Challenging gender norms through participatory action research: A cross-country study of women close-to-community healthcare providers in fragile settings

Despite their critical role in delivering health services in fragile settings, women close-to-community (CTC) health providers, often face marginalisation due to deep-rooted gender norms. This study explores how participatory action research (PAR) can support these women in addressing gendered power relations and enhancing their agency in two fragile contexts. Through a PAR study with women CTC providers in Nepal and Lebanon, a community advocacy film was co-produced and disseminated in Nepal, and a grassroots “Working Women” support group was established in Lebanon. Thematic analysis was conducted to examine the PAR process and its outcomes using the community-based participatory research (CBPR) framework. Women CTC providers in both countries shared experiences of being undervalued, limited agency, and gendered constraints. The PAR process enabled reflection on these challenges, build solidarity, and develop context-specific interventions. In Nepal, the film-making process enhanced their visibility, allowing them to challenge community perceptions and advocate for recognition. In Lebanon, the support group created peer networks of 200 refugee women and established childcare systems. Outcomes included increased confidence, community engagement, and policy dialogue. Barriers like legal insecurity, limited resources, and safeguarding risks limited transformative changes. PAR can act as a powerful tool to challenge and address gender norms and enhance agency among marginalised women health workers in fragile contexts. However, without structural reforms, including legal recognition, fair remuneration, and institutional integration, such approaches limit change. This study contributes to feminist global health literature by showing both the potential and limits of PAR in promoting gender-responsive approaches within health systems and its potential transformative change. • PAR helped women CTC providers challenge harmful gender norms in fragile settings • CBPR enabled collective action and co-creation of context-specific interventions • Legal exclusion and informal roles limited systemic change in Lebanon • Safety risks, low pay and resistance to women-led advocacy limited change in Nepal • Structural reform is required to help PAR achieve transformative change • PAR strengthened women’s agency, improved visibility and built early advocacy