| Selection and recruitment |
Partnerships and role modelling at community level to support women to come forward to become CHWs and communities to endorse that this is important. Ensuring women’s active participation in community dialogue via the creation of spaces where women are listened to and feel comfortable to talk. Training with community leaders and communities on gender and power relations, roles of CHWs to ensure women have equal opportunity for selection9. Ensuring that there is preferential hiring of women CHWs until gender parity is reached.
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| Remuneration |
Commitment of governments to reliably provide allowances for all CHWs is important—there is a need to consider the financial package to remunerate CHWs as a part of the overall health system planning44—but this is challenging in some FCAS settings where health workers on the payroll are not being regularly paid. In the meantime, local level initiatives are critical in supporting women and men CHWs, such as support for income generation through farming collectives, seed funding for enterprises as seen in Sierra Leone with rearing poultry.
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| Training |
Flexible module-based training processes that are close to CHW homes to avoid long periods of time away from family and other responsibilities, which may be particularly challenging for women. Embedding literacy skills as part of the CHW training programme (eg, Liberia) can help address the literacy gaps which disproportionately affect women (this is also likely to improve recruitment parity).
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| Promoting safety and security |
Male–female CHW pairs to support safety when travelling far or at night can be a helpful ‘sticking plaster’ in the short term and may also help support community acceptability. However, there are risks that need to be carefully thought through, as this may leave female CHWs vulnerable to abuse. Creation of safe spaces in/near health facilities for CHWs to stay overnight when attending delivering women at night. Longer term solutions are required too that should focus on community sensitisation and multi-sectoral action to address gender based and violence9.
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| Career progression |
Support for female CHWs who are juggling multiple responsibilities, so that they can undertake further professional development such as literacy or health topics training. Support through mentorship, that can potentially lead to senior CHW roles and other roles in the health system. Preferential hiring of female supervisors until gender parity is reached—so women can see themselves in positions of authority/leadership.
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| Supervision |
Ongoing regular supportive supervision processes that include space to reflect and problem solve on how gender norms shape CHWs own experiences and those of the communities they serve. Development of peer support strategies which have strong potential as demonstrated by the group discussions in photovoice. Sustained reflective practice: It takes time to challenge gender norms, to learn about what works, and how to respond to changing contexts.
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| Contracts |
Contracts should be issued to formalise labour rights for CHWs, such as maternity and paternity leave9. These contracts could also provide a framework to recognise flexible working approaches that support CHWs to balance community health work with domestic responsibilities.
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