Empowering refugee close-to-community healthcare providers through advocacy networks

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

The research team plans to employ Participatory Action Research (PAR) to inform and oversee the development and implementation of a sound and realistic advocacy plan aimed at fostering social change and empowering marginalized female Syrian, refugee health workers in Lebanon. This will involve several stakeholders, including the Working Women support group’s executive committee and general assembly, two NGO partners, and external stakeholders, through the following action points.

• Amplifying the voices of workers: Ensure that marginalized health workers are heard, striving for systemic changes that protect their rights and improve their working conditions.
• Raising awareness: Educate the public, policymakers, and employers about the unique challenges faced by refugee women health workers, including discrimination and a lack of access to resources.
• Influencing policy change: Lobby for laws and regulations that safeguard the rights of health workers, emphasizing fair wages, job security, and safe working environments. To strengthen this effort, we will identify key local stakeholders, utilize evidence-based advocacy, develop targeted campaigns, engage in public forums, hold direct meetings with policymakers and administrators of the health facilities employing informal workers, and build coalitions with other advocacy groups.
• Empowerment: Provide resources and training to help female close-to-community providers understand their rights and navigate the healthcare system effectively.
• Building alliances: Collaborate with other organizations and groups focused on human rights and women’s empowerment to strengthen advocacy efforts.
• Enhancing internal dynamics: Study and implement strategies to boost the internal dynamics of the group by fostering inclusion, transparency, and commitment. This will involve promoting social activism principles within the group to cultivate a supportive environment where members feel empowered to participate actively in advocacy efforts.

Background to the study

In 2022, the American University of Beirut team, in collaboration with ReBUILD for Resilience, conducted qualitative research on the gendered experiences of Syrian, refugee, close-to-community healthcare providers (more on that study here). It showed that during the COVID-19 pandemic, the demand for qualified health workers in Lebanon increased markedly, and the regions with large proportions of Syrian refugees saw a substantial increase in refugee health workers, especially women, entering the informal healthcare market. This phenomenon was vital in maintaining healthcare access and resilience, with the workers shouldering a significant portion of healthcare delivery during challenging times. It simultaneously created a large community of qualified but marginalized and underpaid health workers, subject to an array of challenges related to the intersection of gender, legal status, informal working, and social norms. Those challenges included legal barriers, insecurity, low wages, challenging use of public transport, economic pressures, the dual burden of domestic and professional responsibilities, and social exclusion (see Yamout et al., 2024). These in turn undermined the workers’ ability to maintain healthcare provision.

To address these issues, a follow-on PAR study worked with a smaller group of women to identify and prioritise challenges and critical leverage points, and to co-develop interventions to alleviate the difficulties experienced by the women (more on that follow-on study here). Again, PAR revealed that the women faced multiple layers of vulnerability stemming from their identities as women, mothers, refugees, and informal workers, often resulting in exploitation, marginalization, a lack of recognition, distress, diminished motivation, and a desire to seek better opportunities elsewhere.

The discussions resulted in the establishment of the Working Women support group, which serves as a crucial platform for female, Syrian, informal, close-to-community healthcare providers to address their collective challenges and vulnerabilities. Subsequent workshops, reflective meetings, and focus group discussions have informed future advocacy strategies and established a robust foundation for continued co-design, offering valuable insights into how such co-designed interventions can improve the work and life conditions of marginalised groups of health workers.

In this study, PAR will again be used, this time to help document and analyse the process through which Working Women members co-create, implement, and refine advocacy strategies. Working Women will collaborate with two local NGOs (Women Now and Multi Aid Programs (MAPS)) to acquire mentorship and support to implement a large-scale advocacy campaign. It aims to promote the rights of informal health workers and negotiate for the rights of informally-employed health workers, amplifying their voices, raising community awareness about the challenges they face, and influencing policies and practices to improve their freedom and well-being.

Research questions and objectives

The primary research question guiding this study is: How do grassroots advocacy strategies empower female Syrian refugee close-to-community healthcare providers to improve their rights and working conditions?

This investigation encompasses two critical dimensions:

1. Activism and advocacy: Examining how the involvement of marginalized close-to-community healthcare providers in social activities can reshape advocacy structures within healthcare systems, promoting a rights-based approach that leads to tangible improvements in their working conditions and strengthening the resilience of local healthcare systems by addressing community-level issues.
2. Gender dynamics and community engagement: Exploring the importance of gender dynamics and coping mechanisms, and uncovering how women’s empowerment through community engagement can be leveraged to sustain meaningful advocacy efforts.

Specific objectives:

1. Explore the perceptions and insights of Working Women members, employers, health stakeholders, and local authorities regarding the working conditions of Syrian close-to-community healthcare providers, their rights, and possible solutions for just and inclusive health system.
2. Identify the themes, principles, and values of the advocacy campaign through PAR, drawing inspiration from the specific challenges faced by the women while adhering to the principles of gender equity and justice, and ensuring respect without resorting to accusations or bullying towards the host community.
3. Co-develop advocacy strategies and tools that empower marginalized women close-to-community healthcare providers and enhance their capacities to promote their rights within health systems.
4. Monitor collaborations with other organizations to create a robust advocacy effort on behalf of marginalized healthcare workers.
5. Observe the internal group dynamics and their relations to the attainment of goals

Further information

• Details and outputs from the original study – The gendered experience of close-to-community providers in fragile and shock-prone settings: implications for policy and practice during and post COVID-19 – can be found here
• More on the follow-on study which led to the formation of Working Women can be found here
• A short film about the women’s lives – Health Workers – can be watched here

Image: The ladies of the Working Women group, staff from the Women Now centre and AUB and LSTM staff