The Gendered Experience of Close to Community Providers during COVID-19 Response in Fragile Settings: A Multi-Country Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Document Review
2.2. Key Informant Interviews
2.3. In-Depth Interviews or Focus Group Discussions with CTC Providers
2.4. Analysis
3. Results
3.1. Document Review Findings
3.2. Findings from the KIIs, IDIs and FGDs
3.2.1. Who Has What?
Access to Training, Resources and Supervision
“There was no proper training—our main source of information was Facebook”. CTC provider, woman, Myanmar, IDI
“It was one way communications. When the phone rang, we just had to receive. Then, they would provide all the information about the symptoms. Only when they ask us to guess the right answer, we would guess it. Then they would respond that our answer is correct. That’s all”. CTC provider, woman, Nepal, IDI
“We can hardly secure the PPE for the employees”. Man, Lebanon, KII
“It would be really good if the health department recognizes the community health volunteers and tries to connect and collaborate with them more”. CTC provider, woman, Myanmar, IDI
Remuneration
“The money that they gave us was too small… during a lockdown, we have to buy things in the house to eat. The family burden is too much on us we have our children to look after and other family members”. CTC provider, woman, Sierra Leone, FGD
“It was not easy…especially for us with kids … we were just working in the community and we had nothing … so the little we had is the only thing we were using”. CTC provider, woman, Sierra Leone, FGD
Mental Stress and Support
“We were bashed at in some communities … sometimes we cannot even do our work … as most were claiming that we were disease carriers … coupled with a lot of provocation so that led to serious mental health issues amongst us”. CTC provider, man, Sierra Leone, FGD
“We forwarded several complaints to our superiors … we were admonished to give deaf ears and do the job as we have decided to help our communities … Our superiors also had engagements with community leaders, so that they can take measures as safeguards for responders to do their work effectively”. CTC provider, Man, Sierra Leone, FGD
3.2.2. Who Does What?
Roles and Responsibilities
Workload and Hours
“The workload was much … we have to visit quarantine homes twice a day and talk to them and check their temperature … And in some households, there are many people”. CTC provider, woman, Sierra Leone, FGD
“Need to adjust to have equilibrium between work and family. More sacrifice for women than men as men do not have much responsibility like women”. CTC provider, woman, Myanmar, IDI
“Family comes first: When the children are not going to schools, it exerts pressure on me. I am working outside, and when my children study online, I had to stay with them for hours. My husband is at home due to corona. This also exerts pressure”. CTC provider, woman, Lebanon, IDI
“They gave me a phone call from health post instructing me to deliver kit box to COVID patients and bringing back their health reports. Both works [farm work and duty as CHW] coincided at the same time. There was no one at home. I asked my neighbour to prepare some pickle and snacks for farm worker. I cooked potato and handed it to her. After I reached health post to receive kit box, I called 2, 3 people from my own community and sent them to the field. Then after, I visited to COVID patient’s home”. CTC provider, woman, Nepal, IDI
