At least six million women—often in low- and middle-income countries—work for little or no pay in community health centers. Many work as community health workers (CHWs). But, although these are qualified tasks that should be paid, only 34 countries They register, train and offer salaries to CHWs.
Most of these workers are exploited, which reduces their effectiveness with patients. If we are serious about “health for all” being a global priority, this must change.
CHWs are essential to strengthen health systems on a national scale: it is proven that they improve maternal and child health services, expand access to family planning and support prevention and treatment of diseases, both infectious and non-communicable. If TSC were used for 30 vital health services in countries with the highest disease burdens, they could be saved 6.9 million lives per year and reduce infant mortality by almost half. Furthermore, the Covid-19 pandemic demonstrated that resilient community health programs can provide essential services, even in situations of great adversity.
But those programs will only reach their full potential if services are designed according to evidence-based best practices. That means treating CHWs as professionals who require training, fair compensation and safe working conditions. When used as a stopgap or source of cheap labor, CHWs are less effective than their well-resourced counterparts.
In Africa, up to 85% of community health workers are not paid, and globally a third of the time they do not have the essential medicines for their work.
In Africa, until 85% of the TSC does not charge, and in the world a third of the time They do not count with the essential medicines for your task. In our home country of Uganda, there is a shortage of health workers, so CHWs are the ones who have filled that gap. Although these workers provide vital services to their communities and perform many of the same tasks as their salaried supervisors, their compensation is often minimal or nonexistent.
Why are CHWs, who are often Black women, expected to work and save lives without being recognized or compensated? Clearly, this is also a gender rights issue. Patriarchal norms and power dynamics condition women to accept very low wages and even work without pay. For example, women from households with low incomes and educational levels often see this type of unpaid work as an opportunity to access paid jobs, or objects such as mobile phones or bicycles. Unpaid work in the health sector can also provide women with social recognition. In many contexts it is seen as honorable work and one that families find acceptable for women. Therefore, CHWs often juggle combining these positions with casual paid work and family responsibilities.
These women face an unenviable dilemma: If they leave their CHW job to seek full-time employment to support themselves, who will provide much-needed health care in their communities? Cornered by systemic inequalities and traditional gender roles, they often continue to push themselves, sacrificing their stability, economic security, career development and well-being in the process.
Clearly, this is also a gender rights issue. Patriarchal norms and power dynamics condition women to accept very low salaries and even work without pay
To redress this deep-rooted social and economic injustice, the professionalization of CHWs must be the norm rather than the exception. At a minimum, CHWs must be registered to ensure certain standards are met, paid competitive salaries, provided with ongoing training and support from designated supervisors; and integrate them into health systems (including primary health care facilities and broader monitoring and evaluation systems). In this way they will be able to carry out proactive surveillance and see patients at the places of care without this representing a cost to them.
In short, CHWs must be paid, trained, supervised, and provided with the necessary inputs.
After years of marginalization and isolation, CHWs are organizing and establishing national networks, largely with digital technologies, to achieve those goals. More than 5,000 health workers and organizations aligned in 40 countries have joined together through the Community Health Impact Coalition (Community Health Impact Coalition) to turn shared research and advocacy work into policy changes on a national scale. Our shared mission is to ensure that all low- and middle-income countries—including Uganda—adopt policies to professionalize CHWs.
The international community must decide whether to fairly compensate those who for decades supported the health systems of low- and middle-income countries or continue to exploit a largely female workforce. The moral alternative is clear: countries that professionalize CHWs and integrate them into a robust health infrastructure will be better positioned to move toward “health for all,” including that of the very women who provide most of the care. .
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