Community Health Workers and Trainers Perspectives on Education and Practice: A Qualitative Case Study in the Context of Maternal and Child Health in Rwanda
Abstract
Achieving global health-care goals hinges on a health workforce that is available, competent, and productive. Chronic health worker shortages impede the abilities of health systems to provide equitable services, especially in low-resource settings.
Global consensus on bridging health workforce gaps calls for alternatives such as using community health workers (CHWs) to achieve health-care aims. CHWs are laypeople who are closely connected with communities and provide frontline health services. Although CHWs are an integral part of workforces in many countries, with potential to inform global health systems, CHW programs continue to operate on the fringe and are fraught with challenges.
This dissertation applies a critical pedagogical lens to study CHW education and practices in Rwanda. Identifying CHWs and trainers as key stakeholders, this work brings their perspectives to the fore. The dissertation a) unpacks CHWs’ and trainers’ experiences with CHW education and practices, b) discusses preferred pedagogical approaches for optimized CHW education, and c) highlights drivers, enablers, and challenges of community maternal and child health work.
This work comprises three integrated manuscripts along with introduction, methodology, and discussion chapters. The first manuscript contributes to broad health-care systems discussions on addressing worker shortages with a focus on CHW programs and calls for critical systems thinking to be applied to CHWs’ engagement. The second examines CHW education from the perspectives of CHWs and trainers. The third discusses enablers, drivers, and challenges of community health work, highlighting inherent assumptions and ethical issues. It also unpacks burdens and support needs identified by CHWs.
Qualitative case study methodology was used to investigate the perspectives of 16 CHWs and 10 trainers on CHW education and practices. Data was analyzed using thematic analysis, mind mapping, and NVivo software. The data reveals gaps in CHW education and practices, and highlights contextual factors shaping their work.
This thesis contributes to knowledge about CHWs within health systems, approaches to optimize CHW programs, and CHW education. The results suggest holistic systems-thinking approaches situating CHWs within varying sociocultural, educational, and practice-specific contexts should be adopted in designing CHW educational programs. Furthermore, it demonstrates the benefits of engaging CHWs and trainers as key stakeholders.