Community health workers (CHWs) usually form the backbone of the primary health care system, especially in an underserved and remote region. They make long journeys to attend to patients, administer health care in very difficult conditions and take up the emotional and psychological stress of the whole community. However, besides their selfless dedication and perseverance, there is one important question that has not been raised, who takes care of the takers?
CHWs experience burnout and secondary trauma along with the isolation and systemic negligence qualities, there is a lack of proper support structures when it comes to addressing the well-being of CHWs specifically. Service delivery outcomes are what institutions, policymakers and health systems tend to drive without acknowledging the human cost incurred by those frontline caregivers.
Understand more about the conditions that community health workers have to deal with and what must be improved.
This article goes into the insider perspective of the invisible burden that CHWs are shouldering and outlines sustainable methods of institutional and community level support that recognize and appreciate the mental, emotional, and psychological health of CHWs.
The Unseen Strain Behind the Smiles
In the eyes of the world, community health workers are pleasant faces who introduce vaccines to the home, point pregnant women to the clinic, or lead the fight against malaria. The emotional labor that they have to experience is something that is not visible:
- Providing space for bereaved parents in their loss of a maternal or child Death
- Helping people undergo gender based violence
- Dealing with anger of patients that are irritated by system inadequacies
- Losing things due to lack of infrastructure and getting affected by severe poverty
CHWs have no formal channel of addressing these experiences and thus many of them keep the pain and end up burnout and depression and ultimately drop out of the work they love doing.
The Absence of Formal Support Systems
Although it is much needed, CHWs often lack the form of support that other medical workers enjoy. Some of the remaining gaps are:
- No Routine Debriefing Sessions
CHWs unlike doctors or nurses in hospitals do not have organized debriefing rooms to unwind the emotional and ethical dilemma that their job exposes them to. Following a difficult case, they just move to the next assignment.
Consequence: These pent-up feels build up and result in a mental burnout, lack of compassion and chronic psychological suffering.
- Lack of Counselling or Mental Health Services
CHWs are also not given priority over other beneficiaries of healthcare even in communities where healthcare offers are accessible. Their work is to assist others, but in case they suffer trauma or depression, then the support systems may not be accessible to them.
Consequence: Numerous individuals resort to being solitary, to using ineffective coping techniques, or they leave the profession altogether.
- Missing Peer Mentorship Structures
New CHWs frequently find themselves in the field without adequate preparation on the human challenges that will confront them without any formal peer mentoring program. In absence of mentorship the learning process becomes more difficult and lonelier.
Consequence: Fear of greater results, avoidable errors as well as an increase in the dropout rates.
What Community Health Workers Are Saying
A desire to act, of a similar grain and reflection, follows surveys and field interviews in a number of low- and middle-income countries.
“We take care of the sick, the poor and the voiceless. In our own cases though, there is no one to complain to when we are the ones breaking down”.
Most of the CHWs have said that they feel unseen by the systems they serve. They are supposed to take care of others, educate, mobilize and keep records but are hardly ever appreciated as people who need to be taken care of emotionally and mentally.
Why Supporting CHWs Matters
CHWs cannot be left alone to fend on their own, beyond being just being a case of compassion, it is a case of system sustainability.
✅ Improved Retention
By staying in their roles, CHWs become less likely to turnover and this saves the cost of hiring and training new employees.
✅ Enhanced Quality of Care
Workers who are in good mental health give patients more humane, patient-centered, and precision care.
✅ Community Trust
The supported CHW can become more active and will not violate trust and are more effectively connected to the community.
Rethinking Support: Strategies for Sustainability
We have to develop it into a kind of institutionalization of emotional support as the fundamental component of community health programs, if we are going to abandon lip service in favor of actual change. The below solutions can be implemented on a sustainable, scalable basis:
- Trauma Informed Care Training
CHWs are in a continued trauma state- it could be the experience of child abuse as they witness it, it could be the handling of cases of domestic violence or handling epidemics. However, very few receive training on how to comprehend these psychological consequences of the trauma on either the patients or themselves.
Solution:
Trauma informed care modules are introduced into community health worker training curricula. This all include:
- Identifying trauma indicators and self-indicators in the clients
- Putting through skills for emotional regulation
- Developing safe communications and referrals to the mental health care
This enables CHWs to take care of their own safety as they are giving more delicate care.
