"Empowering Change: Story of a Heroine of Community Health”
Female community health workers create a bridge to health services and challenge social norms in Guinea Bissau
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In Clonato an ordinary day begins to weave its tale. This small vibrant community, a cornerstone of the Biombo region, embodies a mix of both urban and rural characteristics, where the socio-economic and cultural dynamics of Guinea-Bissau meet a way of life shaped by nature and tradition.
Lunchtime brings the house of Francisca Silva to vibrant life. The laughter and cries of her five children fill the air, creating a metaphorical welcoming wave for Lariza Cabral, 36 years old, a local community health worker. Her mission extends beyond mere visits; Lariza is dedicated to checking on the well-being of families, bringing health knowledge, and educating her neighbors on preventive and promotive health practices. She asks about changes in the number of family members and their health status, conducts a series of screening tests to identify health issues early, and discusses any health concerns with the families. Lariza has also taken on the vital task of informing families about the importance of COVID-19 vaccinations, ensuring her community stays protected against the pandemic’s far-reaching impacts.
Her commitment to families’ well-being, marked by regular check-ins with households, make her a trusted person, a figure transcending the role of a simple health worker. She is someone whose advice and services count, not just to Francisca but to many other families in the community. Should they need to seek treatment from health services, she will be there for them.
Yet, Lariza’s journey to become a reliable person in the heart of her community has encountered more than a fair share of bumps in the road.
"At first it was difficult because people didn’t want to listen to me and sometimes made nasty comments”, - she says. Nonetheless, overcoming moments of discouragement and doubt, Lariza persevered, earning the trust and respect of her community over time. Her awareness work focuses on topics such as hygiene, nutrition, and disease prevention – especially malaria, diarrhea and pneumonia. She tailors her messages to resonate with the concerns of mothers, pregnant women, and caregivers.
"It's easier to talk to women because they are more patient and they're the ones who take care of others, especially children."- Lariza explains - "Women feel comfortable talking to me”.
"Women feel comfortable talking to me”.
Community health workers play a crucial role in Guinea Bissau, where the quality of and access to primary health services often result in significant challenges for the people. There are around 2400 community health workers in this small West African country, a number that falls drastically short, particularly considering that the majority of communities (66%) are situated in remote, hard-to-reach rural areas where it is common to have to walk for more than an hour to reach the nearest health center. Their job transcends the ordinary, embodying a mission in the truest sense. They serve as a vital link between communities and formal health services, fostering trust in a primary healthcare system that is only now beginning to recover from decades of neglect.
Adding to these challenges, another deep-seated issue further complicates the landscape. Lariza is an exception in her field: she is among the 16% minority of community health workers who are women, a stark contrast to the global average of 70%, highlighting a pronounced gender imbalance. She is committed to serving her community as a volunteer, despite the modest financial compensation of just 10,000 XOF (approximately USD 16) per month. The lack of economic empowerment and financial incentives poses significant challenges, and Lariza, a single mother, supplements her community duties by selling homemade palm wine and cakes to provide for her daughter. However, this doesn’t discourage her. As she proudly emphasizes, her motivation stems from a desire to serve her community rather than financial gain, a sentiment that fills her daughter and her family with pride.
Gender parity remains utopian in Guinea Bissau, hindered by entrenched social norms, traditions, and stereotypical gender roles. This is shown by preliminary data from a UNICEF evaluation study on the “Expanded Program on Immunization Strategic Communication Plan of Guinea-Bissau”. This study, alongside support for integrating COVID vaccines into the routine immunization program, stands as a notable achievement of the financial grant from the Government of Canada. It reveals that a partner's perceptions can significantly influence the success of female community health workers, serving either as a barrier or a catalyst. Marriage, influenced by social pressures and entrenched gender norms, often becomes an obstacle, with some women compelled to abandon their community worker roles post-marriage due to these challenges. This issue is further exacerbated by the widespread lack of autonomy among women.
The selection process for community health workers starkly illustrates these gender-based challenges. Decisions made by traditional leaders, known as the Chief of the Tabanka or the Committee, often reflect prevailing gender norms and biases. These leaders tend to select men over women, influenced by concerns that the responsibilities associated with being a community health worker might conflict with societal expectations placed on women. In the area of Ilondé, which includes Lariza’s community, this bias is evident as only 8 out of the 24 community health workers are female.
When Lariza was nominated by her Chief of the Tabanka, she experienced a mix of rational skepticism and instinctive hope. Despite being acutely aware of the traditional barriers, her enthusiasm and the smoldering hope to actively contribute to her community's well-being remained undeterred.
Destiny however, intervened positively, clearing the path for her unexpected appointment when the nominated candidates, both men, stepped aside. Now, four years into the job, Clonato’s Chief of the Tabanka acknowledges unreservedly Lariza’s accomplishments. “She has helped many patients who don't go to the health center and just stay at home” - says 56-year-old Inacio Cabral. The changes in both behavior and health within the community since Lariza began her work are clear to everyone.
Community health workers play a crucial role in Guinea Bissau, where the quality of and access to primary health services often result in significant challenges for the people.
UNICEF has been supporting the government of Guinea Bissau in developing strategies and policies for community health programs within the national health system. Now, with the generous Canadian support, UNICEF aims to address the gender-related constraints faced by female community health workers and strengthen their role in the health system. By promoting social and behavioral change, UNICEF seeks to integrate gender-sensitive primary health care services in Guinea Bissau, empowering women like Lariza to fulfill their vital roles.
By promoting social and behavioral change, UNICEF seeks to integrate gender-sensitive primary health care services in Guinea Bissau, empowering women like Lariza to fulfill their vital roles.
Counting with the support of community health workers, UNICEF is also advocating for the integration of COVID-19 vaccination into the national routine immunization programs, so everyone can have access to it. Thanks to Canadian support, the aim is to not only increase equitable access to and uptake of COVID-19 vaccines but also strengthen the resilience of the health system, while reaching the global recommended level of vaccination.
Back in Francisca's home, Lariza continues her work, surrounded by a symphony of curious young eyes, all observing with admiration this authoritative figure in the community. Francisca asks her advice on breastfeeding because her one-year daughter has not been weaned yet. Lariza patiently explains how to introduce other foods into the baby’s diet, taking care of her nutritional needs. It’s little touches like these that show how personalized her support is. A significant member of her community, an undaunted female health worker.
