Equally able, but unequally accepted: Gender differentials and experiences of community health volunteers promoting maternal, newborn, and child health in Morogoro Region, Tanzania

Abstract

BackgroundDespite emerging qualitative evidence of gendered community health worker (CHW) experience, few quantitative studies examine CHW gender differentials. The launch of a maternal, newborn, and child health (MNCH) CHW cadre in Morogoro Region, Tanzania enlisting both males and females as CHWs, provides an opportunity to examine potential gender differences in CHW knowledge, health promotion activities and client acceptability.MethodsAll CHWs who received training from the Integrated MNCH Program between December 2012 and July 2013 in five districts were surveyed and information on health promotion activities undertaken drawn from their registers. CHW socio-demographic characteristics, knowledge, and health promotion activities were analyzed through bi- and multivariate analyses. Composite scores generated across ten knowledge domains were used in ordered logistic regression models to estimate relationships between knowledge scores and predictor variables. Thematic analysis was also undertaken on 60 purposively sampled semi-structured interviews with CHWs, their supervisors, community leaders, and health committee members in 12 villages from three districts.ResultsOf all CHWs trained, 97 % were interviewed (n = 228): 55 % male and 45 % female. No significant differences were observed in knowledge by gender after controlling for age, education, date of training, marital status, and assets. Differences in number of home visits and community health education meetings were also not significant by gender. With regards to acceptability, women were more likely to disclose pregnancies earlier to female CHWs, than male CHWs. Men were more comfortable discussing sexual and reproductive concerns with male, than female CHWs. In some cases, CHW home visits were viewed as potentially being for ulterior or adulterous motives, so trust by families had to be built. Respondents reported that working as female–male pairs helped to address some of these dynamics.ConclusionsMale and female CHWs in this study have largely similar knowledge and health promotion outputs, but challenges in acceptance of CHW counseling for reproductive health and home visits by unaccompanied CHWs varied by gender. Programs that pair male and female CHWs may potentially overcome gender issues in CHW acceptance, especially if they change gender norms rather than solely accommodate gender preferences.

Reflecting strategic and conforming gendered experiences of community health workers using photovoice in rural Wakiso district, Uganda

“…From our exploratory study, CHWs felt that community members are generally more likely to consult a CHW of the same gender concerning health issues. This finding is understandable as a CHW of the same gender as a community member would not only use their expert knowledge on the issue of concern while attending to them but also their personal experiences, as shown in other settings [ 14 ]. It has also been shown even among health professionals that patients many times prefer to see those of the same gender as them [ 22 – 24 ].…”

“…On the other hand, male CHWs usually have household support, receive recognition for their work, and are more respected [ 6 ]. While performance of CHWs in undertaking maternal and newborn work is not necessarily different by gender, community norms can make male and female CHWs differentially accepted [ 14 ]. Although recognition of gendered experiences of CHWs is emerging [ 7 ], very little is known about CHWs’ perspectives of such experiences using community-based participatory research methodologies such as photovoice.…”

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

“…The findings thus suggest a need for gendered SMAG roles [ 45 ] and male-female task sharing functions if MNH services are to be optimised for marginalised women in remote and hard-to-reach areas. Feldhaus et al argued that pairing male and female SMAGs may potentially address and accommodate gender preferences among SMAGs for pregnancy-related issues [ 46 ]. All in all, these findings highlight the interrelationships between the contextual factors and the implementation processes of the intervention.…”

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study

“…Because of this the male volunteers were replaced by female volunteers or FCHVs, who are married and are mothers. Female service users often find it easier to discuss their pregnancies and childbirth with female volunteers as shown by Feldhaus et al [ 19 ]. In addition to the unpaid FCHVs, there are paid CHWs who work full-time and can be male (village health workers) and female (maternal and child health workers), but FCHVs are the key PHC providers in villages.…”