Empowerment-washing: A Critical Systematic Review of Community Health Worker Participation in Program Planning and Case Study of an Non-Governmental Organization's Experience

While many Community Health Worker (CHW) programs globally utilize the language of empowerment justified through “participation”, it is unclear how programs define, incorporate and measure participation. MeSH, CINAHL and PubMed were searched for publications in the last 20 years with terms related to participation and empowerment, cross-referenced with common descriptors for CHWs employed in the health and development literature. 382 articles met criteria, and 141 were selected for review. Two independent reviewers evaluated articles to analyze the type, extent and location of CHW participation.  Evaluation strategies and evidence of benefit were recorded and compiled, where possible.  “Model” participatory CHW programs were identified and separately reviewed through surveying 5 leaders in the field, and these programs were compared to the academic literature. The majority of surveyed programs had low participation in all program cycle areas except implementation, with minimal tracking of CHW participation. The vast majority lacked strategies to rigorously evaluate “participation” or its benefits, regardless of the type (“horizontal” vs. “vertical” programs) but not the organization of the program. Fewer still of the programs that utilized empowerment language attempted to define or measure empowerment. The presenters include the directors of a nonprofit in rural Nicaragua that has iteratively increased the involvement of CHWs in program planning and implementation. In the final part of this presentation, a Nicaraguan CHW who became the local Program Director of a non-profit collaboration between UCSF graduate students and local Nicaraguan organizations will present his experience and recommendations for maximizing meaningful participation.