3.2.3. How Are Values Defined?
Family and Household Dynamics
“My family and friends supported me and they encourage us to do the work … They listen to whatever we tell them to do that alone is a big support, because they are making our work easy”. CTC provider, woman, Sierra Leone, FGD
“The family member scold asking, “Why do you need to do that work?” My own husband scolds me asking, “How much do they pay you? Why do you go there?” I have been used to this type of scolding. I let him continue scolding. I’ll carry on with my work”. CTC provider, woman, Nepal, IDI
Community Acceptability and Trust
“Neighbours and people around me used to tell me “Stay away from us. Don’t come closer. You work with Corona. Maybe you could infect us”.” CTC provider, woman, Lebanon, IDI
“Some of them lock their door. When we rang bell, they used to look at us and go inside fearing whether we might have brought corona. When we told them, “We need to discuss something with you,” only then they came out to their balcony”. CTC provider, woman, Nepal, IDI
“[Community] are assuming that we are also playing a huge part in prolonging the period of the disease in communities…In communities, we are only regarded by old people … while young people are accusing us of monetizing the whole response programme … that creates a kind of stigma around us in our communities” CTC provider, Man, Sierra Leone, FGD
“Communities do not tend to often listen to women in certain situations due to cultural beliefs … they are not given the audience they need…so in some cases we provide them with a male back up if there should be pressing issues to be addressed”. Man, Sierra Leone, KII
“Initially during the first wave some people in the community were frightened to talk to me which eventually reduced in the second wave”. CTC provider, woman, Myanmar, IDI
Community Support
“Tokens of appreciation and thank you cards from the Myanmar Red Cross Society, community and health departments make us feel motivated. I feel like I was supported when I felt very tired. I am happy for that. We work not for money and not expecting we will get something in return. From MRCS, we got hats or t-shirts and some other presents from community as tokens of appreciation”. CTC provider, woman, Myanmar, IDI
“After realizing the intensity of the outbreak, we started getting support from some other local NGOs … materials like thermometers and hand washing materials were provided to us … we distributed those at strategic points that could be easily accessed by people to use”. CTC provider, man, Sierra Leone, FGD
Mobility, Safety and Security
“There is a challenge for girls, and it sometimes needs the family to accompany the girls (volunteers) on their way home from work. Sometimes, we have meetings at night. For me, my husband come and pick me up. For girls, we may need to arrange for their return trip. For example, the township committee arranges a car for girls. For boys, there is no problem as they can manage on their own”. Woman, Myanmar, KII
“Their thinking is like: you are a girl and you are attending camps by yourself. People ask: you have nobody else? And even when we quit the camp and look for a car, we are not viewed positively”. CTC provider, woman, Lebanon, IDI
3.2.4. Who Decides?
Participation in Decision Making
“No, I am not aware of COVID-19 specific group formation in the community, and I don’t know about my membership on it either”. CTC provider, woman, Nepal, IDI
“Yesterday, there was a certain programme led by Ward Officials. I didn’t know about the programme. A Ward member invited me at the last hour. They should’ve timely informed me about the program in the morning or in the afternoon so that I could get time to manage my household chores”. CTC provider, woman, Nepal, IDI
“If they have children but don’t have problem with working as frontline workers within COVID-19, it is their own decision. We did not oblige anyone to participate in the response … We also leave the choice for the person. Also, when we have emergency cases, we need to stay late, the person who wants to leave could leave. We don’t exert any retaliation [penalties]”. Woman, Lebanon, KII
Family or Individual Decision Making
“I was really traumatized due to the pregnancy of my younger sister…life was so stressful for me due to additional burden … I have to take care of both the mother and the child … My job was affected due to stress…no help from anywhere else … I have now got more burden on me with less income”. CTC provider, man, Sierra Leone, FGD
3.2.5. How Is Power Negotiated and Changed by People and Environment?
Policy and Guidelines
“During the training at the council, they gave us posters that we used to sensitize people … telling people about the prevention of COVID-19, they gave us megaphones to do the sensitization”. CTC provider, woman, Sierra Leone, FGD
“We have a protocol to approach patients with maximum levels of protection for ourselves, the patients, and the society”. CTC provider, man, Lebanon, IDI
Coping Strategies
“Every morning, I say to myself, “You … are a strong person. You need to bear the difficulties thrown in your way, and you have to challenge them …” Thanks to God, I have work, even if it is tiring, but not every refugee has the chance to work”. CTC provider, woman, Lebanon, IDI
“I come and talk to my husband. I tell him about my day, and he calms me a bit. Usually, each family member needs to be giving to each other in order to build the family”. CTC provider, Lebanon, IDI
“How long will the 15 masks last for? [Laughs] After that, I have been buying them myself until now. My husband buys them in a packet. Everyone uses them. Mostly, we throw them after returning home. We also wash them and reuse sometimes. How often can we buy then? We get tired of buying them continuously. Moreover, it is said that the cloth masks aren’t appropriate. Hence, I reused them”. CTC provider, woman, Nepal, IDI
4. Discussion
4.1. Summary of Key Findings
4.2. CTC Providers and Families
4.3. Community
4.4. Health System
- The pandemic trajectory, the magnitude and speed of infection.
