Community health workers in Bangladesh and Kenya are helping design a support package to protect their own mental health, not just the health of the patients they serve. These workers—often women in slums and remote rural areas—are the backbone of many low- and middle-income health systems, yet they receive little pay, training, or emotional support. Chronic stress from overwork, unsafe conditions, and community trauma damages their wellbeing and, in turn, their ability to deliver care. This project addresses a neglected gap: the mental health of the health workers themselves. If successful, the research will produce a tested, co-designed support package—combining training, community cohesion, and policy advocacy—that is feasible and equitable in two very different settings. The goal is not just to help individual workers, but to strengthen the entire health system by making it more resilient when crises hit. The findings could inform how other low- and middle-income countries support their frontline health workers, shifting a system that currently takes their labour for granted.
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Background: Although community health workers (CHWs) play a crucial human resource role in health systems of many low and middle-income countries, they are largely invisible, under supported and not adequately recognised. Lack of support generates many stressors for CHWs which are further exacerbated when delivering services in challenging contexts (e.g COVID-19, informal settlements, remote areas). Chronic job-related stressors can have a lasting impact on CHW wellbeing which ultimately affects their performance and capacity to effectively undertake their important role as frontline health workers. Drawing on wellbeing and resilience frameworks while considering the hardware (e.g. training) and software (e.g. community cohesion and support) components of the health system, we aim to identify the stressors, challenges, constraints and opportunities faced by CHWs and communities. We will utilise this evidence to co-develop, pilot and evaluate a holistic health systems support package for CHWs in two different LMIC contexts to support CHW wellbeing and agency, ultimately contributing to enhanced health systems resilience. We will focus specifically on integrating support for the mental wellbeing of CHWs, a previously neglected area. . Setting: We will conduct studies within slums and remote rural settings in Bangladesh and Kenya to gain cross context, cross country comparisons and lessons for scale up in other LMIC contexts. Objectives: 1. To identify strategies and programmes to enhance CHWs’ wellbeing, with a specific focus on mental health that is equitable, sustainable and acceptable in LMIC settings. 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 wellbeing that prioritises the diverse needs of CHWs. 4. To contribute evidence and knowledge to inform and advocate for support of CHWs mental wellbeing in future research and programme design in other health systems Methods: Our research will apply ‘Community Based Participatory Research’ (CBPR) situating 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 (photo-voice, stepping stones, body mapping), 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 scale-up. Team: Our interdisciplinary team comprises researchers, implementers, policy makers, with direct engagements and collaborations with CHWs, government, non-governmental organisations, or in each country.
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