Community Health Officers (CHOs) supervise the CHAs inorder to ensure they fulfil their performance goals and provide high-quality healthcare services. It was clear from a recent meeting in Korogocho (which is an urban informal settlement) with both CHOs and CHPs that CHOs frequently endure higher stress levels than CHPs.

The CHOs expressed that their stress stems from the fact that their performance is directly tied to the success or failure of the CHPs. If CHPs do not meet their targets or fail to deliver as expected, it negatively impacts the CHOs’ evaluations. Additionally, CHOs are often caught between the demands of their supervisors and the challenges in the community that are managed by the CHPs, creating a high-pressure environment.

One major source of stress for CHOs is the performance-based system implemented through the electronic Community Health Information System (eCHIS). Under this system, in order for the CHPs to get their stipend they must achieve an 80% target by visiting at least 33 households and making referrals, unlike when the process was manually because the CHOs now have no control over the system-generated results. Previously, CHOs could intervene to adjust scores to ensure CHPs received their stipends, but this is no longer possible.

Sometimes CHPs achieve the required 80% but still do not receive their stipends. When this happens, CHAs must handle complaints and provide explanations, despite having no control over the system. When the stipends delay, the CHOs are usually called late at night or early morning by the CHPs seeking answers, further adding to the CHO’s stress. In many cases, CHOs are forced to give CHPs false reassurances just to prevent excessive follow-up calls, all while dealing with the uncertainty themselves.

CHPs receive a total stipend of Ksh6,000, comprising Ksh3,500 from the performance-based and Ksh2,500 from the national government. However, these payments are not made simultaneously, and the national government often delays disbursements for months. This financial uncertainty contributes to frustration among CHPs, which in turn increases the stress on CHOs who must handle their grievances.

Both CHOs and CHPs acknowledged that the pressures of their roles contribute to burnout, disagreements, and workplace tension though afterwards they laugh about them. There was a request for a structured mental well-being interventions and debriefing sessions for both CHOs and CHPs to help them cope with the demands of their work.

The role of CHOs extends beyond supervision for they are the bridge between CHPs and the healthcare system, often bearing the brunt of systemic failures. It is important to address their mental well-being for it will be impactful to effectively fulfill their critical roles in community health services.

By Faith Munyao