Examining the gender imbalance in the National Community Health Assistant Programme in Liberia: a qualitative analysis of policy and Programme implementation

Abstract The Revised National Community Health Services Policy (2016–2021) (RNCHSP) and its programme implementation, the Liberian National Community Health Assistant Programme (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women. This study...

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Bibliographic Details
Published in:Health policy and planning 2023-02, Vol.38 (2), p.181-191
Main Authors: Hafez, Sali, Munyati, Bob Mwiinga, Zeno, Katie, Gbozee, Catherine K Z, Jusu, Mbalu, Reeves, Mantue S, Wesseh, C Sanford, Wiah, S Olasford, AlKhaldi, Mohammed, Johnson, Kristin, Subah, Marion
Format: Article
Language:English
Subjects:
Access to education
Affordability
Assistants
Committees
Community
Community health care
Community Health Services
Counties
Cultural factors
Education
Fairness
Female
Gender
Gender equity
Gender Identity
Gender inequality
Gender roles
Health care
Health Policy
Health services
Humans
Imbalance
Implementation
Liberia
Male
Nominations
Original
Ownership
Perceptions
Policy making
Public Health
Qualitative analysis
Qualitative research
Recruitment
Responsiveness
Strengthening
Women
Workforce
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Summary:Abstract The Revised National Community Health Services Policy (2016–2021) (RNCHSP) and its programme implementation, the Liberian National Community Health Assistant Programme (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women. This study was designed to assess the gender responsiveness of the RNCHSP and its programme implementation in five counties across Liberia to identify opportunities to improve gender equity in the programme. Using qualitative methods, 16 semi-structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia’s intention to prioritize women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the programme, unfavourable gender norms influenced women’s nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women’s nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its programme implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programme will likely increase the effectiveness of community healthcare services.
ISSN:1460-2237
0268-1080
1460-2237
DOI:10.1093/heapol/czac075