Community perceptions of ethics and professionalism of community health workers – a qualitative exploration

Background Community health workers (CHW) work closely with communities and therefore encounter several important ethical issues in their work. Community perceptions about their practice of ethics and professionalism is important. Methods We conducted 4 focus group discussions (FGD) among pregnant women and lactating mothers, 4 FGDs among women in the community, 3 in depth interviews (IDI) among women and 2 IDIs among men in two districts of Tamil Nadu, India. We explored the various practices of ethics and professionalism in these discussions and interviews. We transcribed the data, coded the transcripts, and built themes by combining the codes meaningfully. Results The CHWs ensure good quality of services by effective use of mobile phone and by going beyond the call of duty. They face several challenges in doing good to the community. On the other hand, there were many instances where they failed to deliver their duties which led to harms. Living far away from the community, spending less time there, delegating their work to lay persons all compromised the performance of their duties. CHW’s lack of good communication skills, lack of updated knowledge, and inefficient work were pointed out by the community. Treating the people as mere statistics and not caring for them as people was a reason for dissatisfaction. The quality of a CHW’s work was assessed relatively in comparison with other CHWs who were perceived as good and not in comparison with standards or expectations. Lack of honesty, demanding bribes, disrespectful treatment, discrimination of the marginalized communities, coercion, and lack of privacy and confidentiality were also reported in the CHW’s work. Reports of such unethical practices were more from people belonging to scheduled castes and tribes compared to those from dominant castes. The attributes of professionalism of a CHW reported by the community were altruism, empathy, inspiring confidence and trust, honesty, humility, kindness, relatability, adaptability, care, and tolerance. Conclusions The community identified important good and bad practices among CHWs. There is a need to share this information with CHWs and train them to improve practices of ethics and professionalism in their work.