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‘You must make a plan or [...] some story’: Community Health Workers’ Re- appropriation of the Care Manual

‘You must make a plan or [...] some story’: Community Health Workers’ Re- appropriation of the Care Manual

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This paper investigates community health workers’ negotiation between the prescribed ‘manual’ for care and the lived realities of their field, exploring how standards of public health are re-appropriated through the micro-politics of everyday practice. What inventiveness, agency and tactical maneuvers are woven between abstract ideals and situational demands and what are the implications for our understanding of carework? The paper shows community health work, as a model for care, to be complex and demanding – a composite of practices prescribed by a range of institutions with diverging interests. To add to this, this onerous care manual is expected to be delivered by a cadre of lay health workers positioned at the interface between communities and clinics - with minimal training, limited resources and little authority. Within this demanding occupational terrain, careworkers have crafted space for agency and tactics. Through a series of improvisations, respondents mediate between the often-incongruent demands of patients, employers, funders and state policy, whilst also negotiating their own self-care and aspirations for upward mobility. In a policy context that has sought to standardise, systematise and regulate carework, this practice is contrastingly inventive and adaptive. The makeshift, unplanned and chancy nature of carework is often far from its original design, calling into question how the success of this model should be understood.
This paper investigates community health workers’ negotiation between the prescribed ‘manual’ for care and the lived realities of their field, exploring how standards of public health are re-appropriated through the micro-politics of everyday practice. What inventiveness, agency and tactical maneuvers are woven between abstract ideals and situational demands and what are the implications for our understanding of carework? The paper shows community health work, as a model for care, to be complex and demanding – a composite of practices prescribed by a range of institutions with diverging interests. To add to this, this onerous care manual is expected to be delivered by a cadre of lay health workers positioned at the interface between communities and clinics - with minimal training, limited resources and little authority. Within this demanding occupational terrain, careworkers have crafted space for agency and tactics. Through a series of improvisations, respondents mediate between the often-incongruent demands of patients, employers, funders and state policy, whilst also negotiating their own self-care and aspirations for upward mobility. In a policy context that has sought to standardise, systematise and regulate carework, this practice is contrastingly inventive and adaptive. The makeshift, unplanned and chancy nature of carework is often far from its original design, calling into question how the success of this model should be understood.

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Categories:Types, Research
Published by: Centre for Social Science Research on Nov 23, 2012
Copyright:Attribution Non-commercial

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05/13/2014

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 CENTRE FORSOCIAL SCIENCE RESEARCH
‘You must make a plan or [
] somestory’: Community Health Workers’Re-appropriation of the Care Manual
 
Elizabeth ValeCSSR Working Paper No. 312November 2012
 
 
Published by the Centre for Social Science ResearchUniversity of Cape Town2012This Working Paper can be downloaded from:http://cssr.uct.ac.za/pub/wp/312/ISBN 978-1-77011-266-7© Centre for Social Science Research, UCT, 2012
 
 About the Author:Elizabeth Vale was a postgraduate student at the University of Cape Town. Thispaper is based on her Masters dissertation on understandings and experiences of care amongst community health workers in Cape Town, South Africa. She is now aPhD student at Oxford University in the UK.
 
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‘You must make a plan or [
] somestory’: Community Health Workers’ Re-appropriation of the Care Manual
Abstract
This paper investigates community health workers’ negotiation between the prescribed ‘manual’ for care and the lived realities of their field, exploring how standards of public health are re-appropriated through the micro-politics of everyday practice. What inventiveness, agency and tactical maneuvers arewoven between abstract ideals and situational demands and what are theimplications for our understanding of carework? The paper shows communityhealth work, as a model for care, to be complex and demanding – a composite of  practices prescribed by a range of institutions with diverging interests. To add to this, this onerous care manual is expected to be delivered by a cadre of layhealth workers positioned at the interface between communities and clinics -with minimal training, limited resources and little authority. Within thisdemanding occupational terrain, careworkers have crafted space for agencyand tactics. Through a series of improvisations, respondents mediate betweenthe often-incongruent demands of patients, employers, funders and state policy,whilst also negotiating their own self-care and aspirations for upward mobility. In a policy context that has sought to standardise, systematise and regulatecarework, this practice is contrastingly inventive and adaptive. The makeshift,unplanned and chancy nature of carework is often far from its original design,calling into question how the success of this model should be understood.

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