They call me 'Sista': How Caroline Afwandi became Vihiga village's trusted health guardian
Ms CarolineAfwandi, a community health promoter, during an interview in Gidu, Vihiga, on February 26, 2025.
What you need to know:
- In Vihiga County, women like Caroline Afwandi form the backbone of the community health system, using smartphones and personal connections to bridge critical healthcare gaps in rural areas.
- Despite challenging conditions and minimal compensation, these Community Health Promoters walk from home to home, providing vital maternal and child health services.
The red dust of Gidu Village rises in small clouds beneath Caroline Afwandi's well-worn shoes as she walks purposefully along a winding pathway. The midday sun beats down mercilessly on Vihiga County, sending most residents scurrying for shade, but Caroline continues her journey, undeterred. A gentle hymn escapes her lips, carried away by the warm breeze.
Her melodic whispers are interrupted by the cheerful chime of her mobile phone. She stops, answering with a smile that creases the corners of her eyes. The voice on the other end brings news that makes her day: One of her pregnant clients has just delivered a healthy baby girl.
“Has she received all her vaccinations?” Caroline asks, her voice warm with concern.
The new mother confirms that her daughter has received the necessary vaccines administered at birth and will be discharged that evening. Before ending the call, Caroline promises to visit them the following morning, her voice filled with genuine care. This is just another day in the life of a community health promoter (CHP) in rural Kenya.
Frontline of community care
After walking a few more minutes under the scorching sun, Caroline arrives at Esther Nanjala's modest home. She's here to check on Esther and her two young children, aged seven months and three years.
“Habari, Esther! How are you and the children today?” Caroline greets warmly, settling onto a wooden stool in the shade of Esther’s small veranda.
Caroline Afwandi, a community health promoter, looks through an immunisation booklet while attending a household visit to see her client, Ms Esther Nanjala, on February26, 2025.
The 49-year-old CHP spends the next half hour engaged in conversation with the mother, her fingers deftly navigating through a workflow on her smartphone, recording each response with careful precision. Through their conversation, she learns that the seven-month-old has just been introduced to solid foods. She nods approvingly when Esther shares that she recently visited the nearby public hospital for family planning services—a decision influenced by Caroline's previous education on the importance of spacing births.
“As much as she is feeding on solids now, don't forget to supplement her diet with breast milk,” Caroline advises, looking directly at Esther.
“Also, just as we spoke last time, ensure the baby has a balanced diet.”
Caroline is one of 1,447 CHPs in Vihiga tasked with promoting universal healthcare at the grassroots. These healthcare warriors walk from home to home, offering vital health information and basic medical care to communities where healthcare facilities might be distant or inaccessible.
Women leading community health
According to Gabriel Masinde, the county focal person, an impressive 80 per cent of CHPs in Vihiga are women. When asked why the profession is dominated by women, he explains that the role is largely voluntary, with CHPs receiving a monthly stipend of no more than Sh5,000, despite creating a tremendous impact in primary healthcare.
“The men in our society tend to go for income-generating jobs because of the fact that they are considered breadwinners, while women are considered nurturers,” Gabriel explains, his voice reflecting both pride and pragmatism.
He notes that women CHPs have proved to be remarkably effective. “Over the years, one of the major impacts of working with women in this profession is the fact that they are more organised. They plan their duties and are able to juggle between community health service and other roles without any difficulties.”
The women, Gabriel observes, plan methodically and visit all their allocated households on time, spending quality time with their clients and showing genuine empathy. “The men, on the other hand, tend to rush the activity, with a majority only committing their time to visit clients in the last week of the month,” he adds. “Such poor planning compromises service delivery.”
A day in a CHP’s life
Caroline has served her community as a CHP for the past 14 years. Each month, she is charged with visiting 104 households in her community unit. The mother of three aims to visit five households daily, taking Sundays off to attend church and tend personal matters.
As she navigates the dusty paths between homes, her smartphone and medical kit are constant companions. Her work primarily focuses on maternal and child health, educating clients, including expectant mothers and women of reproductive age, their spouses and under-fives.
“During the household visits, I educate my clients on antenatal and postnatal care services, family planning, childhood vaccines, and general sanitation,” Caroline says, her voice reflecting the pride she takes in her work.
She has also been trained to diagnose and treat common childhood illnesses. “I can treat conditions like malaria and diarrhoea,” she explains.
“For complicated cases, I refer the mothers to healthcare facilities.”
Her responsibility doesn't end with diagnosis or referral. She follows up each child within 24 hours to monitor their progress. She also tracks down vaccine defaulters, ensures pregnant women deliver in health facilities, and promotes proper infant nutrition, including exclusive breastfeeding.
“I derive my joy in seeing a healthy society,” she says, her eyes bright with passion. “Raising a healthy individual begins right at conception until one is fully grown.”
Chosen by the community
Caroline's journey as a CHP began in 2014 when she was selected by community members during a baraza (community meeting). Before this role, she worked at a private health facility in Vihiga as a caregiver to patients under the supervision of nurses.
This background, combined with her natural compassion and desire to serve, made her an ideal candidate for the CHP position. Now, as she walks through her community, she is known affectionately as “Sista”, a term commonly used to refer to nurses in the community.
“The relationship I have been able to build with my clients is something I don't take for granted,” Caroline reflects. “I am the community’s first line of response in case of an emergency.”
In 2023, Caroline was among 100,000 CHPs who received healthcare kits and smartphones from the national government as part of an initiative to digitise community health work. The CHPs in Vihiga were trained in using these tools by the county government in partnership with Living Goods, a non-governmental organisation. As she sits with Esther, the smartphone in her hand represents this blend of technology and traditional care. She navigates through digital workflows with ease, recording vital information that will help track the family's health over time.
Living Goods also provides regular refresher training, which she says enables her to serve her community more efficiently. The digital tools have streamlined her work, allowing her to reach more families and provide more consistent care.
Unsung heroes
As Caroline finishes her visit, promising to return in two weeks, she gathers her belongings and prepares for the long walk to her next household. The afternoon sun has begun its descent, casting long shadows across the dusty pathway. For Caroline and thousands of female CHPs across Kenya, this daily journey is more than just a job—it's a mission to transform rural healthcare from the ground up.
“As the world marks International Women's Day, I want to specially commend the female CHPs for the role they play in promoting community health services,” Gabriel says. “Many people may fail to recognise the impacts you have created in the community, but that should never be a challenge. You are our primary healthcare heroes.”
In Gidu village, as Caroline continues her rounds, that heroism takes the form of dusty shoes, a gentle voice, and a smartphone—simple tools wielded with extraordinary dedication by women determined to build healthier communities, one household at a time.