Center for Social Entrepreneurship

at Middlebury

Svea Closser

Listening to Community Health Workers
CSE Friday Speaker Series: Professor Svea Closser
April 25, 2014

            Public health in the developing world has been revolutionized by technological innovation. Vaccines for some of the most deadly diseases, like polio and tuberculosis, can be produced for mere cents. A yearly course of antiretroviral drugs (ARVs) used to treat the symptoms of AIDS used to cost tens of thousands of dollars. Now, a yearly course of ARVs cost less than 500 dollars. The result of this rapid biomedical progress has been giant leaps in health outcomes in the developing world. The AIDS epidemic that swept through Africa in the late 1990s and early 2000s is now under control. After vaccination campaigns around the world, it seems that polio could finally be eradicated.

The success of the recent push to improve public health in the developing world is due in large part to the resurgence of community health workers (CHWs). These health professionals are individuals who work on the ground within their communities to administer healthcare. CHWs are equipped with innovative treatments, vaccines, and tests that do not require the infrastructure of a hospital.

Although essential in this grassroots approach to delivering healthcare in developing countries, CHWs are often over-looked by those planning the projects. On Friday, April 25, Middlebury College Professor Svea Closser gave a talk entitled “Listening to Community Health Workers.” Professor Closser drew upon her own research on polio eradication campaigns in Pakistan and research from two fellow scholars who worked in Addis Ababa, Ethiopia and Chimoio, Mozambique.

Individuals are drawn to become CHWs for many reasons. Some are survivors of conflicts who want to help their country heal. Some wanted to become doctors but could not afford it. Many women become CHWs because it is one of the few professions available to them. One woman in Karachi said that her daughter’s death led her to become a CHW.

CHWs report that they feel under-appreciated. They lack opportunities for advancement. They are often not paid well. In Pakistan in 2012, CHWs went on strike. They were protesting the lack of pension and the lack of maternity leave. Their salaries had been in arrears for months. There had also been a recent string of murders against polio vaccinators, but vaccinators were told that they had to continue to work or they would be fired.

Listening to CHWs and knowing their stories enables planners to utilize their potential. CHWs can also provide a valuable perspective on healthcare projects that can help planners make interventions more effective. In surveys, CHWs report that human relationships are more important than the technology they are using. Professor Closser believes that “big ideas should start with listening to the people we’re meant to serve, not exciting technological innovations.” Those working closest with the ones we are meant serve are CHWs. We not only have an ethnical obligation to listen to CHWs but also a practical one. To demonstrate this belief, Professor Closser teamed up with Professors Carpenter and Gong of Middlebury’s Economics department to apply for research funds from the World Health Organization (WHO) to examine health outcomes when CHWs were better compensated.

Professor Closser’s work is an example of using academic research to make policy more effective. She has translated her skills into positive social change, which is the core of social entrepreneurship. We’re honored to have Professor Closser here at Middlebury, and we wish her all the best with her valuable work.

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