Abstract:
Community health volunteers (CHVs) act as vital links between communities and health facilities,
bridging the health service delivery gap common in low- and middle-income countries. In 2013,
changes in funding in western Kenya left most CHVs without their individual monthly stipend. In this
article, we explore how the implementation of a pooled incentive model had an impact on the lives of
CHVs from two counties in western Kenya. Participation in this form of table banking was meant to al-
low CHVs to pool their resources together and invest in income-generating activities to offset the
costs of unpaid health work. A pre-post qualitative study, consisting of focus group discussions and
in-depth interviews explored CHV compensation, motivations and challenges experienced in 2013
and 2015, prior to and after the implementation of this pooled incentive model. Following withdrawal
of the monthly stipend, we found that CHVs continued to take on roles and responsibilities of paid
health workers, motivated by shared social identities and connections to their communities. However,
replacing the stipend with a pooled-group incentive model seemingly exacerbated the financial bur-
den already experienced by this vulnerable population. This study brings into question the sustain-
ability and viability of a volunteer community health worker programme and highlights the need to
address the financial burden associated with the CHV role in western Kenya.
