By Meghan Bruce Kumar
In March, the REACHOUT consortium gathered in Nairobi, Kenya for our seventh consortium meeting, bringing together health systems researchers, implementers, and policymakers working on community health in six countries. As the world celebrated International Women’s Day, we gathered to discuss the role of gender in the work of Community Health Workers (CHWs) in these diverse contexts. Presentations from the various countries highlighted the fact that the problems were largely common yet solutions were local, demanding a deep understanding of the complexity of the context and individuals involved to be effective over time.
Broadly, our work is mixed-methods implementation research. In qualitative work, we have spoken with communities, health workers, health system managers, and decision-makers at all levels - and of course, with the CHWs who serve at the interface of communities and health systems. Even as we as researchers aggregate these voices into findings relevant to the health system, we feel the power of the individual stories. In the words of Miriam Taegtmeyer, what continues to bubble to the surface is the “moral obligation to ensure the voices of the community health workers are heard in the halls of power”.
What emerges strongly in all countries where we are working is the role of power and politics in achieving local change and system-wide change. Despite the overwhelming prevalence of researchers at the Health Systems Research meeting in Vancouver last November, the key message I came away with was the fact that in many cases, evidence was not the gap. Sometimes, evidence is indeed the foundation of policy, but the policies are not implemented. As Penina Ocholla of Great Lakes University, Kisumu stated: “…all these wonderful policies are gathering dust!”
In “How Change Happens”, Duncan Green emphasizes the importance of “dancing with the system”, embracing complexity and moving away from logical frameworks. This resonated with me on a very deep level. In simple words, REACHOUT supports district health management teams to improve documentation and measurement, bringing data to the forefront of community health systems management. Despite this seemingly straightforward task, we are left with questions that have answers difficult to quantify:
As REACHOUT moves toward the end of its funding period, we actively observe and embrace non-linear pathways to change. These changes come largely through ‘software’ elements of the system like relationships, trust, leadership and mentorship – as well as the fundamental ideas, institutions, and interests that define the system.
This project is funded by the European Union.