Strengthening health systems by addressing community health workers’ mental wellbeing and agency
Department of Health and Social Care
BRAC James P. Grant School of Public Health, BRAC University
Community Health Workers (CHWs) are the backbone of the health system. In remote rural and slum settings, they are often the only point of contact with formal health services for many communities. COVID-19 has demonstrated how CHWs are critical in ensuring adaptability of health systems during crises. Supporting CHWs is fundamental to improve their resilience and agency, maintain trusting relationships with communities and the sustainability and responsiveness of the broader health system. Despite this, CHWs are under-prioritised and lack support. Limited available support focuses on additional service provision, often overwhelming CHWs and neglecting their wellbeing. Evidence across LMICs suggests that CHWs face many job related stressors: physical, including regular risks; and emotional, including trauma and pressure due to the scale of community demands for help in under-resourced contexts. Yet, these stressors remain invisible to health systems, which offer little or no support to preserve CHWs wellbeing, risking their effectiveness and retention.   Our research aims to develop a holistic support package for community health workers (including training, supervision, physical and emotional support) to address a multitude of job-related stressors with a specific focus on psychosocial support to contribute to enhanced CHW wellbeing, agency and resilience.   Our research will take a co-production approach, situating CHWs as peer-researchers who are central to data collection, analyses and co-designing of solutions with collaborators, working across sectors. We will: 1) develop an evidence base through analysis of existing policies and practices on support for wellbeing of CHWs; interdisciplinary research with CHWs to understand their experiences and challenges, including qualitative, participatory (photo voice, stepping stones, body mapping), quantitative surveys, and participatory evaluation methods; 2) utilize the evidence generated to co-produce a package of interventions with CHWs and key stakeholders, to support CHWs wellbeing, with a specific focus on mental wellbeing to promote agency of CHWs and resilience of health systems; and 3) pilot and evaluate interventions for cost, equity, feasibility and scale up. This work brings together global and national expertise in health systems strengthening, gender, mental health and participatory health research from Bangladesh (BRAC JPGSPH) and Kenya (LVCT Health, APHRC), and partners in the UK (LSTM) who have a proven track record of CHWs research and implementation. Collaborators include representatives from Community Development Organization, Associations of CHWs, Ministries of Health, National Institute of Mental Health, and the Divisions of Mental Health and Community Health Services at national and county levels. Capacity strengthening of CHWs and health systems actors will be embedded throughout.
7.1 Individual care needs / GHPSR