Understanding Resilience and Well-Being Among Community Health Workers in Ghana: Meanings, Contextual Processes, and Seasonal Dynamics

Abstract

Community health workers (CHWs) are central to the delivery of primary health care interventions in many low- and middle-income countries. In Ghana, CHWs play an important role within the Community-based Health Planning and Services programme, supporting household follow-up, health promotion, referrals, community mobilization, disease prevention, and public health campaigns. Despite their importance to community-based primary health care, CHWs often work under difficult social, material, programmatic, and environmental conditions. Many also combine their health-related responsibilities with household, livelihood, and community obligations. These realities raise important questions about how CHWs experience resilience and well-being, what conditions shape these experiences, and whether they change across seasonal contexts.

This article-based thesis examines resilience and well-being among CHWs in Ghana through three connected studies conducted in the Upper East Region. The first study explored how CHWs understand and describe resilience and well-being in their own terms. The second examined the contextual processes and factors that shape these experiences across individual, relational, community, structural, and seasonal domains. The third used a prospective longitudinal cohort design to examine seasonal variation in resilience and well-being across dry, rainy, and transition/harvest seasons, and to assess the relationship between resilience and well-being over time. The qualitative studies used phenomenological inquiry and interpretative phenomenological analysis, while the longitudinal study used repeated seasonal surveys and linear mixed-effects models.

The findings show that CHWs understood resilience not as a single personal trait, but as a dynamic process involving cognitive and adaptive strategies, emotional regulation, communal support, and spiritual coping. Well-being was similarly described as broad and interconnected, encompassing environmental, financial, mental and emotional, physical, social, and spiritual dimensions. Across the studies, resilience and well-being were shaped by personal motivation, family support, peer relationships, community recognition, supervision, incentives, gendered expectations, resource constraints, and seasonal pressures. The longitudinal findings showed clear seasonal patterns in both outcomes, with important differences by district and incentive frequency. Higher resilience was consistently associated with higher well-being, although this relationship varied across seasons and was strongest during the rainy season.

Overall, the findings show that CHW resilience and well-being are dynamic, social-ecological, and seasonally shaped experiences. Supporting CHWs therefore requires more than expecting them to remain committed and resilient. It requires attention to the relationships, resources, recognition, supervision, incentives, and seasonal realities that make resilience and well-being possible. This thesis contributes to a context-sensitive and programme-relevant understanding of how CHWs sustain themselves while supporting primary health care in Ghana.