Resilience, ingenuity, and identity: A multi-level analysis of the Filipino community health worker experience in rural and remote municipalities in the Philippines.

Community Health Workers (CHWs) have an extensive involvement in augmenting service capacities in primary care settings. This study sheds light on the unique experiences of CHWs as they navigate barriers and enablers in the Philippine healthcare setting through their journey for professionalization. This study aims to: (1) Describe the roles assumed by CHWs in rural and remote municipalities in the Philippines; and (2) Identify the multi-level barriers and enablers CHWs perceive to influence their performance of these roles. From June to July 2023, the Philippine Primary Care Studies parent program piloted a study on a clinical decision support tool for CHWs, involving 34 CHWs across six focus group discussions. The interviews also touched upon the roles of CHWs and the factors influencing their performance within their local health settings in-depth. A mixed inductive/deductive approach was used to investigate this subset of the FGD data. CHWs assume diverse roles that often surpass health service provision. While their roles were crucial, CHWs described being positioned against a volatile political landscape fraught with material insecurity. They utilized their individual and interpersonal capacities to overcome situational limitations and were augmented with organizational level interventions like improved network connectivity, training, or expanded access to clinical decision-support tools. Amidst resource scarcity, CHWs demonstrated remarkable resilience through their own ingenuity and by maximizing support from their social networks. While their commitment is an asset to the health workforce, support from national policymakers and local governments units are crucial to ensure CHWs remain protected against systemic exploitation. Ensuring accountability and stronger implementation of pre-existing laws to ultimately recognize the role of CHWs are an essential way to support CHWs and improve community health.