Report on the Think-in on Community Health Worker Voice, Power, and Citizens’ Right to Health  

Date: January 2018
Authors: Marta Schaaf, Caitlin Warthin, Amy Manning, Stephanie Topp
Publication type: Learning Exchange Report
Published by: Accountability Research Center and Averting Maternal Death and Disability

Community health workers (CHWs) are increasingly put forward as a remedy for lack of health system capacity, including addressing challenges associated with low health service coverage and with low community engagement in the health system. CHWs are often explicitly mandated or implicitly expected to enhance or embody health system accountability to the populations they serve.

While definitions vary, CHWs are generally community-based workers who: are members of the communities where they work; are (at least in part) selected by the communities they serve; and are required to represent and/or deliver health services (WHO, 2007). CHWs are also commonly envisioned as being answerable to the community for their activities, and they often perform a linking function between communities and the health system (WHO, 2007).

In June of 2017, thirty researchers, health advocates, and program implementers from eight countries attended a two-day ‘think-in’ at American University. While many country experiences were discussed, the meeting focused in particular on the experiences of Brazil, India, South Africa, and the United States. These countries were selected because, with the exception of the United States, they have large, scaled-up CHW programs where there have been at least some instances of CHWs facilitating—or demanding—greater health system accountability.

Marta Schaaf

Marta is the Deputy Director of the Averting Maternal Death and Disability (AMDD) Program at the Mailman School of Public Health, Columbia University. She works on the “Accountability on the Frontlines” project developing program research and implementation to promote accountability for health programs. Marta has conducted research and policy analysis and implemented programs on minority health, health and social exclusion, tuberculosis, and health systems for the World Lung Foundation, HealthRight, the Open Society Foundation, and the WHO. Marta has lived in Burkina Faso, Kosovo, and Macedonia. She has a Masters in International Affairs and an MPH from Columbia University, and a BA from Smith College. She is currently pursuing a doctorate in public health at Columbia University.

Caitlin Warthin

Caitlin is a Program Officer at the AMDD Program at the Mailman School of Public Health, Columbia University. Her work focuses on measuring and improving the availability and quality of maternal health care. She also contributes to AMDD’s work on accountability in health systems and emergency obstetric care (EmOC). Caitlin previously worked in monitoring and evaluation for reproductive health programs in the Philippines and global EmOC programming for USAID. She holds an MPH in Population and Family Health from Columbia University and a BA in Economics from Williams College.

Amy Manning

Amy is the Program Assistant of the AMDD Program at the Mailman School of Public Health, Columbia University. She provides support including desk research, report writing, and communications across all of AMDD’s research projects. Amy graduated from American University in 2015 with a Bachelor’s degree in International Studies. Prior to joining AMDD, she interned with the German Marshall Fund of the United States, the Wilson Center, and the U.S. Department of State.

Stephanie Topp

Stephanie has a background in politics, sociology and medical anthropology. She is a Senior Lecturer at James Cook University, Australia. Steph’s research interests include health policy analysis and exploration of the way social accountability and trust shape primary health service delivery and uptake. Steph has worked in Zambia, South Africa, India and Papua New Guinea. She was lead investigator on a four-year program to strengthen the Zambian prison health system and is a member of the Partners for Tropical Health consortia building health systems research capacity in a cluster of Pacific Island countries. Steph is an Associate Editor for the journal BMJ Global Health. She has a PhD from the University of Melbourne, a Masters in Development Studies from Oxford University and a Masters in International Public Health from the University of Sydney.

Report on the Think-in on Community Health Worker Voice, Power, and Citizens’ Right to Health

This brief is intended to provide background to participants of the meeting on Community Health Worker Voice, Power, and Citizen’s Right to Health. The guiding questions for the meeting are as follows: What factors promote or undermine community health workers as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? The text below provides a basic overview on community health workers and accountability, as well as a non-exhaustive discussion of some of the kinds of issues that will likely arise during the meeting.
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