Close-to-community providers addressing gender norms and power dynamics: participatory action research in fragile and shock-prone settings

Partners: Liverpool School of Tropical Medicine, UK, American University of Beirut, Lebanon and HERD International, Nepal

The health workforce is a key component of the health system that underpins Universal Health Coverage efforts. Most countries in the global south, and particularly fragile and shock-prone contexts, have a shortage of formal health workers and increasingly look to a range of close-to-community (CTC) providers to fill this gap. CTC providers are health workers, eg Community Health Workers and traditional birth attendants, who carry out promotional, preventive and/or curative health services and who are the first point of contact at the community level, based in the community or in a basic primary facility.

This study has built on previous ReBUILD for Resilience research, bringing together CTC health care providers to address two interrelated issues that clearly emerged during that formative research: 1) challenging gender norms and navigating power dynamics within their communities and 2) gender and power issues experienced by CTC health care providers themselves such as supervision, support, and juggling multiple responsibilities. Participatory action research was used to support CTC providers to address gender norms and power relations within their communities and in the health systems, focusing on Lebanon and Nepal. Working closely with CTC providers, this study co-developed low-cost interventions that can support them in addressing these harmful gender norms.

Research objectives

The specific research objectives were:

1. To identify and prioritise the gender norms and power dynamics within communities and health systems that affect the work of CTC providers and undermine their agency
2. To identify areas for action on issues related to gender norms and power dynamics that would benefit CTC providers
3. To co-create new and or adapt existing strategies with CTC providers to mitigate issues related to gender norms and implement these within the communities and the health system
4. To document and evaluate the implementation of these strategies and understand how effective they are
5. To synthesise learning across countries about how CTC providers can address the harmful gender norms and power dynamics that affect their work and undermine their agency

Outputs from this study

Lebanon

• Film: ‘Health Workers’
• Case study: Empowering women in healthcare: A community-led initiative for resilience and integration
• Poster: Empowering Female Syrian Refugee Health Workers in Navigating Multiple Vulnerabilities – presented at Health Systems Global 2024
• Blog post: Interview with a member of Beqaa’s Working Women group
• Blog post: Women, mothers, wives, refugees, health workers, activists: the roles of close-to-community health workers in Lebanon
• Blog post: “Together we do!” Establishing a female CTC providers’ support group
• Blog post: Women in turmoil: empowerment as a solution to inequity
• Follow-on study: This second participatory action research study seeks to inform and oversee the development and implementation of an advocacy plan for the Working Women group formed during this study.

Nepal

• Film: A Story of Female Community Health Volunteers in Nepal
• Presentation: A video presentation on the impact of the FCHV film
• Blog post: A rollercoaster ride of film making for female community health volunteers

Project-wide

• Case study: How this research is impacting on policy and practice
• Poster: Using participatory research to address gender norms of female close-to-community health providers in Lebanon & Nepal – read it here

Image: Female Community Health Volunteers in Satungal village in western Kathmandu. Public Services International via Flickr [opens new tab]