Community Health Workers (CHWs) are essential to the success of healthcare systems, particularly in low- and middle-income countries (LMICs) like Kenya and Bangladesh. CHWs bridge the gap between formal healthcare facilities and underserved populations, ensuring that even the most marginalised communities receive basic health services. However, their role comes with immense challenges, from overwhelming workloads to a lack of resources, training, and psychological support. These stressors often take a toll on their mental well-being and can hinder their ability to deliver quality care.
Recognising this, the Strengthening health systems by addressing community health workers’ mental well-being and agency (SHINE) project has embarked on an innovative approach to strengthen health systems by addressing the mental health and agency of CHWs in both urban slums and remote rural areas in Kenya and Bangladesh. In Kenya, the urban informal study sites are; Viwandani and Korogocho, both in Nairobi City County. The rural setting study sites on the other hand are Lari and Gatundu North which are both in Kiambu County. The project, which runs from 2023 to 2026, aims to ensure that CHWs are resilient, well-supported, and equipped to thrive in their roles. The interdisciplinary team comprises researchers, implementers, policymakers, CHWs, government (National and County) and, non-governmental organisations.
Understanding the Challenges Faced by CHWs
CHWs often find themselves working in some of the most challenging environments, dealing with heavy caseloads, limited training, and poor working conditions. These issues are amplified in LMIC contexts, where health systems are already strained. In Kenya’s urban slums and Bangladesh’s rural regions, CHWs are critical in providing preventive care services at household level s ranging from infectious diseases, water and sanitation, maternal and child health. However, the personal and professional stressors they face—be it societal expectations, financial constraints, or limited access to mental health services—can diminish their productivity and emotional resilience.
Without appropriate support structures, these health workers are at risk of poor mental health outcomes, which could ultimately affect the communities they serve.
SHINE is designed to tackle these complex challenges by focusing on four main objectives:
1. Identifying strategies for well-being
The project aims to develop strategies and programs that promote CHW mental health in a way that is equitable, sustainable, and contextually appropriate. By examining the diverse experiences of CHWs in Kenya and Bangladesh, SHINE will gather insights into the most effective ways to address mental well-being within these settings.
2. Co-designing innovative interventions
At the heart of the project is co-design. CHWs, along with healthcare system leaders, are involved in shaping innovative interventions tailored to their unique challenges. These interventions will address not only the mental health aspects but also social, material, and human stressors that affect CHWs on a daily basis.
3. Enhancing existing support approaches
SHINE seeks to enhance the quality and equity of existing support structures within the health systems of both countries. By doing so, the project will ensure that CHWs receive adequate mental health support, with a focus on addressing their diverse needs, whether they arise from personal stress or job-related demands.
4. Advocating for CHW mental well-being
Beyond direct intervention, SHINE also aims to contribute to the growing body of evidence on CHW mental health. The project’s findings will provide critical insights for future program design and research, influencing policy-makers and health system stakeholders to prioritize mental health support for CHWs across other LMICs.
The lessons learned from the SHINE project are not limited to Kenya and Bangladesh. By conducting cross-contextual and cross-country comparisons, SHINE will develop a scalable framework that can be adapted and implemented in other LMICs. The goal is to create a global movement that recognizes the mental well-being of CHWs as central to the functioning of robust health systems.
As the project progresses, SHINE will engage with various stakeholders, including local communities, health system leaders, and international organizations, to ensure that the support structures developed are inclusive, sustainable, and adaptable.
Written by Freshiah Njoroge, a communication expert supporting the SHINE project, at LVCT Health