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Hafez S, Munyati BM, Zeno K, Gbozee CKZ, Jusu M, Reeves MS, Wesseh CS, Wiah SO, AlKhaldi M, Johnson K, Subah M. Examining the gender imbalance in the National Community Health Assistant Programme in Liberia: a qualitative analysis of policy and Programme implementation. Health Policy Plan 2022; 38:181-191. [PMID: 36069652 PMCID: PMC9923372 DOI: 10.1093/heapol/czac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its programme implementation, the Liberian National Community Health Assistant Programme (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women. This study was designed to assess the gender responsiveness of the RNCHSP and its programme implementation in five counties across Liberia to identify opportunities to improve gender equity in the programme. Using qualitative methods, 16 semi-structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia's intention to prioritize women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the programme, unfavourable gender norms influenced women's nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women's nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its programme implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programme will likely increase the effectiveness of community healthcare services.
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Affiliation(s)
- Sali Hafez
- *Corresponding author. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, 9 Tavistock PI, London WC1H 9SH, United Kingdom. E-mail:
| | | | - Katie Zeno
- American University School of International Service, 4400 Massachusetts Avenue NW, Washington, DC 20016, United States
| | - Catherine K Z Gbozee
- Cuttington Graduate School of Professional Study and Health System Strengthening Unit, Last Mile Health Liberia, 77C6+984, Monrovia, Liberia
| | - Mbalu Jusu
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, 9 Tavistock PI, London WC1H 9SH, United Kingdom
| | - Mantue S Reeves
- Mekelle University and the Monitoring, Evaluation and Research Unit, Last Mile Health Liberia, 77C6+984, Monrovia, Liberia
| | - C Sanford Wesseh
- The Department of Health and Vital Statistics, the Ministry of Health, SKD Boulevard, Congo Town 1000, Monrovia, Liberia
| | - S Olasford Wiah
- Director, Community Health Services Division, the Ministry of Health, SKD Boulevard, Congo Town 1000, Monrovia, Liberia
| | - Mohammed AlKhaldi
- Faculty of Medicine, School of Physical and Occupational Therapy, Person-Centred Health Informatics Research-PCHI lab, McGill University, 3605 Rue de la Montagne, Montréal, QC H3G 2M1, Canada
| | - Kristin Johnson
- Department of Public Health, Boston University, Boston, MA 02215, United States
| | - Marion Subah
- Department of Nursing, Catholic University of America, United States and Country Director, Last Mile Health Liberia, 77C6+984, Monrovia, Liberia
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Khalid S, Dixon S, Vijayasingham L. The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows. Soc Sci Med 2021; 293:114665. [PMID: 34954676 DOI: 10.1016/j.socscimed.2021.114665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.
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Affiliation(s)
- Shazmin Khalid
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; School of Business, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Shrijna Dixon
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; Rockefeller College of Public Affairs and Policy, University at Albany- State University of New York 1400 Washington Ave, Albany, NY, 12222, USA
| | - Lavanya Vijayasingham
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia.
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