Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia – BMC Public Health

Sustainable Development Goals and Community Health Workers in Rural Zambia

This report analyzes the roles of Community-Based Health Workers (CBHWs) in addressing adolescents’ Sexual and Reproductive Health and Rights (SRHR) needs in rural Zambia. The findings highlight the challenges posed by sociocultural norms and the dual role of CBHWs as part of the community and the health system. The study emphasizes the importance of CBHWs as boundary spanners and their potential to contribute to the achievement of the Sustainable Development Goals (SDGs).

CBHWs as Boundary Spanners

The study reveals that CBHWs play a crucial role in bridging different arenas, including schools, healthcare facilities, community leaders, and law enforcement. This role as boundary spanners is essential for delivering primary healthcare and reaching marginalized individuals. At the community level, CBHWs link adolescents to parents while navigating sociocultural norms. At the organizational level, they connect adolescents in need of SRHR services with healthcare facilities and support those who dropped out of school to re-engage with education. CBHWs’ ability to span boundaries and foster collaboration is vital for promoting adolescents’ SRHR.

CBHWs: Navigating a Dual Role by Exercising Discretion

The study highlights that CBHWs exercise discretion in providing SRHR information and services and advocating on behalf of adolescents. Their dual role as grandmothers in the community and professional CBHWs in the health system creates both complementary and conflicting expectations. CBHWs tailor their approach to each adolescent, considering sociocultural norms and individual needs. However, limitations in training, resources, and the social context can hinder their effectiveness as boundary spanners.

Limitations and Strengths

This report acknowledges the limitations of the study, including the selection bias towards female CBHWs and the focus on girls’ sexuality. However, the use of a grounded theory approach and theoretical concepts such as boundary spanning and discretion enhances the transferability of the findings. The study provides valuable insights for implementing SRHR interventions and empowering CBHWs in similar contexts. The findings contribute to the achievement of the SDGs, particularly Goal 3 (Good Health and Well-being) and Goal 5 (Gender Equality).

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 4: Quality Education
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs
• Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development
• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences
• Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator 3.7.1: Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods
• Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development, including gender equality and human rights, are mainstreamed at all levels in (a) national education policies, (b) curricula, (c) teacher education, and (d) student assessment
• Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care
• Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities

4. Table: SDGs, Targets, and Indicators

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Fuente: bmcpublichealth.biomedcentral.com

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