Kenya

Some meetings feel like a formality. This wasn’t one of them. The SHINE Annual Partners Meeting 2025 turned a virtual setting into a space for real connection and clarity. I’ll admit, when I saw it stretched across two weeks, I braced myself for screen fatigue. But the format was surprisingly light: two to three hours a day, spaced out enough to stay engaged and still get other work done.

The project consortium consists of LVCT Health and APHRC (Kenya), JPG BRAC (Bangladesh), and LSTM (UK). At the meeting, we gathered our voices not just to exchange updates, but to realign, rethink, and reimagine how we support community health workers and their mental well-being. Community health workers play important frontline roles in linking communities to healthcare services. They, however, bear many burdens in discharging their roles. We must care for carers. The SHINE study strategically employs mixed methods- quantitative surveys and a range of community-based participatory methods, to explore motivations, stressors, coping mechanisms and policy environment for mental health and wellbeing for community health workers in Kenya and Bangladesh. This study is in its third year, and we were convening a virtual annual meeting to reflect on progress, celebrate collective achievement, and, in true collaborative spirit, map the way forward towards the next exciting stage- dissemination of study findings and co-designing appropriate interventions, based on data.

What set this meeting apart was its design. Beyond live sessions and presentations of various stages of the research and emerging findings, we worked through breakout rooms to dive deeper into thematic discussions. These smaller sessions allowed for more candid and collaborative thinking, whether we were shaping country-specific workplans or adapting evaluation frameworks to fit local realities. In those rooms, the tone shifted from presentation to co-creation, and the insights felt rooted, practical, and bold.

We also used discussion boards throughout the meeting to actively gather feedback, exchange ideas, and surface priorities. These boards became living threads of reflection, helping us clarify complex issues and collectively shape the way forward. Whether probing intervention strategies or revisiting partnership values, the responses guided key decisions and amplified voices that might otherwise get lost in the flow.

A recurring theme throughout was the importance of context. As we reviewed and refined the project work plan, it became clear that timelines and strategies couldn’t be one-size-fits-all. Teams surfaced the unique rhythms, opportunities, and constraints they face in their respective countries. This awareness of local realities led to more adaptable planning and reaffirmed our commitment to inclusive implementation.

We explored formative research, mental health literacy, capacity strengthening, and advocacy, all underpinned by a consortium-wide focus on equity, agency, and resilience. There were moments of challenge, plenty of insight, and a deepening sense of unity and duty. One of the most powerful moments for me was revisiting our core partnership values: a community health worker-centred, equitable, sustainable, and transformative approach. It was an opportunity to ask ourselves if we’ve stayed true to what we agreed on in 2024. That reflection urged us, urged me, to pause, take stock, and confront that question with sincerity. It was an opportunity to recalibrate or reemphasise.

As we step into final stretch of the project-2025/2026, I’m carrying with me not just action points, but a renewed appreciation for the brilliance that emerges when we design together, listen deeply, and stay rooted in real-world impact. The SHINE consortium is more than a partnership; it’s a collective driven by shared values and vision.

The SHINE Project aims to develop a comprehensive approach that promotes well-being and resilience among Community Health Workers (CHWs) while incorporating training, community cohesion, and support within the health systems of Kenya and Bangladesh.

Read More: https://lvcthealth.org/nihr-shine/

Written by: Nkatha Mutiga, Project Management Lead at LVCT Health Kenya.

Working in community health is not for the faint-hearted. As one community health worker put it, “You need a heart to continue.” This simple but powerful sentiment speaks volumes about the challenges faced by community health promoters – especially when it comes to their mental well-being. Through the SHINE study, taking place in Nairobi County’s Korogocho area and Kiambu County’s Limuru, a comprehensive approach is being developed to foster resilience, well-being, and support for these crucial frontline workers.

Prioritising people over pay

For community health promoters, the mission is about transformation, not targets. Their purpose is driven by the impact they see in the communities they serve. Often, they are called to action at all hours, ready to help someone get to a hospital, even if that means dipping into their own resources or taking on debt. This dedication is a powerful example of how a people-first approach lies at the heart of their work.

