Department of Anthropology, Oregon State University, Corvallis, OR, USA.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
Soc Sci Med. 2019 Jun;230:138-146. doi: 10.1016/j.socscimed.2019.04.005. Epub 2019 Apr 10.
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.
越来越多的批判社会科学文献关注非西方低收入国家卫生项目中的志愿服务,但很少有研究采用定量和定性相结合的方法来考察这些背景下无偿社区卫生工作者的心理和社会福利。我们利用来自埃塞俄比亚国家组织的妇女发展军的无偿社区卫生工作者(CHW)和其他妇女的数据来解决这个问题。我们利用 2013 年至 2016 年期间收集的定性和横断面调查数据,来检验在农村环境中,各种心理社会和经济福利与志愿者身份之间的联系。我们在阿姆哈拉州调查了 422 名成年妇女,其中 73 名是“军队”中的无偿 CHW。我们还对卫生官员、领薪的卫生推广工作者、志愿 CHW 以及其他成年妇女进行了访谈和焦点小组讨论。我们对定性和定量数据集的分析表明,志愿 CHW 在各种心理社会和经济方面实际上比同龄人更差,而 CHW 招募过程是造成这种差异的最可能原因。此外,无偿 CHW 职位增加了已经负担沉重的妇女的工作量,使妇女——尤其是未婚妇女——容易受到负面谣言和高度心理困扰的影响。在一定程度上,志愿 CHW 职位也增强了已婚妇女的主观社会经济地位和对未来获得地位提升的信心。这些发现表明,无偿 CHW 不一定能享受到心理福利,并且可能会因为工作而受到伤害,这进一步证实了在贫困背景下,应向 CHW 支付工资并提供更好支持的建议。
Health Policy Plan. 2019-5-1
Health Policy Plan. 2011-9-7
Glob Public Health. 2025-12
PLOS Glob Public Health. 2024-8-1
Hum Resour Health. 2023-5-1
Int J Environ Res Public Health. 2023-1-11