I spent eight weeks researching community health workers (CHWs) in western Kenya, in the city of Kisumu. My research examined how CHWs operate within the specific local setting of Kisumu, and particularly how community perceptions had an impact upon the efficacy of CHW services. I partnered with a local NGO that ran a CHW program and used participant-observation and interviews to gather data. I interviewed various individuals involved in the field of community health, including CHWs themselves, their clients, local community members who did not receive CHW services, NGO administrators, and doctors and nurses who worked in the area. I conducted 62 interviews total, with 18 interviews done with the aid of a translator.
Through my research, I found that the perceptions of CHWs among community members, NGO administrators, and local health professionals were all generally positive. As my research progressed, I found that community perceptions had less of an impact on CHW efficacy than several other important factors, and thus the direction of my research changed as the project was progressing. While some organizations poured money into the CHW project and provided their CHWs with a monthly income and health kits, others started out with very little funds and relied on volunteer CHWs and cost-less initiatives such as health education. The differences between CHWs of various organizations had significant implications within the community. Furthermore, I noticed an “NGO culture” of competition among some organizations within Kisumu— instead of collaborating on a similar project, the various NGOs would compete against one another to get the highest numbers of community members (seen as a sign of “success”) for their projects. Among the CHWs, there were often several CHWs from different organizations working within the same neighborhood, sometimes resulting in client overlap.
Generally, although CHWs are demonstrably valuable to their communities, I found that the CHW program of this specific organization was lackluster and under-resourced, resulting in diminished local effectiveness. Although the CHW program that I studied had all the hallmarks of a “sound” public health strategy— it was home-grown, sustainable, culturally-sensitive, and necessary— the CHWs were unable to serve their communities effectively, and thus this specific health development project failed to achieve its goals.