Millicent Miruka is a community health worker (CHW) in Lwala, Kenya, where she provides essential healthcare to dozens of families. Her daily rounds include checking on families, answering health-related questions, and providing guidance on issues like birth registration, child development, and mosquito net usage. Despite her extensive knowledge and authority in health matters, Ms. Miruka is a volunteer, part of a large network of CHWs in Kenya and around the world who play a crucial role in delivering healthcare in underserved areas.
In Kenya, there are around 100,000 CHWs, with their responsibilities ranging from basic medical checks to educating communities on nutrition and family planning. Globally, more than 3.8 million CHWs work in nearly 100 countries, providing essential health services in areas where healthcare systems are stretched thin. Most CHWs are women, and their contributions are seen as a cost-effective way to fill gaps in overburdened health systems.
However, despite their critical role, CHWs often face underappreciation and inadequate compensation. They frequently perform tasks similar to those of trained nurses and clinical officers but receive little or no pay for their work. This lack of recognition is a major concern for CHWs like Ms. Miruka, who advocate for better working conditions, fair compensation, and opportunities for career advancement. They argue that CHWs should be treated as professionals, with the same respect and benefits as other healthcare workers.
Kenya’s healthcare system faces significant challenges, particularly in rural areas, where there are few doctors, nurses, and midwives. The country has only about 13.8 healthcare professionals per 10,000 people, far below the World Health Organization’s recommended minimum of 45. In these regions, many people must travel long distances to reach the nearest clinic, often at great cost. CHWs like Ms. Miruka help bridge this gap by bringing healthcare directly to communities, making it more accessible and affordable.
Ms. Miruka’s own experience with healthcare disparities has shaped her commitment to the work. When her young daughter fell seriously ill, the community believed the illness was caused by witchcraft, and Ms. Miruka treated her with local herbs. Tragically, her daughter died, and it was only later that Ms. Miruka discovered the true cause of her illness: malnutrition. This experience motivated her to become a CHW and later a supervisor, training others in the community.
International donors, including the Global Fund, have recognized the value of CHWs and invested heavily in community health programs. The Global Fund, supported by organizations like the Gates Foundation, has allocated hundreds of millions of dollars to community health initiatives, including in Kenya. Studies have shown that CHWs can significantly improve health outcomes, such as increasing immunization rates and ensuring more women deliver in clinics. Their ability to speak the local language and gain the trust of community members makes them particularly effective in promoting preventive health measures.
Despite these successes, CHWs in Kenya have long struggled with inconsistent pay and training. Many CHWs were historically paid very little, with some earning as little as 2,000 to 5,000 Kenyan shillings ($15 to $35) per month. In 2023, the Kenyan government took steps to address this issue by officially registering CHWs, providing them with medical kits and smartphones for digital data collection, and standardizing pay at 5,000 shillings ($35) per month. While this is a step forward, CHWs like Ms. Miruka continue to advocate for better compensation and career opportunities, as they still face significant barriers to career advancement.
For Ms. Miruka, the dream of becoming a nurse remains unfulfilled, but she remains dedicated to her work as a CHW. Her journey reflects the broader struggle of CHWs in Kenya and around the world, who provide invaluable services to their communities but often face challenges in gaining recognition, fair pay, and career advancement opportunities.
