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Metrics details. Although large scale public sector community health worker programs have been key in providing sexual and reproductive health SRH services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants CHAs gained entry and acceptability into community health systems to provide SRH services to youth in Zambia.
A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically. In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders.
CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth.
Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits.
Limitations to the acceptability of CHA-driven SRH services are a product of challenges both in the community and in the formal health system. We conducted a qualitative study to identify the conditions and strategies through which community health assistants CHAs gain entry and acceptability in community health systems for promoting sexual and reproductive health SRH in Zambia.