TY - JOUR
T1 - Political connections and psychosocial wellbeing among Women's Development Army leaders in rural amhara, Ethiopia
T2 - Towards a holistic understanding of community health workers' socioeconomic status
AU - Closser, Svea
AU - Maes, Kenneth
AU - Gong, Erick
AU - Sharma, Neha
AU - Tesfaye, Yihenew
AU - Abesha, Roza
AU - Hyman, Mikayla
AU - Meyer, Natalie
AU - Carpenter, Jeffrey
N1 - Funding Information:
We are deeply grateful to our study participants, especially the Health Extension Workers and Women's Development Army members who participated in multiple interviews and invited the authors into their homes. We thank Yasmine Gilbert, Sarah Fossett, Cindy Esparza, Lydia Aguilar, Angela Phan, Melkamu Bedinu, Hana Gebremariam, Hannah Blair, and Garrett Flowers for their work on data collection, entry and analysis. Thanks to Kait Atkins and Erin Cooney for thoughtful comments on the manuscript. We are also grateful to the anonymous reviewers. This research was funded by a grant from the U.S. National Science Foundation Cultural Anthropology Program (#1155271/1153926) and by Middlebury College.
Funding Information:
We are deeply grateful to our study participants, especially the Health Extension Workers and Women's Development Army members who participated in multiple interviews and invited the authors into their homes. We thank Yasmine Gilbert, Sarah Fossett, Cindy Esparza, Lydia Aguilar, Angela Phan, Melkamu Bedinu, Hana Gebremariam, Hannah Blair, and Garrett Flowers for their work on data collection, entry and analysis. Thanks to Kait Atkins and Erin Cooney for thoughtful comments on the manuscript. We are also grateful to the anonymous reviewers. This research was funded by a grant from the U.S. National Science Foundation Cultural Anthropology Program ( #1155271/1153926 ) and by Middlebury College .
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/12
Y1 - 2020/12
N2 - Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n = 74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n = 422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.
AB - Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n = 74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n = 422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.
KW - Community health workers
KW - Cultural consonance
KW - Ethiopia
KW - Volunteer
UR - http://www.scopus.com/inward/record.url?scp=85092501029&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85092501029&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2020.113373
DO - 10.1016/j.socscimed.2020.113373
M3 - Article
C2 - 33068871
AN - SCOPUS:85092501029
SN - 0277-9536
VL - 266
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 113373
ER -