17
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      ‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

      research-article
      a , *
      Global Public Health
      Routledge
      integration, community health workers, trust, teamwork, India

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.

          Related collections

          Most cited references33

          • Record: found
          • Abstract: found
          • Article: not found

          'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa.

          This study investigates how a group of nurses based in busy urban primary care health clinics experienced the implementation of the free care (the removal of fees) and other South African national health policies introduced after 1996. The study aimed to capture the perceptions and perspectives of front-line providers (street-level bureaucrats) concerning the process of policy implementation. Using qualitative and quantitative research methods, the study paid particular attention to the personal and professional consequences of the free care policy; the factors which influence nurses' responses to policy changes such as free care; and what they perceive to be barriers to effective policy implementation. The research reveals firstly that nurses' views and values inform their implementation of health policy; secondly that nurses feel excluded from the process of policy change; and finally that social, financial and human resources are insufficiently incorporated into the policy implementation process. The study recommends that the practice of policy change be viewed through the lens of the 'street-level bureaucrat' and highlights three sets of related managerial actions. Copyright 2003 Elseiver Ltd.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Trust relations in health care--the new agenda.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Vaccinations in the Third World: a consideration of community demand.

              M Nichter (1995)
              Impressive increases in immunization rates have been reported in several less developed countries (LDCs) as a result of intensive EPI programs. An issue arises as to whether existing rates of immunization coverage can be sustained/increased given projected cutbacks in funding. This issue calls into question the assumption that as immunizable disease rates fall, local populations will need less encouragement to secure immunization services. This article considers how immunizations are perceived by lay populations and how perceptions of utility and need effect demand which in turn effects the sustainability of EPI programs. Among issues addressed is the observation that when specific diseases are not linked to specific immunizations, misimpressions related to the number of immunizations needed for "good health" abound. Also considered are metamedical reasons immunizations (and immunization programs) are both resisted and demanded in particular political contexts.
                Bookmark

                Author and article information

                Journal
                Glob Public Health
                Glob Public Health
                RGPH
                rgph20
                Global Public Health
                Routledge
                1744-1692
                1744-1706
                14 September 2014
                15 July 2014
                : 9
                : 8 , Critical Ethnographies of Health Systems Policies and Practices
                : 960-974
                Affiliations
                [ a ]Health, Nutrition and Development Initiative, Azim Premji University , Bangalore, India
                Author notes
                Article
                934877
                10.1080/17441692.2014.934877
                4166967
                25025872
                5e2ce1d2-17a5-48fd-a406-f8c96de5c639
                © 2014 The Author(s). Published by Taylor & Francis.

                This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.

                History
                : 15 November 2013
                : 13 May 2014
                Page count
                Figures: 0, Tables: 0, References: 35, Pages: 15
                Funding
                Funding: This research has been funded by the Norwegian Research Council's Global Health and Vaccination Research programme (GLOBVAC) as part of a larger research project [grant number 196382] on Health systems strengthening within vaccination programmes: an ethnographic study.
                Categories
                Original Articles

                Public health
                integration,community health workers,trust,teamwork,india
                Public health
                integration, community health workers, trust, teamwork, india

                Comments

                Comment on this article