The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh

Abstract

Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the trial, to aid future recruitment, training and retention of CHWs. Nine focus groups and 18 in-depth interviews were conducted with CHWs. Focus groups and interviews were transcribed and thematic content analysis performed to summarize the results. All CHWs described experiencing positive working conditions and many benefits both socially and financially; these contributed to their retention and job satisfaction. Their honorarium was commonly applied towards their children’s education and invested for income generation. CHWs gained self-confidence as women, to move unaccompanied in the community and speak in public. They earned respect from the community and their family members who helped them manage their family obligations during work and were viewed as a resource for advice on health and social issues. Many participated in family decision-making from which they were previously excluded. Health programs should foster a positive experience among their CHWs to aid the recruitment, retention and development of this important human resource.

Household choices of sanitation infrastructure and impact on disease in India

“…Mere availability or access to a sanitation facility does not lead to better hygienic practices and reduced incidence of diseases. A strong push towards using the toilets through behavioural interventions is necessary (Rahman et al, 2021). The policymakers can expand the survey instrument coverage to track the behavioural aspects in addition to the physical infrastructure status to get a higher-order understanding of the challenges and accordingly configure more targeted interventions (Park et al, 2016).…”

“…The problem is far more precarious in rural areas (WHO/ UNICEF, 2015). For improved sanitation outcomes, the provision of infrastructure and behavioural practices need to be complemented, as noted in initiatives in Bangladesh (Rahman et al, 2021) and Jakarta (Sidabutar and Chotib, 2021).…”

Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda

“…The idea is that these incentives on products, coupled with small financial incentives to encourage timely services, would not only move households down the demand curve but also motivate community health promoters to actively provide basic health services to mothers, newborn, and children. 1 Thus, the CHPs operated as micro-entrepreneurs with financial incentives to meet household demand and improve child health.…”