Paper short abstract:

This paper looks at the way Community Health Workers operationalize the 'indigent' label in Eastern DR Congo (which officially entitles to rights), and how this affects their actions and positioning in their own communities.

Paper long abstract:

One of the poorest countries on earth, DR Congo nevertheless has a social protection system that officially entitles the most vulnerable fringes of the population, the so-called 'indigents', to free health-care and social services. The determination of who is an 'indigent' and who isn't is usually left to the communities and, in particular, their official Community Health Workers (CHWs -the 'relais communautaires' set up as part of the health system, who also double as Health Facility Committee members). In a context where public funding is very limited, when not simply inexistent, and where health facilities are often hard to reach and disconnected from health district officials, those CHWs are also the ones who determine and implement the indigent policy and coordinate efforts towards the indigents. Reflecting on an NGO intervention designed to increase CHWs' ability to dismantle the social and financial barriers the indigents face in accessing health-care, this paper explores CHWs' understanding of vulnerability/indigence, the concrete indigent-related activities they organise, and their positioning within their communities. The research is located in rural zones of South Kivu, an unstable and violent province of Eastern DR Congo. It shows how indigent-related CHW work provides them with a vehicle for acquiring power and recognition within their community; it also questions the effects of the deliberate and de facto co-optation of "indigents" as CHWs.