Written by Abigail Krenz
Once distrusted and stigmatized, bodaboda drivers are becoming champions of health in Trans-Nzoia County, Kenya. Since 2019, HealthRight’s SACCO Health and Wellness project has mobilized men in the county’s transport sector to connect tens of thousands of people with free HIV and mental health services. Through the HealthRight Experiential Learning Program this summer, I witnessed first-hand the close collaboration between HealthRight, county officials, community groups, and transport unions that has made this project a success. Unfortunately, with grant funding in Kenya terminating this year, the program will likely end. Even as a model of co-creation and local ownership, the SACCO Project’s uncertain future reveals the persistent challenge of developing sustainable health interventions in an aid-dependent context.
The SACCO project has incorporated community stakeholders at every step of the process to ensure its impact and responsiveness to local needs. The program leverages existing health systems and community structures to extend integrated HIV and mental health services to bodaboda drivers. These drivers work long hours, experience traumatic road accidents, endure long separations from their families, and face stigma due to their reputation for sexually careless behavior. Highly mobile and at risk for STIs, depression, and PTSD, bodaboda drivers have now taken the leading role in encouraging their peers to seek services at HealthRight’s mobile outreaches. These clinics are placed at key transit points where community “edutainers” perform lively skits and dances to attract people to the clinic, entertain them as they wait, and educate the crowd about mental health and HIV. Inside the tent, community health promoters, psychologists, and clinical assistants—all working within the county health system—screen the patients for HIV and mental health issues. Depending on the need, they then refer patients to HIV testing, community-based mental health support, or additional care at a local health facility.
During a meeting with county health officials, we interns observed the deep mutual appreciation between HealthRight and the county that has blossomed as a result of this partnership. In a hospital conference room, County Health Department Director Dr. Pepala Wanjala led the whole group in a series of raucous, celebratory claps. She began by saying, “HealthRight is the only partner supporting mental health integration in our county. And for that we clap.” All of us clapped, smiles wide. She continued, “Trans-Nzoia has seen a 40 to 18 percent reduction in teenage pregnancies. Bodaboda drivers are changing from the main source of teenage pregnancies to health champions for our community.” More claps, wider smiles. After ten more rounds, Dr. Wanjala gave HealthRight Kenya’s Hellen Chemtai, who has managed the program since 2022, an extra special shout-out: “Hellen has become part of the county,” she told us. From county officials to edutainers, to community health promoters, to bodaboda drivers, each stakeholder’s commitment to this project has ensured its impact.
As I listened to the county recount the success of the program, I had one question in my mind: What will happen to the project when the funding runs out? County officials seemed to acknowledge that without external support, the program would come to a close. While in neighboring Uganda, HealthRight’s government partner recently agreed to support their own SACCO project, Trans-Nzoia’s funding appears too tight to prioritize the initiative. While HealthRight secured commitments from participating SACCO cooperatives to devote a portion of their membership fees to sustain the initiative, it is unclear whether bodaboda drivers, already struggling to make a living in Kenya, can spare the money. Without funding to reimburse drivers or support mobile clinics, reaching the remaining seventy percent of drivers scattered across the county will be a challenge. During the meeting, HealthRight CEO Peter Navario recommended that the county solicit additional funding from other organizations as well. While the county officials seemed eager to do so, it is not guaranteed they will secure continued support.
This dilemma is one manifestation of a much larger issue: the dependence of many developing countries’ health systems on foreign aid. Kenyan health officials explained to us that, year after year, the central government under-invests in the health sector with the understanding that NGOs can secure international funding to pick up the slack. Faced with limited grant periods and priorities set by donors, many NGOs work along single disease priorities and struggle to secure long-term funding for their projects. Within this narrow mandate, NGOs are rarely incentivized to help build government capacity or ensure their projects can continue sustainably without their support.
Within this system, HealthRight, which remains largely dependent on grants, must strike a careful balance between engaging communities and recognizing its limited ability to sustain a project for the long-term. For these reasons, it utilizes pre-existing community structures to create the opportunity for its projects to endure. As Peter Navario explained to our cohort, HealthRight essentially works as a strategic consultant by connecting existing community structures and local governments to more effectively work together. It develops low-cost, scalable interventions that can eventually be taken over by its government and community partners. In other words, HealthRight works to make itself replaceable.
In many ways, HealthRight will leave Trans-Nzoia County better equipped to provide HIV and mental health services to those who need it most. County management teams, health care workers, and community health promoters have received trainings on sensitive HIV and mental health care. Newly empowered bodaboda-turned-champions are eager to continue serving their communities. Tens of thousands of drivers have already been sensitized to HIV and mental health issues. When finally forced to leave the county, HealthRight will continue doing what it does best elsewhere: Developing community-driven interventions to extend care to the most marginalized and co-creating these initiatives—to the best of its abilities—to endure after it’s gone.
As HealthRight does this work, how can we—as voters, students, educators, bureaucrats, donors, and aid recipients—help design and advocate for a health aid system where community-driven interventions like the SACCO project can last?
