Strengthening health systems by addressing community health workers’ mental well-being and agency

Region: Bangladesh and Kenya
Funder: National Institute for Health and Care Research | NIHR
Project Duration: October 2022 to September 2025

Strengthening health systems involves recognizing the importance of Community Health Workers (CHWs) and addressing their mental well-being and agency. CHWs play a vital role in delivering healthcare services and bridging the gap between formal healthcare systems and local communities. However, they often face numerous challenges, including heavy workloads, limited resources, insufficient training, and inadequate support, which can negatively impact their mental health and overall well-being.

Setting: This project will entail conducting studies within urban slums and remote rural settings in Bangladesh and Kenya to gain cross-contextual, cross-country comparisons and lessons for scale up in other low- & middle-income Country (LMIC) contexts.

Our Intervention

Our Evaluation study aims to develop a comprehensive approach that promotes well-being and resilience among Community Health Workers (CHWs) while incorporating training, community cohesion, and support within the health system.

Study Objectives

Our objectives are to

  1. To identify strategies and programmes to enhance CHWs’ wellbeing, with a specific focus on mental health that is equitable, sustainable and acceptable in the Kenyan setting
  2. To co-design and test innovative health system interventions that are responsive to the diverse personal and job-related stressors (social, material and human) experienced by CHWs.
  3. To enhance the quality and equity of existing support approaches to ensure a focus on mental well-being that prioritises the diverse needs of CHWs.
  4. To contribute evidence and knowledge to inform and advocate for support of CHWs mental well-being in future research and programme design in other health systems

Our Approach

Our research will apply ‘Community Based Participatory Research’ (CBPR) to situate CHWs and stakeholders as equitable partners and co-researchers who are central to data collection, analyses and co-designing solutions. We will:


  1. Undertake analysis of existing global and national policies and practices that support CHWs wellbeing.
  2. Conduct interdisciplinary research with CHWs, supervisors and key decision/policy makers using qualitative, participatory methods, quantitative surveys, and embedded participatory evaluation to generate evidence on their experiences and challenges.
  3. Utilize evidence to co-produce interventions with CHWs and key stakeholders, to support CHWs’ mental wellbeing, promoting their resilience and agency to strengthen health system resilience.
  4. Pilot and evaluate interventions for cost, equity, feasibility, acceptability and scalability.

Our Team

Our interdisciplinary team comprises researchers, implementers, policymakers, CHWs, government (National and County) and, non-governmental organisations.

Our Partners

  1. National Institute for Health and Care Research (NIHR)
  2. LVCT Health (Lead)
  3. BRAC-James P. Grant School of Public Health (Co-Lead)
  4. African Population & Health Research Centre (APHRC)
  5. Liverpool School of Tropical Medicine (LSTM)
  6. Nairobi County Government
  7. Kiambu County Government