PAR in Action: Empowerment of Women through Paid Community Health Work in Informal Settlements in Nairobi, Kenya

Background and Purpose: Best practice social work research incorporates community, and often community health workers (CHWs), as team members. Yet women, including CHWs, face pervasive gender inequality, resulting in social, economic, and health disparities. Women’s empowerment is a crucial strategy to address such inequality and improve women’s lives. We seek to determine if a participatory action research approach (PAR), including continuous paid community work and professional and mental health training are effective tools for sustainable psychological, social, and economic empowerment for CHWs in informal settlements.

Methods: Focus group discussions (FGDs) were conducted with 16 CHWs residing in Mathare and Kibera to assess the impact of 6 months of paid employment, professional development, and mental health training. CHWs, who are residents themselves, were hired to conduct longitudinal surveys assessing climate and mental health among women living in informal settlements. Guided by empowerment theory, FGDs were recorded, transcribed, and analyzed using an a priori coding scheme based on psychological, social, health, and economic empowerment theory domains.

Results: Women expressed increased financial security and a newly formed “savings” culture positively impacting their self-efficacy and social networks, as well as stability and strengthening of ties to and with the broader community. Specifically, some women reported being able to pay school fees for their children for the first time, and being able to save up to buy farmland outside of the city. With more economic stability, some women also report being a source of financial support to others in their social networks and feel increased self efficacy to be leaders in addressing critical problems women face in their community. Paid and sustainable work was observed to relieve mental stress about personal and group finances, and women are more interested in identifying ways to broaden the “savings” culture widely throughout the settlements, aiding community development.

Conclusions and Implications: Findings inform intervention components, programs and policies focused on development, empowerment, and gender equality in Kenya. Integrating PAR and economic empowerment may serve as a model for empowering women across low- and middle-income countries, globally. Furthermore, these preliminary findings highlight the need for PAR research designs that assess research team member experiences and outcomes in addition to participant outcomes, especially when these team members are also part of the affected communities.