Department of Anthropology, Oregon State University, Corvallis, OR, USA.
Department of Anthropology, Middlebury College, Middlebury, VT, USA.
BMC Public Health. 2018 Feb 14;18(1):258. doi: 10.1186/s12889-018-5159-5.
Many Community Health Workers (CHWs) experience the same socioeconomic and health needs as their neighbors, given that they are by definition part of their communities. Yet very few studies aim to measure and characterize experiences of deprivation, poverty, and wellbeing among community health workers. This study quantitatively examines deprivation and wellbeing in Ethiopia's Women's Development Army (WDA), a massive unpaid community health workforce intended to improve population health and modernize the country.
We conducted a survey of 422 volunteer WDA leaders and community members in rural Amhara state, part of a mixed-methods ethnographic study of the experiences of women in the WDA. The survey asked a variety of questions about respondents' demographics, education, assets, and access to government services. We also used survey measures to evaluate respondents' levels of household food and water security, stressful life events, social support, work burden, and psychological distress.
Volunteer WDA leaders and community members alike tend to have very low levels of schooling and household assets, and to be heavily burdened with daily work in several domains. Large proportions are food and water insecure, many are in debt, and many experience stretches of time with no money at all. Our survey also revealed differences between volunteer WDA leaders and other women that warrant attention. Leaders are less likely to be married and more likely to be divorced or separated. Leaders are also more likely to experience some aspects of food insecurity and report greater levels of psychological distress and more stressful life events. They also report slightly less social support than other women.
In rural Amhara, women who seek out and/or are sought and recruited for leader roles in the WDA are a population living in precarity. In several domains, they experience even more hardship than their neighbors. These findings highlight a need for careful attention and further research into processes of volunteer CHW selection, and to determine whether or not volunteering for CHW programs increases socioeconomic and health risks among volunteers. CHW programs in settings of poverty should stop using unpaid labor and seek to create more paid CHW jobs.
许多社区卫生工作者（CHWs）与他们的邻居有着相同的社会经济和健康需求，因为从定义上讲，他们是社区的一部分。然而，很少有研究旨在衡量和描述社区卫生工作者的贫困、贫穷和福祉经历。本研究定量考察了埃塞俄比亚妇女发展军（WDA）中贫困和福祉的情况，WDA 是一支庞大的无薪社区卫生工作者队伍，旨在改善人口健康并使国家现代化。
我们对农村阿姆哈拉州的 422 名志愿 WDA 领导人和社区成员进行了调查，这是对 WDA 中妇女经历进行的混合方法民族志研究的一部分。该调查询问了受访者的人口统计学、教育、资产和获得政府服务等方面的各种问题。我们还使用调查措施来评估受访者的家庭粮食和水安全、生活压力事件、社会支持、工作负担和心理困扰水平。
志愿 WDA 领导人和社区成员的受教育程度和家庭资产都非常低，而且在多个领域的工作负担沉重。很大一部分人粮食和水不安全，许多人负债累累，许多人甚至长时间没有钱。我们的调查还揭示了志愿 WDA 领导人和其他妇女之间存在的差异，值得关注。领导者不太可能结婚，更有可能离婚或分居。领导者也更有可能经历一些方面的粮食不安全，并报告更高水平的心理困扰和更多的生活压力事件。他们报告的社会支持也略低于其他女性。
在阿姆哈拉农村，寻求并/或被招募担任 WDA 领导角色的妇女是一个处于不稳定状态的群体。在几个领域，她们的生活比邻居更艰难。这些发现强调需要仔细关注和进一步研究志愿 CHW 选拔过程，并确定志愿 CHW 计划是否会增加志愿者的社会经济和健康风险。贫困地区的 CHW 计划应停止使用无偿劳动，并寻求创造更多的有偿 CHW 工作岗位。
