Task Shifting, Tools, and Tactics: Investigating the Collaborative Practices of Community Health Workers in India

Abstract

In this study, I investigate the work practices of health workers across five different health centers in India in rural, peri-urban, and urban settings. Study methods includes a clinic site survey, semi-structured interviews, and direct observations. Participants included 26 health workers in roles such as medical officers, lab technicians, junior health assistants, and supervisors. I use critical theory such as De Certeau’s concepts of strategies and tactics, and feminist standpoint theory to understand how health workers navigate the challenges of their daily work. The findings of this study show that: (a) the structural conditions in which health workers work strongly shape their responsibilities; (b) health workers depend on a range of collaborative practices to accomplish their work; and (c) the information tools they use both help and hinder their ability to navigate these challenges. Finally, this study identifies four kinds of practices that health workers employ to confront these challenges. These practices include resistance, making work meaningful, self- representation, and reconfiguration. Understanding these practices can thus be used to develop more impactful technologies for global health.