The Hidden Heroes: Mental Health and Well-being of Community Health Promoters
Imagine you’re a CHP in rural Kenya, tirelessly visiting households and providing critical care, often without the support or recognition you deserve. You’re not just managing the physical health of your patients, but also carrying the emotional weight of their struggles. Now add the challenge of balancing your responsibilities to the community with those at home, all while facing limited resources and overwhelming workloads [1, 2 ,3]. For many CHPs, this is reality, but they tell us the community connections they build and lives they impact make it worthwhile.
A study we conducted in Busia County, Kenya, illuminated mental health challenges faced by CHPs and other health workers. Revealing the emotional toll, pressures of meeting community expectations, and burnout many CHPs endure as they persevere day in and day out in their mission. This post delves into their stories, uncovering the often-unseen mental strain behind their critical work but also provides insights into why they do the work they do.
For Many – It is More Than Just a Job
For many CHPs, their role goes beyond simply administering tests or providing treatments—they take on the emotional burdens of the people they serve. One CHP shared,
“This work is good because I get close with people and when I talk to them, I get to hear their problems. You take their problem as yours, and you become selfless to help them.”
However, watching patients suffer or fail to recover, despite their best efforts, can leave CHPs feeling discouraged and emotionally drained. As one supervisor revealed,
“There are times when you do all you can, but the patients don’t get better.”
This emotional burden, combined with the lack of formal mental health support, leaves many CHPs feeling isolated in their struggles.
This personal connection is both the beauty and the burden of being a CHP. It creates a strong sense of purpose, but it also means carrying the emotional weight of each patient’s struggles, which can quickly become overwhelming.
Another CHP echoed this sentiment:
“If a patient is sick, you put yourself in that position and look for a way to help them either by advising them so that they can get a chance to be treated, and you refer them to the hospital.”
For CHPs, the line between work and emotional investment often blurs, and while this commitment is admirable, it can take a toll on their own well-being.
Balancing Community and Family
One of the toughest challenges CHPs face is balancing their professional responsibilities with their personal lives. Many are parents or caregivers themselves, and finding time to attend to both their family and community can be a difficult act to juggle.
As one CHP shared:
“You are not supposed to put more time into the community and forget your family or put yourself in the family and forget the community. You must balance yourself.”
In this study we found that CHPs were often seeing patients well into the night - demonstrated by the figure below which shows the time of day that the CHPs were capturing photos of malaria RDTs administered on patients:
Number of image captures of malaria RDTs administered on patients by CHPs by time of day
Overwhelming Workloads and the Risk of Burnout
CHPs in Kenya frequently manage large numbers of households, which require constant monitoring, follow-up, and care. On average CHPs may visit 5 to 6 households per day, although the number can fluctuate depending on the workload, travel distances, and specific health activities required in their community [4, 5]. The sheer volume of work can quickly become overwhelming. One CHP expressed the intensity of their workload:
“It's very technical when you wake up and you had attended to some patients the previous day... then there is the group of children under one month and those under one year who need to be visited every week.”
This nonstop workload, coupled with the emotional demands of the job, puts CHPs at risk of burnout. They are often required to deliver care with limited resources and knowledge, which only adds to their stress and feelings of helplessness.
The Need for Mental Health Support
Despite these challenges, CHPs often have limited access to mental health resources. Many have expressed a desire for emotional support networks or counseling to help them cope with the stresses of their work. One CHP remarked:
"It helps when we can talk about our experiences and get advice. It makes me feel like I am not alone."
One supervisor suggested having group chats to help CHPs stay motivated and feel connected:
"When I am doing my work, I get motivated by what you are doing, and therefore at the end of the day, it brings about healthy competition."
Looking ahead, we’re curious whether AI-based companions could play a role in this space. These tools could offer CHPs real-time advice, emotional support, and even stress-reduction techniques through their mobile devices. While this is not a reality just yet, it’s an exciting area for future exploration—AI companions could help CHPs feel less isolated and more empowered in their work and provide 24/7 access to information to support them in their role.
Creating spaces for CHPs to share their challenges, connect with peers, and receive professional mental health support would go a long way in helping them manage the psychological demands of the job. This kind of support isn’t just beneficial for CHPs—it’s essential to ensure the sustainability and effectiveness of healthcare delivery in underserved areas.
What We’ve Learned and What’s Next
This study, conducted in the first half of 2022, highlights the urgent need to address the mental health and well-being of CHPs. The emotional toll of their work, coupled with overwhelming workloads and a lack of mental health support, puts them at high risk of burnout. However, promising strides have been made since then. Kenya is now compensating CHPs for their essential work, a major step toward professionalizing their role. [6] Additionally, emerging technologies, such as large language models (LLMs), show potential for providing accessible mental health support directly through mobile devices. With ongoing research and advocacy pushing for systemic changes, there is hope that CHPs will receive the mental health resources and support they need to continue serving their communities without sacrificing their own well-being.
Look out for the next post in this series, where we’ll explore “Bridging the Gap: Overcoming Barriers to Digital Health in Rural Areas.”
References
https://www.caregiver.org/resource/women-and-caregiving-facts-and-figures/
https://www.frbsf.org/research-and-insights/publications/community-development-research-briefs/2022/03/rapidly-growing-home-care-sector-and-labor-force-participation/
https://nationalpartnership.org/wp-content/uploads/2023/02/female-face-family-caregiving.pdf
https://chwcentral.org/resources/kenya-national-community-health-strategy-2020-2025/
https://chwcentral.org/kenyas-community-health-volunteer-program/
https://www.kenyanews.go.ke/community-health-promoters-to-join-county-payroll/
