In Kenya’s vast and diverse communities, Community Health Promoters (CHPs) are the unsung heroes holding the fabric of grassroots healthcare together. Individuals like Alice Mbote* embody the spirit of public service, tirelessly working to ensure that the health needs of their neighbors are met, despite facing harsh economic realities. Her typical day is filled with tasks that would overwhelm many—from tracking down patients who have defaulted on tuberculosis and HIV treatments, to conducting health screenings and reporting gender-based violence. Yet, this vital work is often performed under conditions that strain her to the brink.
Becoming a CHP is no small feat. Mbote volunteered in her community for four years before receiving training that qualified her for this role. She continues to serve with dedication, even as the system she works within often falls short of supporting her. Her commitment is evident in the lengths she goes to provide care, including door-to-door visits where she performs blood sugar and blood pressure tests, despite having little to no medical supplies. Many of her patients are referred to facilities where they must pay out of pocket for medication—costs they frequently cannot afford. When treatment becomes a financial burden, many simply abandon it, undermining efforts to manage preventable and treatable conditions.
This stark reality underscores the challenges that CHPs face in connecting their communities with proper healthcare services. They form the backbone of Kenya’s Universal Health Coverage (UHC) strategy, which aims to prioritize primary healthcare, yet they operate in a system riddled with logistical and financial hurdles. The stipend they receive a modest Sh5,000 split between county and national governments is irregular at best. Payments from the national government often never arrive, and those from the county come late and are backdated. For many CHPs, this means living hand to mouth, constantly juggling their unpaid service with small income-generating activities just to survive.
Florence Mbithe*, another CHP, finds herself in a similar struggle. She passionately advocates for childhood immunizations, facing not only resistance and misconceptions from parents but also verbal abuse. Her work requires her to spend her own money on communication and transport as she follows up with families, sometimes repeatedly, to ensure that children receive critical vaccines. Despite the emotional and financial burden, Mbithe continues to serve, aware that any lapse in her efforts could result in preventable deaths. To make ends meet, she makes and sells liquid soap, a side business that now sustains her more than the delayed stipend from her public service.
Kenya’s Ministry of Health reports that over 8.5 million households have been registered in the Electronic Community Health Information System, edging closer to a national target of 12.5 million. Behind these numbers are the CHPs, ensuring not just registration but also follow-ups, health screenings, and life-saving referrals. Yet, these milestones are reached with minimal support for the individuals driving them.
Earlier this year, the government acknowledged financial constraints in funding CHPs, a sentiment echoed across Africa. At a recent health conference in Kigali, many CHPs voiced frustration over inadequate remuneration, calling their earnings “peanuts” and lamenting the lack of governmental commitment. Despite their indispensable role in delivering healthcare at the grassroots level, CHPs often feel undervalued and overburdened.
The plight of Kenya’s CHPs illustrates a broader issue in healthcare systems reliant on frontline workers who are neither sufficiently paid nor adequately supported. Their service, driven by passion and necessity, deserves not just recognition but fair compensation and improved working conditions. Without meaningful change, the health of Kenya’s most vulnerable populations remains precariously balanced on the goodwill of overworked and underpaid community health promoters.
