TY - JOUR
T1 - Psychosocial distress among unpaid community health workers in rural Ethiopia
T2 - Comparing leaders in Ethiopia's Women's Development Army to their peers
AU - Maes, Kenneth
AU - Closser, Svea
AU - Tesfaye, Yihenew
AU - Abesha, Roza
N1 - Funding Information:
We would like to express deep gratitude to all the people who participated in this study, especially the Health Extension Workers and Women's Development Army members who participated in multiple interviews and invited the authors into their homes. Yasmine Gilbert, Natalie Meyer, Mikayla Hyman, Lydia Aguilar, Angela Phan, and Garrett Flowers provided helpful assistance with data entry and analysis. We are also grateful to the anonymous reviewers for their very helpful feedback. This research was funded by a grant from the U.S. National Science Foundation Cultural Anthropology Program (# 1155271/1153926 ).
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/6
Y1 - 2019/6
N2 - There is a growing critical social science literature on volunteering in health programs in non-western, low-income countries, yet few have mixed quantitative and qualitative methods to examine the psychological and social wellbeing of unpaid community health workers in such contexts. We address this issue with data from unpaid community health workers (CHWs) and other women who comprise Ethiopia's state-organized Women's Development Army. We draw on qualitative and cross-sectional survey data collected between 2013 and 2016 to test links between various aspects of psychosocial and economic wellbeing and volunteer status in a rural context. We surveyed 422 adult women in Amhara state, 73 of whom were unpaid CHWs in the “Army”. We also conducted interviews and focus group discussions with health officials, salaried Health Extension Workers, volunteer CHWs, and other adult women. Analyses of our qualitative and quantitative datasets show that volunteer CHWs are actually worse off than their peers in various psychosocial and economic respects, and that CHW recruitment processes are the most likely explanation for this difference. Additionally, the unpaid CHW position adds work to already burdened shoulders, and makes women—especially unmarried women—vulnerable to negative gossip and high levels of psychological distress. To a limited extent, the volunteer CHW position also bolsters married women's subjective socioeconomic status and confidence in achieving future gains in status. By showing that unpaid CHWs do not necessarily enjoy psychosocial benefits, and may experience harm as a result of their work, these findings reinforce the recommendation that CHWs in contexts of poverty be paid and better supported.
AB - There is a growing critical social science literature on volunteering in health programs in non-western, low-income countries, yet few have mixed quantitative and qualitative methods to examine the psychological and social wellbeing of unpaid community health workers in such contexts. We address this issue with data from unpaid community health workers (CHWs) and other women who comprise Ethiopia's state-organized Women's Development Army. We draw on qualitative and cross-sectional survey data collected between 2013 and 2016 to test links between various aspects of psychosocial and economic wellbeing and volunteer status in a rural context. We surveyed 422 adult women in Amhara state, 73 of whom were unpaid CHWs in the “Army”. We also conducted interviews and focus group discussions with health officials, salaried Health Extension Workers, volunteer CHWs, and other adult women. Analyses of our qualitative and quantitative datasets show that volunteer CHWs are actually worse off than their peers in various psychosocial and economic respects, and that CHW recruitment processes are the most likely explanation for this difference. Additionally, the unpaid CHW position adds work to already burdened shoulders, and makes women—especially unmarried women—vulnerable to negative gossip and high levels of psychological distress. To a limited extent, the volunteer CHW position also bolsters married women's subjective socioeconomic status and confidence in achieving future gains in status. By showing that unpaid CHWs do not necessarily enjoy psychosocial benefits, and may experience harm as a result of their work, these findings reinforce the recommendation that CHWs in contexts of poverty be paid and better supported.
KW - Community health workers
KW - Ethiopia
KW - Volunteerism
KW - Wellbeing
UR - http://www.scopus.com/inward/record.url?scp=85064439273&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064439273&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2019.04.005
DO - 10.1016/j.socscimed.2019.04.005
M3 - Article
C2 - 31009880
AN - SCOPUS:85064439273
SN - 0277-9536
VL - 230
SP - 138
EP - 146
JO - Social Science and Medicine
JF - Social Science and Medicine
ER -