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

Abstract

BackgroundCommunity health workers (CHWs) are an important human resource in Uganda as they are the first contact of the population with the health system. Understanding gendered roles of CHWs is important in establishing how they influence their performance and relationships in communities. This paper explores the differential roles of male and female CHWs in rural Wakiso district, Uganda, using photovoice, an innovative community-based participatory research approach.MethodsWe trained ten CHWs (five males and five females) on key concepts about gender and photovoice. The CHWs took photographs for 5 months on their gender-related roles which were discussed in monthly meetings. The discussions from the meetings were recorded, transcribed, and translated to English, and emerging data were analysed using content analysis in Atlas ti version 6.0.15.ResultsAlthough responsibilities were the same for both male and female CHWs, they reported that in practice, CHWs were predominantly involved in different types of work depending on their gender. Social norms led to men being more comfortable seeking care from male CHWs and females turning to female CHWs. Due to their privileged ownership and access to motorcycles, male CHWs were noted to be able to assist patients faster with referrals to facilities during health emergencies, cover larger geographic distances during community mobilization activities, and take up supervisory responsibilities. Due to the gendered division of labour in communities, male CHWs were also observed to be more involved in manual work such as cleaning wells. The gendered division of labour also reinforced female caregiving roles related to child care, and also made female CHWs more available to address local problems.ConclusionsCHWs reflected both strategic and conformist gendered implications of their community work. The differing roles and perspectives about the nature of male and female CHWs while performing their roles should be considered while designing and implementing CHW programmes, without further retrenching gender inequalities or norms.

Ethical practice in my work: community health workers’ perspectives using photovoice in Wakiso district, Uganda

“…Indeed, by the end of the fifth monthly meeting, no new emerging issues were emanating from the photos taken by participants and ensuing discussion. This paper focuses on the findings on ethical concerns as other results emerging from the study have been published separately [18].…”

“…This included routine visits to the field by the research team to assess progress of the participants and offer any necessary support. More details on the workshop and photography assignment can be found in our earlier paper [18].…”

“…Data analysis was carried out by DM and CS using conventional content analysis in Atlas ti version 6.0.15. During data analysis, codes arising from the data were identified which formed categories and then themes as noted in more detail elsewhere [18]. The major themes on ethical concerns from the analysis are presented in this paper as well as selected photographs and quotations from participants.…”

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

“…Furthermore, the gender, caste, HIV status and other attributes of CHWs can also shape the way they are received by various communities. [100][101][102] There is also evidence that when communities perceive CHWs to be affiliated with state actors whose interests differ from patients', they are less likely to be understood as boosting health system accountability to patients. In India, CHWs are incentivised to encourage women to deliver in facilities even though this may contradict the preferences of some patients.…”

“They have been neglected for a long time”: a qualitative study on the role and recognition of rural health motivators in the Shiselweni region, Eswatini

“…the presence of more men in the programme might address widespread notions that community health work is for women and deals with “women’s issues” only. However, careful attention must be paid to not further compound gender inequality [ 36 , 37 ].…”