STRATEGIES TO SUPPORT COMMUNITY HEALTH WORKERS IN THE FRAGILE AND CONFLICT-AFFECTED BUEA HEALTH DISTRICT, CAMEROON

Abstract

Community Health Workers (CHWs) have been acknowledged as critical in providing essential health services, especially within under-resourced health systems and fragile contexts. There has been renewed interest in CHWs in recent years in relation to achieving universal health coverage due to their unique position in the community and their ability to link communities and the health system. However, the best way to optimise CHW programmes and support CHWs is debatable. The optimisation of CHW programmes is particularly relevant in urban, fragile and conflict-affected settings (FCAS), such as Buea Health District in western Cameroon, where challenges CHWs face are exacerbated by the unstable context and their needs are dire. At the same time, there is a dearth of evidence and research to guide policies and practices.

This study seeks to explore strategies to support CHWs in the Buea Health District by understanding the current functioning and challenges of CHW programmes, how individual CHWs and their managers cope with and respond to shocks and uncertainty, and their views on the preferred support. Employing a mixed-methods approach, this study integrates key informant interviews (16) with CHW programme managers, supervisors, and community representatives alongside four focus group discussions with CHWs in the Buea Health District. In addition, participatory ranking exercises facilitated quantitative data collection, highlighting preferred support strategies from the CHWs’ perspective. Finally, the work-life histories (5) of selected CHWs were documented to capture their experiences before and during the armed conflict in the Anglophone Regions of Cameroon.

The findings of this research highlight the lived experiences and challenges that CHWs encountered, including insecurity, which sometimes posed a risk to life, mistrust from the community, especially during the COVID-19 pandemic and population displacement. Some of these challenges, such as population displacement, eventually led to expanding roles for CHWs and a shortage of CHWs. Some of the coping mechanisms employed by CHW programme managers involved community engagement with local leaders, recruitment of temporary CHWs and remote supervision of CHWs. Overall, the analysis points to CHW's support strategies, such as compensation and benefits, operational support and work environment, and recognition and status for the CHWs, which are preferred strategies to support CHWs in the Buea Health District.

These findings have significant implications when designing and implementing CHWs programmes and support packages for CHWs. Stressing the relevance of context-specificity in approaches to CHW programming, the study proposes and applies a framework to support CHWs in FCAS, which intersects the CHW programme features, the local context, and the individual characteristics of the CHWs. Considering the intersection of these three variables would inform effective CHW programme designs and support packages that are sensitive and tailored to the unique characteristics of CHWs and their programmes in different settings. It also has implications for the design of agile CHW programmes that are responsive to the rapidly changing nature of fragile and conflict-affected settings and that cater to the well-being of CHWs in such settings to ensure improved CHW motivation, performance, and retention, as well as improved community health outcomes.