At least six million women worldwide provide unpaid or grossly underpaid labor in community-health centers, often in low- and middle-income countries (LMICs). Many work as community-health workers (CHWs). Though these are skilled jobs that should be salaried, only 34 countries offer CHWs accreditation, training, and salaries, leaving the majority exploited and therefore less effective for their patients. If we are serious about making \\"health for all\\" a global priority, this must change.
CHWs are crucial to strengthening health systems at the national level: they have been proven to improve maternal- and child-health services, expand access to family planning, and support prevention and care for both non-transmissible and infectious diseases. Deploying CHWs who consistently provide just 30 life-saving health services in countries with the highest disease burden would save as many as 6.9 million lives annually and reduce child mortality by almost half. Moreover, the COVID-19 pandemic demonstrated how resilient community-health programs can provide essential services even in the face of great adversity.
But such programs will reach their full potential only with service design that adheres to evidence-based best practices. That means treating CHWs as professionals who require training, fair pay, and safe working conditions. When used as a stopgap solution or a source of cheap labor, CHWs are less effective than their well-resourced counterparts.
In Africa, up to 85 percent of CHWs are unpaid, and, worldwide, CHWs' essential medicines are out of stock one-third of the time. In Uganda, our home country, there is a shortage of health-care workers, so CHWs have stepped up to fill the gap. Though these workers provide vital services to their communities, performing many of the same tasks as their salaried supervisors, they often receive little to no pay.
Why are CHWs, who are often women of color, expected to work and save lives without recognition or remuneration? It is clear that this is also a gender-rights issue. Patriarchal norms and power dynamics condition women to accept no or low wages for what should clearly be paid work. For example, women from low-income households and with low levels of education often view this type of unpaid work as an opportunity that might lead to paid work or an asset like a mobile phone or bicycle. Unpaid work in health care can also bring women social recognition. In many contexts, it is seen as honorable work that families will approve of for a woman. As a result, CHWs tend to juggle these positions with piecemeal paid jobs and family responsibilities.
Reference(s):
cgtn.com
