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‘It’s the sense of responsibility that keeps you going’: stories and experiences of participation from rural community health workers in Guatemala
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Strengthening Primary Health Care)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Strenthening Primary Health Care)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Strenthening Primary Health Care)ORCID iD: 0000-0002-8052-479X
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Strengthening Primary Health Care)ORCID iD: 0000-0001-7087-1467
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2012 (English)In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 70, 18- p.Article in journal (Refereed) Published
Abstract [en]

Background: In 1978, the Alma-Ata declaration on primary health care (PHC) recognized that the world’s healthissues required more than just hospital-based and physician-centered policies. The declaration called for a paradigmchange that would allow governments to provide essential care to their population in a universally acceptablemanner. The figure of the community health worker (CHW) remains a central feature of participation within thePHC approach, and being a CHW is still considered to be an important way of participation within the healthsystem.Methods: This study explores how the values and personal motivation of community health workers influencestheir experience with this primary health care strategy in in the municipality of Palencia, Guatemala. To do this, weused an ethnographic approach and collected data in January-March of 2009 and 2010 by using participantobservation and in-depth interviews.Results: We found that the CHWs in the municipality had a close working relationship with the mobile health teamand with the community, and that their positions allowed them to develop leadership and teamwork skills that mayprove useful in other community participation processes. The CHWs are motivated in their work and volunteerism is akey value in Palencia, but there is a lack of infrastructure and growth opportunities.Conclusion: Attention should be paid to keeping the high levels of commitment and integration within the healthteam as well as keeping up supervision and economic funds for the program.

Place, publisher, year, edition, pages
BioMed Central, 2012. Vol. 70, 18- p.
Keyword [en]
Community health workers, Community participation, Guatemala, Primary Health Care, Alma-Ata declaration
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-59860DOI: 10.1186/0778-7367-70-18OAI: oai:DiVA.org:umu-59860DiVA: diva2:556953
Available from: 2012-09-27 Created: 2012-09-26 Last updated: 2017-12-07Bibliographically approved
In thesis
1. The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
Open this publication in new window or tab >>The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy recommendations, but participation in health is still seen as a means to make the health system more responsive to local health needs, and as a way to bring the health sector and the community closer together.

Aim: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs.

Methods: The fieldwork for this study was carried out over eight months and three field visits between early January of 2009 and late March of 2010. During this time, 38 indepth interviews with provincial and district-level health authorities, municipal authorities, community representatives and community health workers were conducted. Using an overall applied ethnographic approach, the main means of data collection were participant observation, in-depth interviews, group discussions and informal conversations. The data was analyzed in two different rounds. In the first one we used documentary analysis, role-ordered matrices and thematic analsis (see papers I-IV) and in the second round, thematic analysis was utilized.

Results: We found four themes that frame what the role of social participation in the municipality of Palencia is. The first theme presents the historical, political and social context that has contributed to shaping the participation policies and practices in Guatemala as a whole. The second theme takes a deeper look at these policies and how they have been received in the municipality of Palencia. The third theme presents data regarding the three situated practices of participation, each occurring at a different level: municipal, community and the individual level. Finally, the last theme presents reflections on what it means to participate to the people that were involved in this study.

Conclusion: In the process of social participation there are two different and complementary kinds of power that depend on the amount and the kind of resources available at each level of the participation structure. Stakeholders that have higher levels of power to formulate policies will have better access to financial, human and material resources while stakeholders that have higher levels of power to implement policies will have resources like community legitimacy, knowledge of local culture, values and mores, as well as a deep understanding of local social processes. The coordination of financial, human and material resources is just as important as the legitimacy that comes from having community leaders involved in more steps of the process. True collaboration can only be obtained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders and other stakeholders that are working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 71 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1517
Keyword
Social participation, community participation, community heath workers, primary health care, Palencia, Guatemala
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-59865 (URN)978-91-7459-470-6 (ISBN)
Public defence
2012-10-19, Bergasalen, Byggnad 27, NUS, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
FAS, Swedish Council for Working Life and Social Research, 2006-1512
Available from: 2012-09-28 Created: 2012-09-26 Last updated: 2015-04-29Bibliographically approved

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