A typical day in the life of Sheringham Odhiambo is jam-packed. This Nairobi-based community health worker (CHW) is responsible for facilitating connections between his community and local primary care facilities, including running health awareness campaigns around the prevention of diseases such as TB and polio, identifying contact cases and conducting screenings, updating disease registries, and following up on lab results.
As an informal urban settlement, Odhiambo’s densely populated community is at high risk for the transmission of infectious diseases—like COVID-19. “The pandemic was a truly eye-opening event in all our lives,” says Odhiambo. “We saw that vulnerable and marginalized populations were disproportionately affected and this was something which was very much avoidable.”
Today, Odhiambo and his peers are focused on strengthening their community’s preparedness for future pandemics and other health emergencies via well-coordinated, collaborative efforts, including advocacy to make professional CHWs the norm . His passion for a better, more equitable healthcare system led Odhiambo to join Community Health Impact Coalition (CHIC) as a CHW Advocate. As a trained CHW Advocate, he is also a member of CHIC’s CHW Speaker Bureau, a first-of-its-kind registry of CHWs ready to take on speaking engagements and ensure that CHWs are given a seat at the table in every conversation that impacts CHWs, their patients and their communities.
Nothing about CHWs without CHWs
Part of CHIC ’s wider Activate work, the CHW Advocates program focuses on recognizing, cultivating and building the power of CHWs, given that CHWs with advocacy training are 2-4 times more likely to engage in political, civic and workplace advocacy. With funding from Johnson & Johnson Foundation, CHIC, working with Stanford’s Digital Medic and a CHW Advisory Group, developed free digital training to equip CHWs and CHW supervisors with the skills to become a force for global norm change and create a powerful ripple effect to push for solutions. Nearly 7,000 CHWs have enrolled in the training to date.
For Odhiambo, this work is a personal, as well as a professional, mission. “CHWs have been neglected for a long time,” he says. “We face a number of challenges including being unsalaried and, as a consequence, a lack of empowerment. We are often running low on basic and critical essentials, including medicines and personal protective equipment, putting us at additional risk.”
Odhiambo adds that he has often referred a community member to a local health facility for a particular service or treatment, only for the facility not to have the capacity or equipment necessary to provide it. “This is a big challenge; it is demoralizing for our community and reduces their trust in us as healthcare providers.”
He believes strongly in WHO’s recommendation that improving primary care is the best way to achieve Universal Health Coverage. “Making community health a priority is a crucial step towards a more equitable health system. CHWs promote primary healthcare services and make those services accessible.” Odhiambo points out that he is usually the first point of contact for his community when it comes to health. “I conduct home visits and can reach out to people proactively to ensure they access primary care when they need it, as well as taking preventative measures.”
As part of his professional CHW advocacy work, Odhiambo is adamant about the need to ensure that CHWs are integrated properly into the primary care system in order to strengthen the entire health system. “It is paramount to work in partnership with other stakeholders to create an environment where healthcare services are accessible to all, in relentless pursuit of a stronger, more resilient and equitable healthcare system designed to leave no one behind.”
The impact of Kenya’s community health initiative
Earlier in 2023, the Kenyan Government—led by the President of Kenya, His Excellency Dr. William Samoei Ruto, who Odhiambo refers to as “our number one advocate”—formally launched a new initiative to integrate CHWs into the health system. He notes that this historic recognition for CHWs as the backbone of a healthy society is a substantial milestone for all those who have been fighting for health equity globally.
“CHW Advocates have shown unwavering commitment and dedication in championing for CHW rights,” says Odhiambo. “Our vision is now becoming a reality. I hope that the Government will continue to prioritize the interests and needs of CHWs moving forward.”
Odhiambo has already begun to see the impact of the initiative on his day-to-day work, particularly regarding the introduction of digital tools, which have transformed his ability to record data accurately. “We used to have to use hard copies of reporting tools around primary health but essential key indicators, such as gender-based violence, were often missing,” he recalls. “Digitalization has simplified data collection so I can work more professionally, efficiently and effectively.”
There are still obstacles to overcome regarding the professionalization of Kenyan CHWs, he adds, including differences in local funding leading to unequal remuneration between provinces. He is hopeful that the regularization of stipends committed to by the government will address such challenges. But while the battle continues, Odhiambo appreciates how professionalization has boosted the sense of unity among his colleagues and given them a shared focus. “Supporting professional CHWs and strengthening our programs really is a gamechanger for local, regional, national and global health.”