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