A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh
Abstract Background Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthin...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Human Resources for Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12960-022-00773-6 |
| _version_ | 1811165871647752192 |
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| author | Dora Curry Md. Ahsanul Islam Bidhan Krishna Sarker Anne Laterra Ikhtiar Khandaker |
| author_facet | Dora Curry Md. Ahsanul Islam Bidhan Krishna Sarker Anne Laterra Ikhtiar Khandaker |
| author_sort | Dora Curry |
| collection | DOAJ |
| description | Abstract Background Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh. Case presentation The SHE model developed a public–private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs. Conclusion The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives. |
| first_indexed | 2024-04-10T15:44:30Z |
| format | Article |
| id | doaj.art-b029ca6d86274e4c8c531ae0d25082e3 |
| institution | Directory Open Access Journal |
| issn | 1478-4491 |
| language | English |
| last_indexed | 2024-04-10T15:44:30Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj.art-b029ca6d86274e4c8c531ae0d25082e32023-02-12T12:14:06ZengBMCHuman Resources for Health1478-44912023-02-012111910.1186/s12960-022-00773-6A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural BangladeshDora Curry0Md. Ahsanul Islam1Bidhan Krishna Sarker2Anne Laterra3Ikhtiar Khandaker4CARE (formerly for Curry, Islam, and Laterra; current for Khandaker)CARE (formerly for Curry, Islam, and Laterra; current for Khandaker)International Centre for Diarrhoeal Disease Research, Bangladesh (formerly CARE-Bangladesh)CARE (formerly for Curry, Islam, and Laterra; current for Khandaker)CARE (formerly for Curry, Islam, and Laterra; current for Khandaker)Abstract Background Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh. Case presentation The SHE model developed a public–private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs. Conclusion The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.https://doi.org/10.1186/s12960-022-00773-6Frontline health workersAgencySkilled birthing attendantsHealth workforce |
| spellingShingle | Dora Curry Md. Ahsanul Islam Bidhan Krishna Sarker Anne Laterra Ikhtiar Khandaker A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh Human Resources for Health Frontline health workers Agency Skilled birthing attendants Health workforce |
| title | A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh |
| title_full | A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh |
| title_fullStr | A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh |
| title_full_unstemmed | A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh |
| title_short | A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh |
| title_sort | novel approach to frontline health worker support a case study in increasing social power among private fee for service birthing attendants in rural bangladesh |
| topic | Frontline health workers Agency Skilled birthing attendants Health workforce |
| url | https://doi.org/10.1186/s12960-022-00773-6 |
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