On April 18, 2023, I watched in awe as the newly elected president of Kenya, His Excellency Dr. William Samoei Ruto, backed by the Council of Governors that represent the country’s 47 counties, announced on national television that the government will jointly pay stipends and health insurance for 100,000 Community Health Promoters (CHPs), previously referenced as Community Health Volunteers, kit them and digitize them using the government’s own resources.
My heart was racing and even I, the vision holder, could not believe it—our dream had come true.
On Monday, September 25, 2023 in Nairobi County, the Kenyan government formally launched this new initiative to integrate CHPs into the health system. This truly is a historic moment that will change the lives of CHPs. Not only will they have the tools they need to work effectively and efficiently, but the remuneration will alleviate educational and food costs for their families, while access to the health insurance fund means that they and their families will be spared any catastrophic health expenses.
At Johnson & Johnson, we are committed to building on our legacy of supporting the global health workforce. We recognize that CHWs, integrated within strong community health programs, are a proven high-value investment. With support from the Johnson & Johnson Foundation and together with government, The ELMA Foundation, and other stakeholders, we are proud to have led the way in this important work to eliminate barriers that stifle CHWs’ ability to deliver care and that undermine health systems.
The need to protect community health workers
CHWs in rural Kenya are the backbone of a healthy society, volunteering their time to care for those who need it most. These individuals are held in high esteem and are trusted by the community in their village, who appoint them as Community Health Promoters (CHPs).
They are ordinary people doing extraordinary things—husbands, wives, parents, and friends earning an income from efforts such as small-scale farming and offering bike transport. However, for half of their day, these health workers also provide preventive and promotive health services to hundreds of households for which they are responsible, alongside other volunteer colleagues within their community health unit.
They are often the first line of response in a health crisis and are at times the only link between patients and primary health facilities. Although their work is crucial to improving health outcomes in communities across Kenya, they have, until now, carried out this work with no salary or, at best, with irregular stipends. They have not received formal recognition in the health system, nor have they had the basic commodities they need to work efficiently and have had to manually record all patient engagements.
When we look at broader Africa, we see that the continent is facing a serious gap in its health systems, with a projected shortage of more than 6 million health workers by 2030. This includes 2 million CHWs—around 86% of whom, despite delivering care to 40% of Africa’s population, receive little to no compensation for their work.
Ensuring that this crucial staff cadre is financially compensated, upskilled, equipped and supervised will go a far way in accelerating progress towards Universal Health Coverage, global health security and economic recovery. Professionalizing CHWs is also imperative in promoting gender equity—women account for nearly 70% of the global health workforce, yet often occupy low status and unpaid roles.
Our fight for greater health equity
In April 2019, with support from the Johnson & Johnson Foundation, we took steps towards addressing these issues at a systemic level. With government and other stakeholders on board from the outset, we worked together to identify the strategic investments needed to create formalized and supported CHWs in a sustainable community health system.
These meetings led to the development of the Community Health Units 4 Universal Health Coverage (CHU4UHC) platform in early 2020. Co-created with the Ministry of Health and other stakeholders, this effort was the genesis in the journey towards formalizing the community health workforce. Building on from this was the launch of the Kenya Community Health Strategy 2020-2025 (KCHS), which outlines a holistic approach to creating a standardized and robust community-based primary healthcare system.
The CHU4UHC platform convened changemakers in Kenya to collaborate on a single plan and ensure effective and efficient use of resources toward a shared vision—including eliminating silos, integrating community health workers formally into the health system and delivering preventative and promotive healthcare. It has played a catalytic role in mobilizing other co-funders and government to pool resources and to prioritize and fund community health services in the country, all whilst keeping the focus on the real goal—the well-being of CHWs themselves. This led to the platform’s advocacy for the inclusion of community health in Kenya Kwanza’s political manifesto because we felt it truly aligns to the bottom up economic model and provides a major catalyst for the delivery of UHC in Kenya.
When we talk about advancing health equity, this is the kind of progress for the global health workforce we are seeking to support so they can deliver quality care for patients. This milestone victory for CHWs is truly a moment to celebrate. We are excited to tell this incredible story of how they will be paid for the very first time, and how it will change the livelihoods of these individuals.
CHWs hold the good health of their communities in their hands. At Johnson & Johnson, we are inspired by their acts of selflessness and recognize their vital contributions to society. We encourage you to join us in applauding them.