- The fragility of the country and how quickly and well the country and health system could respond.
- The resource availability and in particular the ability to provide PPE to health workers including CTC providers, and how this was prioritised.
- The need for multisectoral action in the COVID-19 response, and how to support CTC providers was identified.
4.5. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Site 1 | Site 2 | Total | |
---|---|---|---|
Lebanon | 3 managers of facilities (3M) | 3 managers of organisations providing outreach (3F) | 6 (3F;3M) |
Myanmar | 2 township supervisors (1M; 1F) | Not applicable | 2 (1F;1M) |
Nepal | 1 Sub-health coordinator (COVID-focal person) (M) 1 Ward chair (F) 1 Mayor (M) 1 Health Post In-charge (M) | 1 Health Post In-charge (F) 1 Health Post In-charge (M) 1 Health Coordinator (M) 1 Mayor (M) 1 Public Health Inspector (COVID focal person) (M) | 9 (2F; 7M) |
Sierra Leone | 1 District health Management Team member (M) 1 CTC Peer Supervisor (M) 1 Section Chief (M) 1 Mammy Queen (Chairlady) (F) | 1 District health Management Team member (M) 1 CTC Peer Supervisor (F) 1 Section Chief (M) 1 Mammy Queen (Chairlady) (F) | 8 (3F; 5M) |
Total | 13 | 12 | 25 (9F;16M) |
Site 1 | Site 2 | Total | |
---|---|---|---|
Lebanon | 6 CTC providers (4F;2M) | 6 CTC providers (4F;2M) | 12 (8F;4M) |
Myanmar | 5 CTC providers (4F;1M) | Not applicable | 5 (4F;1M) |
Nepal | 7 FCHVs | 6 FCHVs | 13 (13F) |
Sierra Leone | 1 FGD with women CTC providers (8) 1 FGD with men CTC providers (8) | 1 FGD with women CTC providers (8) 1 FGD with men CTC providers (7) | 31 (16F;15M) |
Total | 34 (23F;11M) | 27 (18F;9M) | 61 (41F;20M) |
No. Documents Reviewed | Types of Documents | |
---|---|---|
Lebanon | 59 |
|
Myanmar | 7 |
|
Nepal | 16 |
|
Sierra Leone | 6 |
|
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Raven, J.; Arjyal, A.; Baral, S.; Chand, O.; Hawkins, K.; Kallon, L.; Mansour, W.; Parajuli, A.; Than, K.K.; Wurie, H.; et al. The Gendered Experience of Close to Community Providers during COVID-19 Response in Fragile Settings: A Multi-Country Analysis. Soc. Sci. 2022, 11, 415. https://doi.org/10.3390/socsci11090415
Raven J, Arjyal A, Baral S, Chand O, Hawkins K, Kallon L, Mansour W, Parajuli A, Than KK, Wurie H, et al. The Gendered Experience of Close to Community Providers during COVID-19 Response in Fragile Settings: A Multi-Country Analysis. Social Sciences. 2022; 11(9):415. https://doi.org/10.3390/socsci11090415
Chicago/Turabian StyleRaven, Joanna, Abriti Arjyal, Sushil Baral, Obindra Chand, Kate Hawkins, Lansana Kallon, Wesam Mansour, Ayuska Parajuli, Kyu Kyu Than, Haja Wurie, and et al. 2022. "The Gendered Experience of Close to Community Providers during COVID-19 Response in Fragile Settings: A Multi-Country Analysis" Social Sciences 11, no. 9: 415. https://doi.org/10.3390/socsci11090415
APA StyleRaven, J., Arjyal, A., Baral, S., Chand, O., Hawkins, K., Kallon, L., Mansour, W., Parajuli, A., Than, K. K., Wurie, H., Yamout, R., & Theobald, S. (2022). The Gendered Experience of Close to Community Providers during COVID-19 Response in Fragile Settings: A Multi-Country Analysis. Social Sciences, 11(9), 415. https://doi.org/10.3390/socsci11090415