Poor remuneration pushing Kenya's community health promoters to the edge

From tracking down tuberculosis and HIV treatment defaulters to conducting blood pressure and sugar level tests and reporting cases of gender-based violence, Alice Mbote* shoulders the immense responsibility of safeguarding her community’s health. As a community health promoter, she is a source of comfort for many, often stretching herself beyond her limits to assist those in desperate need.

Each day brings an unending stream of challenges, reflecting the deep-rooted struggles of the people she serves. Yet, her work is far from easy.

Persistent hurdles delayed stipend payments, inadequate working conditions, and a lack of essential resources make her role even more demanding. With little financial stability, she is often forced to seek alternative means of survival, balancing her passion for community service with the harsh realities of her profession.

To earn recognition as a community health promoter (CHP), Mbote first served as a community volunteer for four years before undergoing training and officially stepping into the role. She is deeply passionate about her work and committed to helping those in need, but at times, the pressures become overwhelming.

"Right now, we don’t even have medication," she explains. "All we can do is follow up with patients, going door to door to test blood sugar levels and then referring them for further care. While some follow through with treatment, others simply give up. Just recently, I tested a patient’s blood pressure and referred her to a facility. She was only given medication for a week and told to find her own means to buy more. Since she couldn't afford it, she defaulted on treatment."

The challenges she faces highlight the gaps in healthcare accessibility, where financial constraints often determine whether a patient gets better or slips through the cracks.

CHPs are the backbone of Kenya’s primary healthcare system under Universal Health Coverage (UHC) which focuses on primary health care.

Bridging the gap

They provide essential services, bridging the gap between communities and medical facilities, ensuring that even the most vulnerable receive care.

CHPs play a vital role in the healthcare system, yet their efforts often go unrecognised when it comes to financial compensation.

Rather than receiving a salary, they rely on a stipend — Sh2,500 from the county government and Sh2,500 from the national government. However, even this modest amount is rarely disbursed on time.

"I can’t remember the last time I received any funds from the national government. While the county government does pay, it’s usually backdated and never arrives when we need it most,” Mbote says.

The persistent delays in stipend payments leave many community health promoters struggling to sustain themselves, making it difficult to focus solely on their demanding responsibilities.

To make ends meet, many are forced to take on side hustles, balancing multiple jobs just to survive.

"There was a Bill in Parliament proposing an increase in our stipend to Sh15,000. If that happens, it would allow us to fully dedicate ourselves to our work, knowing that our own needs are also taken care of."

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Insufficient income

For many CHPs, a reliable and sufficient income would mean the difference between divided attention and wholehearted service—ensuring they can focus on what they do best: improving the health and well-being of their communities.

Florence Mbithe*, another community health promoter, works tirelessly to advocate for childhood vaccinations, despite the deep-rooted fears and misconceptions that make her job an uphill battle. Beyond the challenge of convincing parents to allow their children to be immunised, she faces constant frustration—from verbal insults to workplace difficulties—that add to the emotional toll of her work.

"Sometimes, you get woken up in the middle of the night to respond to emergencies. Yet, the effort we put in doesn’t always match the support we receive. It’s incredibly tough. We need better working conditions because what we do is significant," she says.

One of the most critical roles of CHPs is following up with patients—ensuring they adhere to treatment, receive necessary vaccinations, and understand the importance of healthcare. Yet, this responsibility often comes at a personal cost.

Mbithe and her team spend their own money to make calls, visit homes and track down individuals who need care.

Despite their relentless efforts, they frequently encounter resistance, forcing them to return to the same household multiple times. In extreme cases, they have to involve local authorities, such as chiefs and community leaders to help persuade families.

"I’ve met parents whose children have never received even the basic vaccines given at birth. Some believe vaccines are harmful, while others are simply suspicious. With so many unvaccinated children, the risk of outbreaks remains high. That’s why raising awareness is so important, especially in communities with diverse populations where vaccine hesitancy is common," Mbithe says.

Delayed stipends

However, the job’s demands, coupled with delayed stipends, make sustaining this work incredibly difficult. To support herself, Mbithe has turned to making and selling liquid soap, which has become her primary source of income.

"I prioritise my business because that’s what puts food on the table. The stipend delays can be discouraging, but we keep pushing forward because we know the importance of our work. If we stop following up, some of our patients could die."

Despite the financial strain and emotional exhaustion, Mbithe remains committed, knowing that every visit, every call and every effort she makes could save a life.

Kenya’s healthcare system continues to expand its reach, with 8,525,305 households now registered in the Electronic Community Health Information System, according to the Ministry of Health. This marks significant progress toward the national target of 12.5 million households, with 68 per cent of the goal already achieved.

Behind these numbers lies the tireless work of CHPs, who serve as the first point of contact for many families in need of medical care.

Their efforts go beyond just registering households; they ensure follow-ups, screenings, and referrals that are crucial in preventing and managing diseases.

Over 7.2 million households have been revisited, demonstrating the commitment to continuous healthcare support.

Financial constraints

The government in January admitted to facing financial constraints in supporting CHPs in their crucial role within the healthcare system, particularly in advancing primary healthcare under the Universal Health Coverage initiative.

CHPs across Africa have long voiced their frustrations over inadequate remuneration, a concern that was strongly reiterated at a recent conference in Kigali, Rwanda.

Many described their earnings as mere “peanuts”, highlighting the lack of government commitment to adequately compensate them for their frontline efforts. Their grievances reflect a growing frustration among healthcare workers who serve as the backbone of community-based health interventions but continue to struggle under poor working conditions and insufficient support.

Community Health Promoters (CHPs) play an essential role in grassroots healthcare, bridging the gap between formal health facilities and the communities they serve. However, their work is not without significant challenges, which often make their efforts both demanding and frustrating.