Paper short abstract:

This paper uses a biosocial approach to explain the variable forms of care and micro-politics in which Ethiopian community health workers (CHWs) engage, comparing across two contexts: urban CHWs deployed by NGO-government partnerships and rural CHWs deployed primarily by the government.

Paper long abstract:

Across localities, community health workers (CHWs) engage in various forms of care, in relation to locally distinct population health needs and goals. This variation and set of relationships are poorly understood largely due to a lack of comparative biosocial research. And yet CHWs participate--or perform--in more than the delivery of health care. CHWs are political actors. They form opinions on the inequalities they witness. They often desire social change. Even in contexts in which CHWs are not autonomously organized as political forces, such as in Ethiopia, they make small steps towards forming collectives to argue and seek better job conditions. Some emphasize that their job conditions are unfair, and that this impedes their capacities to improve community health and wellbeing. This paper explains the variable forms of care and micro-politics in which Ethiopian CHWs engage, comparing across two contexts: urban CHWs deployed by NGO-government partnerships to perform highly intimate forms of care alongside the roll-out of antiretroviral drugs; and rural CHWs deployed by the government to promote maternal- and child-focused primary health care. A biosocial approach aims in part to identify and understand links between population health, CHWs' capacities and experiences, and officials' and donors' attempts to encourage specific forms of care, discourage collective action, and make programs cost-effective. Such comparative analysis is highly needed to provide insight into the rapidly changing moral and political economies of CHW labor at local and global scales.