Yet this relentless dedication, while admirable, can be mentally taxing. The emotional weight of being continually on call, coupled with the financial strain, can be a serious drain on mental health.

The role of people skills and negotiation

Mental well-being: The need for regular debrief sessions

The SHINE study recognises the mental toll of this work and has created debrief sessions to support community health promoters. Here, they can share experiences, discuss challenges, and rejuvenate their spirits for the week ahead. These sessions are essential for emotional resilience, allowing them to process the week’s hardships and renew their focus. However, these sessions need to happen more regularly to be fully effective, as the demands on their time and energy continue to rise.

Why mental health matters for community health promoters

A healthy mind produces healthy results. For community health promoters to thrive and continue their impactful work, their mental well-being must be a priority. Unfortunately, community members don’t always understand the weight or complexity of their workload, which can lead to a lack of appreciation and support. The SHINE study’s focus on mental well-being is a critical step forward, but it’s also vital that we continue raising awareness around the needs of these health promoters. Continuous counselling, regular debrief sessions, and community sensitisation are essential in ensuring their mental resilience.

Investing in the mental health of community health promoters isn’t just a matter of supporting individuals—it’s about ensuring the well-being and longevity of the communities they serve. When we take care of those who care for us, everyone benefits.

In the densely populated urban slums of Korogocho, Nairobi, Community Health Promoters (CHPs) play a pivotal role in bridging the gap between healthcare systems and the local communities. One such remarkable individual is Wasiaya (aka Wasee), a CHP whose life story illustrates not only personal transformation but also the critical importance of mental health support, self-care, and ongoing training for CHPs.

A Role Model Born from Chaos

Wasiaya’s journey into community health work was anything but straightforward. Before stepping into the role of a CHP, Wasee’s life was marked by turmoil and emotional distress. Growing up in Korogocho, she experienced the harsh realities of urban slum life – domestic violence, substance abuse in her community, and the constant threat of gender-based violence (GBV). The lack of support systems and mental health resources left her feeling isolated and unable to cope with the trauma she carried.

Her chaotic past manifested in anger and emotional instability, making it difficult to navigate personal relationships and community interactions. Yet, these challenges shaped her and motivated her to change. “I was chaotic,” Wasee recalls. “I didn’t know how to deal with my emotions, and I felt trapped in a cycle of pain…”

Wasee’s transformation began when she was introduced to a training program by Amnesty International, focusing on GBV and Violence Against Children (VAC) prevention. The training not only equipped her with knowledge and skills to support victims of violence but also provided her with coping mechanisms to address her own trauma.

Working in Kisumu Ndogo, an area within Korogocho notorious for high cases of GBV and VAC, Wasee began to connect with survivors and support them in accessing health services and legal aid. Through this work, she found a sense of purpose and healing. “Helping others allowed me to heal parts of myself,” she reflects.

Mental Health Gaps: A Hidden Burden

As a CHP, Wasee quickly realised that mental health was an often-overlooked aspect of community well-being. Many community members, burdened by poverty and violence, struggle with anxiety, depression, and trauma. However, stigma and lack of access to mental health services prevent them from seeking help.

“There’s some stress that can’t be hidden,” Wasee says. “But people here fear judgment, so they suffer in silence.” During a mental health session in Mathare, another informal settlement in Nairobi, she witnessed how stigma silenced those in need of support.

For CHPs like Wasee, the mental health burden is twofold—they not only support their community but also carry the emotional weight of the stories they hear. “We carry the community’s struggles on our shoulders, but who carries us?” she asks.

In her experience, women are more open to sharing their struggles, while men often suppress their emotions due to cultural expectations. This gender disparity further complicates mental health interventions in Korogocho. “The ladies are able to share,” Wasee notes, “but men feel that admitting to mental health challenges makes them weak.”

