Session 1.

4 Values and Ethics of Community Health Work

Session By the end of this unit participants will be able to:

Objectives • Explain the key values and ethics they will uphold as CHWs
• Articulate their rights as CHW
Session Respectful and disrespectful care
Topics • CHW Charter: Accountability, respect, compassion, empowerment, equal
access to
all/health for all.
• Rights of CHW

Session plan Activity 1: Determine what they already know

Time: 1h30 Activity 2: Role play: Respectful and disrespectful care
Activity 3: Give relevant information: Values to uphold
Activity 4: Building a commitment: the CHW Charter
Activity 5: Give relevant information: Rights of CHWs
What have we learned

Key words
and phrases Values, charter, accountable, compassion, empower, access, vulnerable, rights

Activity 1: Determine what they already know

Discuss with the BHWs using the following questions.

On the board or flip chart begin creating two lists of ‘positive’ and ‘negative’ practices, qualities or
experiences that the CHWs mention in the discussion:

- What do you think are the qualities of a good health worker?

- How do you think a health worker should behave towards their clients and their families?
- Have you ever been to a health facility and had a negative experience? What happened? How did you
feel?
- How do you think negative experiences affect your willingness to access health services in the future?
- Have you had positive experiences with health workers? Did they show respect? Did they help you
make decisions about your health and discuss alternatives with you?

Explain and Discuss:

As the frontline worker, BHWs are the “face” of the health system in the community, and it is
especially important that they engage community members in positive and professional ways.
Positive Negative
Confidential Critical
Respectful Judgmental
Compassionate Distracted/not listening
Good eye contact Bossy
Reassuring Impatient
Impartial Impersonal
Good listener Not respecting privacy or confidentiality
Friendly ‘Lecturing’
Polite Prejudiced (e.g. racist or discriminating)
Non-judgmental Sexist (e.g. addresses only the husband)
Encouraging Corrupt (asks for bribes or gifts)

Activity 2: Role Play: Respectful and disrespectful care

Discussion of reactions on the role playing activity

Activity 3. Explain relevant information: Values to uphold

• Accountability
• Respect
• Compassion
• Empowering
• Access
• Quality

BHWS ARE ACCOUNTABLE

Accountability is making sure you can answer for your actions or omissions. This means presenting data
openly, being accountable for stocks and resources, admitting mistakes when made and do your best to
overcome difficulties.
Be accountable to the community, and to the Municipal Health Office (MHO).
Share your performance data and progress with community and MHO.
Communicate in an open, and effective way to promote health, safety and wellbeing of your clients.

WHAT DOES BEING ACCOUNTABLE LOOK LIKE?

• Seek help when you struggle.
• Tell clients about what you are doing and why, be open minded and listen to their realities.
• You share your performance data openly
• You control stocks very carefully and never sell them for profit
• You submit reports on time
• You admit mistakes and look for help from others when you need it.
• You tell the truth
• You are honest about your needs and limitations

Short activity: Ask participants: what would this look like in a BHW’s work life?
Write their responses and discuss their reactions
 CHWS ARE RESPECTFUL
This is about client privacy, and the way that you talk to people. Anything that is said between a BHW
and a family is never to be discussed outside the home. Respect family members to resolve issues by
themselves, whilst ensuring the safety of women and children
“Treat my clients and families as I would wish to be treated.”
Promote and uphold the privacy, dignity, rights, health and wellbeing of people who use community
health services at all times.
Respect a person’s right to confidentiality.
Respect their right to make informed choices for themselves about health
(Person-centred care).

WHAT DOES BEING RESPECTFUL LOOK LIKE?

• You introduce yourself and call clients by their names
• You smile, are helpful and polite
• You make eye contact when speaking
• You use simple language and check understanding
• You use a calm respectful tone of voice
• You listen when they are talking
• You do not talk about what happened between a CHW and a family with any other person
• You do not discuss personal details about families in public
• You respect a person’s right to make their own informed choices about their health

Short activity: Role Play: Being respectful

After the role play, ask in plenary: How did the BHW show respect? What could
be improved?

CHWS ARE COMPASSIONATE

This is about communication and dignified care for the clients and families.
Never judge, criticize, admonish or blame.
Never do harm and lead with your heart.
• You look for signs of fear, anger, stress, fatigue, and pain
• You allow them to express their feelings
• You show empathy and understanding by being kind
• You praise their positive actions
• You reassure them when they are worried

Short activity: Ask: why is it important for the BHW to be compassionate when dealing with health
issues of a family?
Note down responses and discuss their reactions

BHWs EMPOWER OTHERS

Empowering is about helping families understand health and identify their own solutions.
Support them to make good choices for the health and wellbeing of their families.
• Do not lecture and do not give advice without asking if they want it.
• Listen to people to understand the roots of their barriers to health.
• Praise their positive actions and reassure when they are worried
 Short activity: Ask: How can BHWs ensure health for everyone, especially the poor, vulnerable,
the disabled and those that live furthest away?
How might a BHW (knowingly or unknowingly) exclude some from services?
Write down their responses and discuss.

Explain and discuss the participants’ responses utilizing this information.

BHWS PROMOTE HEALTH FOR ALL, EXCLUDING NONE

What is equity? Equity means when all families and individuals have equitable access to health care.
Equity is not the same as equal, as those who have less access to health need to be given more priority
in order to achieve equity. Often CHWs will prioritize those households close to their house, rather than
the homes harder to reach. Do your best to reach the families that need the most support, and those
that are often excluded.
Reach out to the isolated, the most vulnerable, the poorest, the infirm and disabled, the
elderly, and the furthest away from care.
What is equality? Equality is root in prejudice or stigma that can be subtle or overt in nature. Equality is
about treating both genders equally and not discriminating against anyone on the basis of tribe, ethnic
group or religion.

What does this look like?

• You spend more time with vulnerable households
• You don’t turn anyone from your community away
• You don’t give preferential care to members of your family/church/ethnic group

Explain that the last aspect is about giving their best to the task required of them.

BHWS WILL DO THEIR BEST IN ALL THAT THEY DO.

 Work in collaboration with the barangay health center staff and barangay officials to ensure the
delivery of high quality, safe and compassionate healthcare, care and support.
 Strive to improve the quality of healthcare, care and support through continuing professional
development – learning and studying.

What does this look like in practice?

• You attend supervisions and meetings
• You understand your BHW Manual
• You seek mentoring from your Barangay Health Midwife
• You follow recommended practices the best that you can
• You give quality care

Activity 4: Create a Commitment Statement Exercise

Provide illustration boards and colorful markers and ask the participants to create a charter
statement to be posted in their barangay health stations.
Example:
BHW CHARTER

1. We are accountable
2. We are respectful
3. We are compassionate
4. We empower others
5. We promote health for all, excluding none.
6. We will do our best in all that we do.

Key messages:
• As the frontline worker of the health system, it is important for the BHW to engage communities in a
respectful and professional manner
• Key values to uphold are – accountability, respectful care, compassion, empowering others, equal
access to all and doing the best.
• BHWs have the right to be respectfully treated by those whom they serve