237 Community health worker payment models in Kenya: intended and unintended consequences

Abstract OP 3: Health Services 5, B304 (FCSH), September 3, 2025, 14:30 - 15:30 Aims Community Health Workers (CHWs) play a crucial role in delivering primary healthcare services, especially in resource-limited settings. Efforts to professionalise CHWs, including providing compensation for their voluntary work, have gained momentum. This study explores the implications of increased pay and formal recognition for CHWs. Methods A qualitative approach was employed, incorporating document review, focus group discussions with CHWs (n = 53), and in-depth interviews with their supervisors (n = 11) and county health management team leaders (n = 7) across various counties (n = 7), each featuring distinct payment models. Results The documentary review findings reveal that the roles of Community Health Workers (CHWs) have evolved, and compensating them has enhanced performance, increased expectations, boosting household visits and referrals. Traditionally, CHWs were selected based on community trust and relied on their personal resources. However, they are now working longer hours and are subject to performance-based systems due to payment. Key insights from the focus groups and interviews suggest that the professionalisation of CHWs could jeopardise existing social reciprocity, alter their core roles, and limit accessibility by necessitating specific certifications—potentially excluding women. The introduction of a formal payment model has resulted in fewer CHW retirements, an influx of young recruits, and increased male participation driven by financial incentives. Notably, CHWs call for improved compensation, which could lead to labour unrest. Furthermore, the politicisation of the workforce may threaten the sustainability of services and fair pay. Conclusions The professionalisation of CHWs is vital in strengthening primary healthcare; however, as the findings highlight, it introduces challenges such as recruitment, payment structures, and job conditions. Policymakers must ensure that CHW professionalisation aligns with community health principles and preserves social capital to safeguard the values of community health, affirmative action and the social reciprocity that the complexities of professionalisation may disrupt.