Examining intersectoral collaboration among volunteer community health workers to address maternal and child health in resource-constrained settings in the Philippines: A qualitative study

• In Event: Sustainability, volunteers and NGOS

Abstract

Achieving the health-related Sustainable Development Goals (SDGs), particularly those related to maternal and child health, requires meaningful collaboration between different sectors (Hussain et al., 2020). Community health workers (CHWs) are uniquely positioned within their communities, typically as volunteers, to act as an intersectoral bridge and catalyst for collaborative efforts to improve maternal and child health (Dodd et al., 2021). While volunteer CHWs are widely recognized as crucial actors in the health workforce (Kane et al., 2021; Palafox et al., 2021), particularly in contexts with decentralized public health systems (Atienza, 2004; Dodd et al., 2021), a need exists to critically examine the strategies they employ to facilitate intersectoral collaboration and improve maternal and child health, with an eye to informing the expansion of these volunteer programs across resource-constrained contexts.

This study was anchored by a partnership with a Philippines-based, non-governmental organization (International Care Ministries) and embedded within their ‘Community Health Champions’ (CHW) program, a program that trains and supports volunteer CHWs. In April 2023, CHWs from six locations in Negros Oriental, Philippines were recruited for 11 participatory focus groups (n=75 CHWs) and 64 semi-structured interviews. Data collection focused on strategies used by CHWs to collaborate across sectors to improve maternal and child health. Focus groups and interviews were audio-recorded and transcribed. Transcripts were thematically analyzed using a hybrid inductive-deductive approach (Fereday & Muir-Cochrane, 2006). Ethics approval was provided by the University of Waterloo, Canada (#44828).

CHWs (all female; ages 21-60) facilitated linkages between communities, non-governmental organizations, and the local public health system vis-à-vis working alongside public sector healthcare workers to identify individuals in need of support and to provide treatment or referral to formal care. This collaboration enabled a continuity of care, with CHWs viewing their role as addressing existing gaps within the public sector. Critically, CHWs' positionality and social networks held within communities shaped the degree and quality of intersectoral collaboration. The CHW volunteer role was one of many held by some participants (e.g., leader in a local savings group; employee within the municipality) which facilitated collaboration across sectors. Most CHWs were embedded within communities where they both lived and worked, and thus had expansive social networks to draw upon to facilitate intersectoral collaboration. All CHWs exhibited motivation to care for their communities, which shaped the overall quality of collaboration.

Meeting the child and maternal health-related SDGs across resource-constrained settings demands intersectoral collaboration. This study highlights strategies used by volunteer CHWs as they embody and embed intersectoral collaboration in their efforts to enhance maternal and child health in resource-constrained settings in the Philippines. Opportunities exist to further amplify these efforts and support volunteer CHWs to act as a bridge across sectors. In particular, focused training and material resources could extend CHWs' impact in bridging communities, local health systems, and non-governmental organizations to improve maternal and child health. Within these efforts, further research is needed to examine and understand the role of social networks, trust, and pre-existing relationships in shaping the capacity of volunteer CHWs with respect to intersectoral collaboration.

References

Atienza, M. E. L. (2004). The politics of health devolution in the Philippines: Experiences of municipalities in a devolved set-up. Philippine Political Science Journal, 25(48), 25–54. https://doi.org/10.1080/01154451.2004.9754256

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Hussain, S., Javadi, D., Andrey, J., Ghaffar, A., & Labonté, R. (2020). Health intersectoralism in the Sustainable Development Goal era: From theory to practice. Globalization and Health, 16(1), 1–5. https://doi.org/10.1186/s12992-020-0543-1

Kane, S., Radkar, A., Gadgil, M., & McPake, B. (2021). Community health workers as influential health system actors and not “just another pair of hands.” International Journal of Health Policy and Management, 10(8), 465–474. https://doi.org/10.34172/ijhpm.2020.58

Palafox, B., Renedo, A., Lasco, G., Palileo-Villanueva, L., Balabanova, D., & McKee, M. (2021). Maintaining population health in low- and middle-income countries during the COVID-19 pandemic: Why we should be investing in community health workers. Tropical Medicine and International Health, 26(1), 20–22. https://doi.org/10.1111/tmi.13498

Authors

• Laura Jane Brubacher

• Lincoln Lau, International Care Ministries

• Monica Bustos, University of Waterloo, Canada

• Matthew Little, University of Victoria, Canada

• Warren Dodd, University of Waterloo