One of the most significant barriers Wasee faces in her work is the broken referral system. While CHPs are trained to identify mental health issues and refer severe cases to healthcare facilities, the limited availability of mental health professionals and long waiting times often leave patients without support. “It’s hard to refer someone when you know they might not get help soon enough,” she says.

While CHPs are vital in linking communities to healthcare services, being a CHP means carrying the weight of the community’s health, encountering difficult conditions and significant struggles, including:

• Heavy Emotional Burden: CHPs often bear the emotional weight of community members’ struggles, leading to stress and burnout.
• Limited Mental Health Support: There is minimal access to mental health support for CHPs themselves, despite their exposure to trauma.
• Stigma and Discrimination: Mental health stigma in communities makes it difficult for CHPs to address these issues openly.
• Inadequate Training: Short, one-off training sessions are insufficient. Continuous and inclusive training is necessary for CHPs to stay effective.
• Referral Challenges: Limited healthcare infrastructure and long waiting times hinder effective referrals for mental health cases.
• Gender Disparities: Women are more likely to share their struggles, while men often suppress their emotions due to cultural expectations.
• Lack of Recognition and Support: CHPs are often undervalued and lack financial support and resources to perform their roles effectively.

Wasee believes that for CHPs to be effective, continuous training is essential. “One or two days of training is not enough,” she emphasises. “We need ongoing learning opportunities that are inclusive of all CHPs, especially in mental health support.”

Today, she is recognised as a role model in her community. Her journey from chaos to advocacy inspires other young women and men to join the fight against GBV and support mental health initiatives. Through her work, she is not only helping to heal her community but also breaking the stigma surrounding mental health.

“I found my healing in helping others,” Wasee says with pride. “But I also know that as CHPs, we need support too. When we are mentally well, we can serve our communities better.”

Wasee’s story is a powerful reminder that CHPs are not just service providers; they are individuals with their own struggles and triumphs. Investing in their mental well-being, providing continuous training, and creating supportive networks are essential to building resilient health systems in communities like Korogocho.

As the SHINE project continues to advocate for the mental well-being and agency of CHPs, stories like Wasee’s serve as a beacon of hope and a call to action for policymakers, healthcare providers, and community members to prioritise mental health at all levels.

Written by Freshiah Njoroge, a communication expert supporting the SHINE project, at LVCT Health

Imagine giving someone a camera and asking them to tell their story through images. The narrative shifts from words alone to something more powerful—visual, tangible, and deeply personal. This is the essence of Photovoice, a participatory research method that merges photography with storytelling, empowering individuals to share their lived experiences. Developed by Wang and Burris in the 1990s, Photovoice serves as a tool for community engagement, fostering dialogue, bridging gaps in understanding, and inspiring action. By enabling individuals to document their realities, it elevates marginalised voices and presents compelling visual narratives that demand attention and change (Hanna & Hanna, 2023).

In mental health research, Photovoice has gained prominence as an approach that uncovers deep insights into lived experiences. One study highlighted how participant-produced photographs captured the stigma, struggles, and recovery journeys of individuals with mental illness (Han & Oliffe, 2016). This demonstrates the transformative potential of Photovoice—not just in research, but as a means of advocacy and system-wide change. The SHINE Project—Strengthening Health Systems by Addressing Community Health Workers’ Mental Well-Being and Agency—integrates Photovoice to document the realities of Community Health Workers (CHWs). Through this method, CHWs become active participants rather than subjects of research, using photography to illustrate their daily experiences. A picture of an empty clinic, an overburdened health worker, or a rare moment of camaraderie among colleagues tells a story that words alone may struggle to convey. By capturing these moments, CHWs highlight their challenges, their resilience, and the systemic changes required to support their mental well-being.

My life feels like this tree — tired and worn from the daily struggles of work and home. But I still have hope. Just like the tree grows new leaves after a tough season, I believe better days will come for me too. – Farida, Female, Barisal

This participatory approach strengthens advocacy efforts by ensuring CHWs’ voices are heard in discussions with policymakers and health system stakeholders. The images they produce serve as evidence, making the case for more supportive policies, better working conditions, and mental health resources within the healthcare system.