- Regular Mental Health Check-in’s
Like screening of physical health done, similar mental wellness check-ups should be created regarding CHWs. These may be quarterly or bi-annual or only when needed and it entails:
- Secret chat with the professionals of mental health sector
- Equipment’s on assessing burnout, stress or depression
- Referrals for supports and therapy groups when mandatory
Long Term Benefits: Prevention of mental health emergencies and a long-term approach to the sustainability of careers may be conducted before mental breakdowns as a result of early intervention.
- Peer Support Circles
The idea of peer support is one of the most successful and most cost-effective ways to enhance mental health. Community health workers may meet in short, facilitated groups:
- Share field journeys
- Run hard emotions
- Problem solving strategies being exchanged
Professional facilitators can conduct these sessions and can be informed by straightforward structures to make the dialogue friendly and efficient.
Bonus: There is also increased information-sharing, decreased isolation, and development of solidarity through peer networks.
- Institutional Recognition and Appreciation
In some cases, the process of support starts with validation. Most CHWs do not feel that they are visible since their efforts are not being recognized publicly.
Proposed actions:
- Recognition awards monthly/quarterly
- CHWs may share their stories by sharing their successes on it
- Inclusion in health planning meetings and policy discussions
appreciation will not stop burnout, however, it aids in regaining sense and dignity.
- Access to Counselling Services
To disregard hosting counselling programs to CHWs should be done in collaboration with NGOs or university or governmental agencies where this counselling is to be affordable or free. This may be:
- Therapy ran one on one
- Family therapy (of the CHWs who have to work on work-life balance pressure)
- Hotline services in times of health emergency
With normalization of counselling, more CHWs will be treated at the initial stages without relying on stigmatization.
- Community Based Resilience Programs
There is another aspect that communities can contribute in taking care of their own CHWs. One does not have to rely on institutions to build resilience. Local adaptations interventions involve:
- Days for community appreciation
- By the village committees, rotational breaks are held.
- Distribution of loads through collective care of the team members
These little gestures amount to a culture of mutual caring where CHWs are not only perceived as workers, but as everyone who is important to the society.
Case Example: A Working Model from Kenya
A community-based program in rural Kenya launched the use of Compassion Circles by means of CHWs. CHWs assembled with one level of trained facilitator within an interval of two weeks where they would:
- Process out difficult cases emotionally
- Reflecting and meditate
- Sharing copy strategies
With a two-year assessment, the following results were uncovered:
- 38 percent decrease in the burnout factors
- Retention increase of community health workers
- Bigger satisfaction scores from patients (due to enhanced community health worker engagement)
This type of models demonstrates that investing in your emotional health, is to get a return in concrete terms.
Barriers to Implementation and How to Overcome Them
The implementations of such strategies do not come without a challenge. The following are some of the typical obstacles:
🚫 Limited Funding
Solution: Treat CHW help as a part and parcel of quality care. Promote emotional well being packages with the support of donors.
🚫 Cultural Stigma Around Mental Health
Solution: Make use of native fragile language such like “strengthening,” “resilience” or “peer wellness” to adhere adoption.
🚫 Policy Neglect
Solution: Push for community health worker enforcement in health forum policies to voice supporting needs directly.
A Call to Institutions, Policymakers, and the Public
Provided that community health systems have the hope to become successful, one should not forget about the following truth:
“You can’t pour from a cup that is already empty”
CHWs do the most emotionally challenging and physically taxing aspects of health care that we ask of them. The negligence of their request to receive care is neither morally upright nor even sound-minded strategically.
- The ministry of health ought to cater to emotional wellness within the CHW training and supervision.
- Resilience and trauma care programs are an essential part of health initiatives that should be financed by donors.
- Societies are supposed to respect, defend and take care of the caregivers.
Since when caring about those who care about others, everybody gains.
Conclusion
Community health workers work with energy, heart and determination. However, beneath the courage are the wounds, the tiredness and the silent struggles that remain hidden and unresolved most of the time. It is high time to realize that emotional support is no luxury anymore, this is something essential.
Trauma informed training, mental health check ins, peer circles and community recognition, we must make a system that takes care of the care takers. It is only then that we will be able to have not only efficient health systems, but also human ones.
