Step up, step down, step out: the gendering of community health work in pastoralist Kenya

Community health is a long-established approach to accessing healthcare, the face of which is female. In the case of rural Isiolo, Kenya, the majority of community health volunteers are men. To understand why, we historicise the move to capitalist work economies in Kenya’s pastoralist north, offering a ‘step up’, ‘step down’ framework to explain the gendering of work in urban versus rural settings. We draw on demographic data from Isiolo’s ∼760 community health volunteers alongside qualitative interviews, focus group discussions and observations over 12 months, centring male perspectives. For rural men, such work promised an opportunity to ‘step up’ but did not realise security over time. Men nevertheless stayed in post owing to social pressures and sunk costs. To understand the frustrations and anger we witnessed among pastoralist men, we draw on Hodgson’s dual masculinities – one ‘modernist’, one longer-standing embodying autonomy and self-determination – that sit in tension in community health work. The costs of diversifying away from pastoralist livelihoods are keenly felt, a source of male angst and lower self-esteem. We conclude that our analysis doubles as a window on insecure, part-paid work in rural Kenya that has not served men well but also compounded gender inequity for women.