Does volunteer community health work empower women? Evidence from Ethiopia’s Women’s Development Army

Abstract

Of the millions of Community Health Workers (CHWs) serving their communities across the world, there are approximately twice as many female CHWs as there are male. Hiring women has in many cases become an ethical expectation, in part because working as a CHW is often seen as empowering the CHW herself to enact positive change in her community. This article draws on interviews, participant observation, document review and a survey carried out in rural Amhara, Ethiopia from 2013 to 2016 to explore discourses and experiences of empowerment among unpaid female CHWs in Ethiopia’s Women’s Development Army (WDA). This programme was designed to encourage women to leave the house and gain decision-making power vis-à-vis their husbands—and to use this power to achieve specific, state-mandated, domestically centred goals. Some women discovered new opportunities for mobility and self-actualization through this work, and some made positive contributions to the health system. At the same time, by design, women in the WDA had limited ability to exercise political power or gain authority within the structures that employed them, and they were taken away from tending to their individual work demands without compensation. The official rhetoric of the WDA—that women’s empowerment can happen by rearranging village-level social relations, without offering poor women opportunities like paid employment, job advancement or the ability to shape government policy—allowed the Ethiopian government and its donors to pursue ‘empowerment’ without investments in pay for lower-level health workers, or fundamental freedoms introduced into state-society relations.

Gender Equity and Norms in Health Programs: Learnings from a Drowning Reduction Program in Bangladesh

“…Equal access to employment for women has health bene ts for all genders. Earning women are able to e ciently access resources such as medicines without depending on others, and men may experience a reduction in stress and take on less risky work if they are not the sole breadwinner (11,18,33,34). The SwimSafe program is already moving towards improving the health of families by providing employment to local women.…”

“…Because community health workers are primarily women, institutions are more likely to manage these workers less formally because gender roles allow them to. Women are also more likely to accept this situation given that formal work is not considered a woman's primary role (8,11,44). In many contexts globally, men working the same roles have not accepted the pay and type of roles that women have accepted (11).…”

“…Women are also more likely to accept this situation given that formal work is not considered a woman's primary role (8,11,44). In many contexts globally, men working the same roles have not accepted the pay and type of roles that women have accepted (11). Similarly, in SwimSafe, men CSIs were less satis ed with the hours and pay as it was below what they may earn elsewhere.…”

“…Similarly, in SwimSafe, men CSIs were less satis ed with the hours and pay as it was below what they may earn elsewhere. The program should consider strategies to reduce rather than reinforce these beliefs around the standards to which men and women are remunerated and treated in the workplace, such as ensuring market-rate pay that men would also be satis ed with and ndings avenues for career growth (11).…”

“…Community-based health programs often employ women, engage a wide range of stakeholders, and build close relationships with communities, and are able to in uence gendered attitudes and norms relating to employment and mobility. These in turn affect health outcomes of individuals (8)(9)(10)(11).…”