Browsing by Author "Otiso, Lilian"

Now showing 1 - 4 of 4

How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
(Science Direct, 2018-07) Steege, Rosalind; Taegtmeyer, Miriam; McCollum, Rosalind; Hawkins, Kate; Ormel, Hermen; Kok, Maryse; Rashid, Sabina; Otiso, Lilian; Sidat, Mohsin; Chikaphupha, Kingsley; Datiko, Daniel Gemechu; Ahmeda, Rukhsana; Tolhurst, Rachel; Gomez, Woedem; Theobald, Sally
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January–September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.
How to prevent and address safeguarding concerns in global health research programmes: Practice, process and positionality in marginalised spaces
(BMJ Journals, 5/13/2020) Aktar, Bachera; Alam, Wafa; Ali, Samiha; Awal, Abdul; Bayoh, Margaret; Chumo, Ivy; Contay, Yirah; Conteh, Abu; Dean, Laura; Dobson, Skye; Edstrom, Jerker; Elsey, Helen; Farnaz, Nadia; Garimella, Surekha; Gray, Linsay; Gupte, Jaideep; Hawkins, Kate; Hollihead, Beth; Josyula, Kunhi Lakshmi; Kabaria, Caroline; Karuga, Robinson; Kimani, Joseph; Leyland, Alastair H; te Lintelo, Dolf; Mansaray, Bintu; MacCarthy, Joseph; MacGregor, Hayley; Mberu, Blessing; Muturi, Nelly; Okoth, Linet; Otiso, Lilian; Ozano, Kim; Parray, Ateeb; Phillips-Howard, Penny; Rao, Vinodkumar; Rashid, Sabina; Raven, Joanna; Refell, Francis; Saidu, Samuel; Sobhan, Shafinaz; Saligram, Prasanna Subramanya; Sesay, Samira; Theobald, Sally; Tolhurst, Rachel; Tubb, Phil; Waldman, Linda; Wariutu, Jane; Whittaker, Lana; Wurie, Haja
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-income countries (Bangladesh, India, Kenya and Sierra Leone). Our manuscript is divided into three key sections. We start by discussing the importance of safeguarding in global health research and consider how thinking about vulnerability as a relational concept (shaped by unequal power relations and structural violence) can help locate fluid and context specific safeguarding risks within broader social systems. We then discuss the different steps undertaken in ARISE to develop a shared approach to safeguarding: sharing institutional guidelines and practice; facilitating a participatory process to agree a working definition of safeguarding and joint understandings of vulnerabilities, risks and mitigation strategies and share experiences; developing action plans for safeguarding. This is followed by reflection on our key learnings including how safeguarding, ethics and health and safety concerns overlap; the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces; and the importance of reflective practice and critical thinking about power, judgement and positionality and the ownership of the global narrative surrounding safeguarding. We finish by situating our learning within debates on decolonising science and argue for the importance of an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.
Limits and opportunities to community health worker empowerment: a multi-country comparative study
(© 2016 Elsevier Ltd, 2016) Kane, Sumit; Kok, Maryse; Ormel, Hermen; Otiso, Lilian; Sidat, Mohsin; Namakhoma, Ireen; Nasir, Sudirman; Gemechu, Daniel; Rashid, Sabina Faiz; Taegtmeyer, Miriam; Theobald, Sally; Koning, Korrie de
Background In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving ‘Empowerment of communities’. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW's empowerment experience. Methods We present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used. Results CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by – the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact. Conclusions While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters.
Limits and opportunities to community health worker empowerment: a multi-country comparative study
(© 2016 Elsevier Ltd, 2016) Kane, Sumit; Kok, Maryse; Ormel, Hermen; Otiso, Lilian; Sidat, Mohsin; Namakhoma, Ireen; Nasir, Sudirman; Gemechu, Daniel; Rashid, Sabina Faiz; Taegtmeyer, Miriam; Theobald, Sally; Koning, Korrie de
Background In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving ‘Empowerment of communities’. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW's empowerment experience. Methods We present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used. Results CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by – the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact. Conclusions While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters.