How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework

Bibliographic Data

ID14675841
AuthorsRosalind Steege (Liverpool School of Tropical Medicine, corresponding author), Miriam Taegtmeyer (0000-0002-5377-2536, Liverpool School of Tropical Medicine), Rosalind McCollum (0000-0003-4982-1734, Liverpool School of Tropical Medicine), Kate Hawkins (0000-0003-2915-1921, Spirent Communications (United Kingdom)), Hermen Ormel (0000-0003-1521-9462, Royal Tropical Institute), Maryse Kok (0000-0003-0889-8663, Royal Tropical Institute), Sabina Faiz Rashid (0000-0003-0916-2631, BRAC University), Sabina Rashid, Lilian Otiso (0000-0003-0164-154X, LVCT Health), Mohsin Sidat (0000-0002-8378-2014, Eduardo Mondlane University), Kingsley Chikaphupha (0000-0002-3534-3172, Research for Equity And Community Health Trust), Daniel G Datiko (0000-0002-8556-3069, REACH ETHIOPIA), R Ahmed (0000-0003-0381-4491, Liverpool School of Tropical Medicine), Rachel Tolhurst (0000-0002-3005-6641, Liverpool School of Tropical Medicine), Woedem Gomez (Liverpool School of Tropical Medicine), Sally Theobald (0000-0002-9053-211X, Liverpool School of Tropical Medicine)
Year2018
Volume209
Pages1-13
Publication date2018-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2018.05.002
PMID29777956
OpenAlexW2799999616
LanguageEN
Citations received37
References cited79

Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January-September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes

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