Physical and mental health of community health workers in Bolivia: Evidence from a large NGO-run program

Introduction: Community health worker (CHW) programs constitute an important component of the health workforce in Bolivia and other low- and middle-income countries. This study seeks to 1) describe the physical and mental health of volunteer CHWs in Bolivia and to 2) explore how individual demographic factors are associated with these health outcomes and 3) examine how CHWs perceived their work to affect their health. Methods: This study used a mixed-methods design that included qualitative and quantitative data collection and analysis. Qualitative interviews were conducted with a purposive sample at five locations across Bolivia where Pro Mujer, a local NGO, is implementing a CHW program. A quantitative survey was distributed to participants from all CHW project sites. The quantitative survey and qualitative interview guide consisted of questions exploring CHW experiences, health effects, and perceived challenges. Results: CHWs generally consider themselves to be in good physical health; however, challenges persist in accessing preventative healthcare services and screenings. Common barriers that CHWs face include long wait times and inconvenient hours. CHWs report applying the knowledge gained in their CHW role to their own lives and the lives of their families. CHWs report many mental health issues including anxiety, depression, and feeling tense, nervous and irritable in their daily activities. However, they also report feeling supported by peers and leaders and that serving others in their communities has lifted their mood and allowed them to leave behind their emotional struggles. Conclusion: This study is the first to analyze the physical and mental health outcomes of volunteer CHWs in Bolivia. Interventions targeting access to preventative healthcare and greater psychological support are key to expanding the reach of CHWs.