A study by Lvcthealth in Nairobi and Kiambu counties identified late and insufficient stipend payments as a key contributor to mental health challenges among community health providers.

The SHINE Study reported that 95 per cent of respondents in Kiambu and 93 per cent in Nairobi said their stipend was not adequate or fair, and Dr Lilian Otiso, Lvcthealth Executive Director, said workers felt the pay was unfair relative to workload and that all reported out-of-pocket expenditure.

Under the agreement with counties, the national government is expected to pay CHPs KSh2,500 and devolved units to add another KSh2,500, bringing the total stipend to KSh5,000, while the report notes that a harsh economic environment forces most CHPs to spend on transport, airtime and medical costs for referred community members.

Between 92 per cent and 94 per cent of CHPs reported regular out-of-pocket spending, which the report says further impacts delivery, and Dr Stephen Mulupi, Head of Research at Lvcthealth, said the study aimed to pinpoint the most stressful aspects of work processes and relationships.

Across the two counties, 22.4 per cent of CHPs showed symptoms suggestive of depression, 30.6 per cent reported anxiety and 12.7 per cent reported stress, with prevalence markedly higher in Nairobi’s informal settlements – about three times the depression, two times the anxiety and five times the stress rates recorded in Kiambu.

Task-completion rates differed, with only 12 per cent of Nairobi CHPs reporting completing tasks on time compared with 34 per cent in Kiambu, and CHP Veronica Muthengi from Viwandani Ward described the need to balance household visits with personal financial challenges and the stress it creates.

Lvcthealth has introduced mental-health literacy and self-care packages, and Dr Mulupi said interventions reached 500 CHPs, including physical training for about 120 and cascade training for 380 through supervisors.

The workforce now numbers 107,000 CHPs equipped with kits and phones running the electronic Community Health Information System, each serving 100 households under supervision of Community Health Assistants, and the study was conducted with APHRC, Liverpool School of Tropical Medicine and BRAC James P Grant School of Public Health.