Late payment of agreed stipend deemed insufficient has been identified as one of key contributors to mental health challenges facing Community Health Providers.
According to a study conducted in Nairobi and Kiambu counties by Lvcthealth shows that majority of CHPs are not satisfied with the current pay.
The SHINE Study indicate that 95% of respondents in Kiambu reported that their stipend is not adequate or fair while in Nairobi, the response was 93%.
“They felt it was also not fair based on the workload they receive and what they are getting and all of them reported having out of pocket expenditure,” said Dr Lilian Otiso, Lvcthealth Executive Director.
Under the deal with counties, the National Government is expected to pay CHP Ksh 2500 as stipend while the devolved units to up another Ksh 2,500 bringing total stipend to Ksh 5,000.
The reported however notes that due to harsh economic environment, most CHPs are forced to engage in out-of-pocket spending on transport, air time and even medical costs for community members they refer.
“You go to a household, a child needs emergency care they don’t have fare, so in both counties they reported having out-of-pocket expenditure but despite all these challenges they were still worried of losing that job,” added Otiso.
The report shows that between 92% and 94 of CHP reported regular out-of-pocket spending which further impacts negatively on their delivery.
The report further highlights the impact of heavy workload CHP are facing and gives recommendation on ways to address poor mental health that results to poor performance.
“Studies have already shown that CHP experience stresses but we wanted to understand what sort of aspects are more stressful and that is how this study was born to get finer details in terms of their work processes, in terms of their relationship and generally in terms of things that might be invisible but do affect them,” noted Dr Stephen Mulupi, Head of Research, Lvcthealth.
Across Nairobi and Kiambu counties, 22.4% of CHPs had symptoms suggestive of depression, 30.6 % reported experiencing anxiety while 12.7% experienced stress.
Lvcthelath further says the experience of poor mental health is markedly higher in urban informal-settlements of Nairobi, compared to Kiambu County.
CHPs in Nairobi reported approximately three times the depression, two times the anxiety and five times the stress prevalence of CHPs in Kiambu, the report indicates.
The poor mental health among CHPs has also shown that only 12% CHPs in Nairobi reported completing their tasks on time compared to 34% in Kiambu.
According to Veronica Muthengi, a CHP based in Viwandani Ward, financial challenges faced by communities they serve, most CHPs are forced to attend to households despite the financial hardships they face.
“If you visit a household and find challenges, you must have boundaries because they have family and you as a person you also have you own problems,” said Veronica.
“So they have to cope with their own situation, either they seek support from family or somewhere else. However when I leave and go back home, that affects me and I have to speak to someone to ease the stress,” she added.
Lvcthealth has since came up with measures to address poor mental health among CHPs including mental health literacy, selfcare package.
“Nairobi and Kiambu we managed to reach 500 CHP with interventions. It involved two main levels, there is a physical training for about 120 of them and then 380 involved in a cascade where the supervisors involved in the training now cascading it to them in their day to day environment,” said Dr Mulupi.
Currently, there is a workforce of 107,000 CPH who have been issued with issued kits, and phones equipped with the electronic Community Health Information System (eCHIS), with each CHP required to serve 100 households for prevention, promotion, screening and referral, supervised by Community Health Assistants (CHAs).
The study was conducted in collaboration with APHRC, Liverpool School of Tropical Medicine (LSTM), and BRAC James P Grant School of Public Health (BRAC JPGSPH).
