# The key role of Community Health Workers in the use of maternal services in rural settings: a Qualitative Study

## TL;DR

This study explores how community health workers help improve access to maternal health services in rural areas by addressing social, cultural, and structural barriers.

## Contribution

The study provides new insights into the multifaceted roles of CHWs in rural maternal health through a qualitative, phenomenological approach.

## Key findings

- CHWs play a key role in identifying pregnancies, making home visits, and managing emergency transfers.
- They act as cultural mediators by integrating traditional practices and addressing community misunderstandings.
- CHWs contribute to reporting and managing maternal health through training and communal referrals.

## Abstract

To understand the perception of the role of Community Health Workers (CHWs) as facilitators of the use of maternal health services in rural settings. Materials and methods. Semi-structured interviews were conducted with 11 CHWs assigned to the Paucara Health Center, selected by theoretical saturation sampling. Data were analyzed using a phenomenological approach, and constant comparison was used to inductively identify emerging themes.

The interviews revealed three categories of perceptions: 1. Accompaniment and monitoring: pregnancy identification, home visits, community awareness, transfers in emergency cases, and challenges such as lack of remuneration and community misunderstandings; 2. Cultural and institutional mediation: integration of traditional practices, respectful treatment, addressing cultural barriers; 3. Management: reporting the situation of pregnant women, training, and communal referral.

CHWs perceive their roles as relevant in mitigating social, cultural, and structural barriers in maternal care. This study provides evidence for the design of public policies that can strengthen the recognition and sustainability of the CHWs’ work, through an equitable and culturally sensitive maternal care model.

Comprender la percepción del rol de los Agentes Comunitarios de Salud (ACS) como facilitadores del uso de servicios de salud materna en entornos rurales.

Se realizaron entrevistas semiestructuradas a 11 ACS asignados al Centro de Salud Paucará, seleccionados mediante muestreo por saturación teórica. Los datos se analizaron mediante un enfoque fenomenológico, y se utilizó una comparación constante para identificar los temas emergentes de manera inductiva.

Las entrevistas revelaron tres categorías de percepciones: 1. Acompañamiento y monitoreo: identificación de embarazos, visitas domiciliarias, sensibilización comunitaria, traslados en casos de emergencia y desafíos como la falta de remuneración y malentendidos comunitarios; 2. Mediación cultural e institucional: integración de prácticas tradicionales, trato respetuoso, abordaje de barreras culturales; 3. Gestión: reporte de la situación de las gestantes, capacitación y referenciación comunal.

Los ACS perciben sus roles como relevantes para mitigar barreras sociales, culturales y estructurales en la atención materna. Este estudio brinda evidencia para el diseño de políticas públicas que puedan fortalecer el reconocimiento y la sostenibilidad de la labor de los ACS, a través de un modelo de atención materna equitativo y culturalmente sensible.