ways. These norms can be internalised and reproduced within the health system leading to inefficiencies and inequities in the way that services function. Because of these norms, and related power relations, CHW programmes can inadvertently deliver a service which reinforces rather than challenges gender inequity and is less efficient as a result. However, CHWs are well placed to understand gender norms and act to counter them.
This brief provides recommendations and guidance for practitioners and policy makers who have responsibility for CHW programmes. It suggests some ways that their workforce may be affected by gender norms and recommends what actions can betaken to address them.