“Treat Them with Love:” empowerment of village health workers as agents of transformation

Background: Over the last 40 years the Jamkhed Comprehensive Rural Health Project (CRHP) has been a leading NGO at empowering poor and oppressed women as village health workers (VHWs) and agents of transformation. A 2006 WHO report described the effectiveness of empowerment to improve health. While characteristics associated with empowerment are known, methods required to achieve empowerment have seldom been studied in detail. Objective: To define a benchmark level of women's empowerment for community-based health and development projects in marginalized communities and to link this to adult learning strategies developed by CRHP. Methods: Utilized qualitative research methods, including focus groups with 18 VHWs. Focus group participants were stratified by years of experience to observe for differences in empowerment strategies over the past 40 years. An empowerment survey developed by Carl Taylor in Afghanistan was adapted to measure these elements in Jamkhed with semi-structured interviews for 11 of 18 VHWs. Results: A highly consistent level of empowerment is observed among all participants despite changes in learning styles, trainers, health concerns of villages partnered with CRHP. This empowerment process has resulted in lowering of IMR from 176/1000 in 1971 to 24/1000 in 2007 and a near elimination of childhood malnutrition, among many other health and social achievements. Conclusion: An environment conducive to learning, self-development and creative expression is a powerful tool for community-based organizations to facilitate a measurable empowerment process. The Jamkhed VHWs, many of whom represent oppressed women, were able to become bold and proactive leaders and agents of social transformation.