Health by and for the community : a socio-anthropological diagnosis of the Community Health Worker paradigm in Côte d'Ivoire

Abstract

Given Sustainable Development Goal 3, which aims to "empower people to lead healthy lives and support the well-being of all people at all ages", the search for solutions to problems of access to healthcare is a concern for humanitarian organisations. This article offers a critical diagnosis of the Community Health Agent paradigm used by humanitarian aid workers to reduce inequalities in access to healthcare in Côte d'Ivoire. A qualitative study combining semi-structured interviews, direct observation and documentary review was used to collect material among the humanitarian, communities, and community workers interacting in implementing this approach in Côte d'Ivoire. As a result, the decentralization of community health by transferring skills to community players, i.e. CHWs, is an innovation that makes it possible to reduce social inequalities in access to healthcare and, above all, to strengthen community resilience. However, the illiteracy of some community players, their lack of financial autonomy and motivation, and logistical difficulties are factors that impact on the effectiveness and sustainability of this innovation. To conclude, the study argues that if the CHW paradigm is to be sustained, it will need to move away from a voluntary paradigm towards the institutionalisation of CHWs by giving them professional status. This also implies implementing a system and mechanisms for recruiting and training these community workers.