Effects of an Intervention to Enhance Frontline Health Worker Power and Agency

• Main Author: Curry, Dora Estelle Ward
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2022
• Subjects: Health care management; Medical personnel; Public health; Social psychology
• ISBN: 9798834013174

Background: This work assesses the effects of the Skilled Health Entrepreneur (SHE) program in Sylhet District, Bangladesh. The SHE program prepared community-based skilled birth attendants (SBAs), known as SHEs. The SHEs offered safe home-based delivery, and the program incorporated activities designed to increase the power of the SHE in their social context. This work 1) described the elements of the program focused on increasing the SHEs’ power and agency; 2) examined whether the SHE program increased the social power of the SHEs, and 3) assessed the increase in autonomy among women in the communities served by the SHEs. Methods: This dissertation consists of three manuscripts: one describing this novel intervention in detail, a second analyzing the change in power and agency in SHEs, and the third analyzing the change in agency in women in the communities serviced by the SHEs. The first was a summary of relevant literature and an in-depth desk review of project documentation. The second analyzed short panel data from 252 SHEs at two points in time using a fixed-effects panel analysis. The third analysis tested the increase in decision-making power among respondents to household surveys conducted at baseline and endline in a logistic regression analysis. Results: The SHE program built SHEs’ entrepreneurial skills, professional confidence, and individual decision-making. This approach supported women from the community in becoming recognized, health workers linked to the public system, and securing their livelihood. Monthly earnings, professional engagement, and independent decision-making increased significantly among SHEs. The analysis found a significant increase in women's autonomy in the project area. Conclusions: The design of this intervention meaningfully increased agency, income, and professional engagement among the SHEs in a project that also successfully improved maternal health outcomes. Designing SBA interventions that increase their power in their social context shows the potential to expand their economic independence and reinforce positive gender and power norms in the community. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors may offer a model for other women in their own lives.