Date: May 2018
Author(s): Marta Schaaf, Jonathan Fox, Stephanie M. Topp, Caitlin Warthin, Lynn P. Freedman, Rachel Sullivan Robinson, Sundararaman Thiagarajan, Kerry Scott, Thoko Maboe, Margareth Zanchetta, Ana Lorena Ruano, Maryse Kok and Svea Closser
Publication type: Scholarly Journal Article
Published by: International Journal for Equity in Health

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.

Author Affiliations (at the time of publication in May 2018)   Marta Schaaf, Caitlin Warthin, and Lynn P. Freedman Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA   Jonathan Fox Accountability Research Center, School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA   Stephanie M. Topp College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Dr, Townsville, QLD, 4812, Australia   Rachel Sullivan Robinson School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA   Sundararaman Thiagarajan School of Health Systems Studies, Tata Institute of Social Sciences, VN Purav Marg, Deonar, Mumbai, 400088, India   Kerry Scott Independent Consultant, Bangalore, India and Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA   Thoko Maboe Qondisa Institute Training for Community Health Care Workers, Monument Road, Duncanville, Vereeniging, 1939, South Africa   Margareth Zanchetta Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria St, Office POD 474A, Toronto, ON, M5B 2K3, Canada   Ana Lorena Ruano Center for the Study of Equity and Governance in Health Systems, Guatemala and Center for International Health University of Bergen, Bergen, Norway   Maryse Kok KIT | Royal Tropical Institute, P.O. Box 95001, 1090, HA, Amsterdam, The Netherlands   Svea Closser Middlebury College, 301 Munroe Hall, Middlebury, VT, 05753, USA