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How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework.

  • Steege, Rosalind1
  • Taegtmeyer, Miriam2
  • McCollum, Rosalind2
  • Hawkins, Kate3
  • Ormel, Hermen4
  • Kok, Maryse4
  • Rashid, Sabina5
  • Otiso, Lilian6
  • Sidat, Mohsin7
  • Chikaphupha, Kingsley8
  • Datiko, Daniel Gemechu9
  • Ahmed, Rukhsana10
  • Tolhurst, Rachel2
  • Gomez, Woedem2
  • Theobald, Sally2
  • 1 Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK. Electronic address: [email protected]
  • 2 Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK.
  • 3 Pamoja Communications, UK Bishopstone, 36 Crescent Road, Worthing BN11 1RL, UK.
  • 4 Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. , (Netherlands)
  • 5 James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh. , (Bangladesh)
  • 6 LVCT Health, Research and Strategic Information Department, P.O Box 19835- 00202, Nairobi, Kenya. , (Kenya)
  • 7 University Eduardo Mondlane, Department of Community Health, P.O. Box 257, Maputo, Mozambique. , (Mozambique)
  • 8 Research for Equity and Community Health (REACH) Trust, P.O. Box 1597, Lilongwe, Malawi. , (Malawi)
  • 9 REACH Ethiopia, P.O. Box 303, Hawassa, Ethiopia. , (Ethiopia)
  • 10 Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK; Eijkman Institute for Molecular Biology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia, Jalan Diponegoro 69, Jakarta, 10430, Indonesia. , (Indonesia)
Published Article
Social science & medicine (1982)
Publication Date
May 05, 2018
DOI: 10.1016/j.socscimed.2018.05.002
PMID: 29777956


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.

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