This essay draws on some findings from a recent study supported by the African Peacebuilding Network (APN) on peacebuilding through health initiatives. It explores how community primary health workers and volunteers (CHW/Vs) contribute to peacebuilding while at the same time performing their core obligation to improve health in informal urban settlements in Nairobi, Kenya.
Nairobi’s informal settlements experience a range of violence, including political, ethnic, religious, resource-related, and gender-based violence. The link between peace, development, and health is a direct one as conflicts and violence can directly impact health or cause a disruption in social and economic systems leading to a decline in health. The World Health Organization (WHO) adopted the “Health as a Bridge for Peace” (HBP) policy framework in 1998 premised on the fact that health care providers play a crucial role in the preservation and promotion of peace. This framework pushes health care providers to go beyond their health provision role to support peacebuilding efforts in communities where they work. While the health-peace link is clear, Kenya’s national peace policy and frameworks such as the National Cohesion and Integration Commission (NCIC) do not acknowledge the contribution of health workers to peacebuilding.
Community health workers and volunteers in peacebuilding
While CHWs are part of the formal health care system, CHVs work on a voluntary basis with little support from the government and the health-related organizations that train them in basic medical and preventive care. Primarily, CHW/Vs provide basic health and medical care to community members, provide health education, and link community members to health care systems. They are also involved in educating providers and stakeholders within health care systems about community health needs. CHW/Vs thus contribute to community development in a very meaningful way. Beyond this core mandate, the study found that both CHW/Vs can and do play a crucial role in creating social cohesion, thereby promoting peace. However, their peacebuilding efforts remain largely invisible and unrecognized within peacebuilding structures in the country.
In-depth interviews with CHW/Vs reveal how they engage in settling disputes and reconciling family members within households that they visit for health care reasons. Because they enjoy a considerable level of legitimacy and are easily accessible to communities, some residents disclose to them information about family and community violence. For instance, in Mathare, a female CHV told me about a woman who phoned her to seek assistance after a male family member sexually assaulted her young daughter. She convinced the mother to report the incident to the police. At the time of this study, this CHV was using her own resources to attend court as a witness in the sexual violence case because there was no support from any government or non-governmental body.
In Kibera, a male CHV helped two young boys involved in gang violence to leave the gang. At the time of the study, they were being trained in community health work by a non-governmental organization. Interviews and group discussions with community residents confirmed that community health workers and volunteers perform multiple roles. However, some residents interviewed accused other CHW/Vs of favoring individuals from their own ethnic groups, thereby creating feelings of ethnic discrimination in service provision.
As residents in these informal settlements, CHW/Vs are conversant with the different dimensions and causes of violence in these areas and how they are linked to health. Furthermore, because of the altruistic nature and requirements of health work, CHW/Vs interact daily with people of different gender, age, religion, political, and ethnic backgrounds. This places them in a position to learn about the needs of diverse groups of people. During interviews, CHW/Vs referred to specific groups of people in their accounts of conflicts and violence in the settlements; some were able to provide a historical account of systemic violence in the communities. They also demonstrated a good understanding of the link between resource scarcity and violence. This suggests that their knowledge about the nature and causes of violence in the settlements can be useful to local and national peacebuilding and development efforts.
The findings of the study suggest that national peacebuilding programs such as the NCIC should work in partnership with CHW/Vs to gain from their knowledge about the factors that engender different forms of violence in informal urban settlements. Their perspectives could strengthen the NCIC’s capacity to advocate for policies and programs that address the causes of violence and thereby build social cohesion in the settlements. In addition, the Nairobi county government should strengthen health care delivery in informal settlements to reduce feelings of marginalization, including ethnic discrimination. It should also acknowledge the roles played by CHW/Vs in promoting health and peace, facilitate their training, and work on bolstering the health-peace nexus. To further support peacebuilding efforts, the existing local peace committees headed by chiefs in informal settlements should incorporate CHW/Vs into their peace initiatives. This study also suggests the need for additional evidence-based research to provide a more comprehensive policy and program strategy for integrating health care workers into the peacebuilding agenda in informal urban settlements in other parts of Kenya and Africa. These studies should pay attention to the constraints and limits of engaging health workers in peacebuilding.