However, it’s important to remember that every step of the photovoice process—from building rapport to sharing the findings—shapes the quality and impact of the outcome. Photovoice is not simply about taking random pictures; —it’s about seeing the world through the eyes of those who live in it. Imagine a group of participants gathering in a small room, some hesitant, others excited, holding cameras or smartphones in their hands. Their mission? To tell their own stories, in their way. Here’s a glimpse into how it was done:

Implementing photovoice in SHINE: a step-by-step process on how to implement photovoice in mental health research

1. Setting the stage: Start with a purpose

The orientation begins with a conversation. Not a lecture, but a dialogue—where laughter, concerns, and curiosity mix. In this stage, researchers inform the participants- co-researchers- about the project goal, and CHWs discuss their role in shaping its outcomes. Participants express their hopes, concerns, and the hidden realities they want to bring to light. Trust-building is crucial—Photovoice is not about perfect images but meaningful storytelling

2. Finding the storytellers

Participants are chosen based on their lived experiences within the healthcare system. A diverse group, considering factors such as age, gender, and geographical location, enriches the collective narrative.

3. Learning the art of seeing

Before stepping into the field, participants engage in hands-on practice. This is a good time to inform them about the ethical considerations of taking pictures. Some are familiar with photography; others hold a camera for the first time. They discuss angles, lighting, and framing, but most importantly, they explore what makes an image speak. Every shot has a purpose. A discarded prescription slip, a quiet street at dusk, a waiting room filled with anxious faces—each image carries a message.

4. Capturing everyday realities

CHWs document their daily experiences over a set period, capturing the struggles, triumphs, and nuances of their work. These images provide raw, unfiltered insights into their mental well-being and professional challenges.

5. Analyse together- bringing stories to life

When the CHWs reconvene, they sit in a circle, sharing their photos one by one. Participants explain the significance of their photos, providing context and depth. Themes and patterns emerge as participants and researchers collaboratively interpret the photographs. This shared process ensures the findings remain authentic and representative of diverse community voices.

6. Turning images into action

The final phase involves using these visual narratives for advocacy. CHWs decide how their stories will be shared— whether through community exhibitions, policy forums, or digital campaigns. The images become powerful tools for influencing decision-makers and advocating for systemic improvements in mental health support for CHWs.

Photovoice is more than just a research method – it is a tool for empowerment, advocacy, and change. By integrating Photovoice into the SHINE Project, CHWs are given a platform to voice their realities in ways that demand attention and action. Their stories, captured in powerful images, illuminate the urgent need for mental health support and systemic reform within community health systems. Through this approach, the SHINE Project not only amplifies CHWs’ voices but also paves the way for a more responsive and supportive healthcare environment.

Written by Obaida Karim and Semonty Jahan

References:

● Hanna, L., & Hanna, L. (2023, November 16). Photovoice as a research method for community development. Applied Worldwide | Making Sociology Count. https://appliedworldwide.com/photovoice-as-a-research-method/

● Strack, R. W. (n.d.). What is Photovoice: a brief summary. In University of North Carolina Greensboro. Retrieved December 19, 2024, from https://communityengagement.uncg.edu/wp-content/uploads/2019/11/What-is-Photovoice-A-Breif-Summary_Strack-Dec-2017.pdf

● Skovdal, M., & Rumi, Sk. R. Ullah. (n.d.). Photovoice guidance: 10 simple steps to involve children inneeds assessments. Save the Children. https://bangladesh.savethechildren.net/sites/bangladesh.savethechildren.net/files/library/Photovoice_needs_assessment_guidelines_full_report_0.pdf

● Han, C. S., & Oliffe, J. L. (2016). Photovoice in mental illness research: A review and recommendations. Health:, 20(2), 110-126. https://www.jstor.org/stable/26652338