Ms. Lilyana Dayo, the County Director of Health in Kisumu County (Kenya), relates the strategic initiatives the county has taken in combating communicable diseases: advocacy programs to minimize HIV transmission, screening programs for TB, distributing anti-malaria medication to households, and more. (1) Yet despite such active measures in the communicable disease sector, she also recognizes that there has been a worrying rise in non-communicable diseases as of late – with few interventions in place to combat the trend. (1) And it is not just her county that lacks measures to combat non-communicable diseases, but rather it is a trend globally. Despite non-communicable diseases making up 74.37% of the global disease burden (via deaths) (2), non-communicable diseases only receive 1.6% of global health financing (3)– of which mental health receives 20% of that 1.6% (or 0.32% of global funds overall) (4). That 0.32% remains a stagnant figure, even though 1 in 4 people will be aected by mental illness in their lifetime – and approximately 14.3% of deaths worldwide can be attributed to mental health disorders (5). With a misalliance between the burden of disease and the funding for disease, organizations looking to make equitable access to quality health systems must nd atypical solutions. One such unconventional solution lies in the integration of community health services.

HealthRight’s Boda Boda driver project represents such an intersection, or integration, of health services – specically by intersecting the sectors of HIV prevention and treatment with mental health services. Boda Boda drivers are motorcycle drivers that are employed for taxi services, and in such a field, young males represent the majority of their population. Comprised of young males that consistently travel away from home for long periods because of their work, Boda Boda drivers are considered a high-risk group for HIV transmission. These conditions are coupled with the social standards that working as a Boda Boda driver is not seen as a desirable field, but rather individuals are only expected to enter the field as a last resort – when life has taken a wrong turn and there are no other options. Therefore, with personnel often in despondent positions, the aforementioned risk for HIV is accompanied by a high rate of mental health concerns, specically with depression.

In HealthRight’s Boda Boda project, drivers from the Boda Boda community receive training to become “Champions”, and in this role, they take on a mentor-like position of advocacy where they screen fellow drivers for risk of HIV and mental health issues. With their screenings, drivers who are agged as being at high-risk are given guidance for the next steps that they can take using the government’s health system to receive treatment. Even if a driver is not seen as being at risk, their conversations with Boda Boda Champions have helped to normalize discussions around mental health and HIV – fields that have historically been surrounded by high levels of stigma. The screenings conducted by these Champions have played a major role in granting Boda Boda drivers access to health services. Previously, many Boda Boda drivers would avoid proactive healthcare measures due to the time, money, or other barriers of entry to going to the hospital. Now, fellow drivers (the Champions) can address instances of HIV and mental health issues through their screening services in the locations where Boda Boda drivers already congregate, and then set up treatment plans for drivers that do need further care. Furthermore, even if a driver is cleared of risk from these issues, the Champions’ conversations on these topics have led to the development of proactive and preventative healthcare models by the clearing of misconceptions and stigma that surrounds these diseases.

With the work of the Champions in HealthRight’s Boda Boda driver project, the Boda Boda driver community has transformed its health accessibility and community relations. Community members, specically the Champions themselves, have vocalized their “empowerment” with their newfound knowledge of the health topics they are raising awareness for. Boda Boda drivers experience a sense of pride in embodying the role of a Champion because of the impact they can deliver to their community and other men in need of support. However, the change is not limited to an internal shift; instead, the Champions have played a role in changing the overall public image surrounding the Boda Boda profession as well. With the Champions’ work, Boda Boda drivers are leaving behind the stigma that has long-surrounded their position “of last resort”, and now the community has become an important gateway (even seen by the general public) to healthcare services. This gateway creates an opportunity for access not only to HIV programs, which have long been supported by government work, but furthermore to mental health issues and services that remain overlooked at large.

HealthRight’s intersectional initiatives such as the Boda Boda Champions project empowers communities, promotes self-advocacy and sustainability, and generates direct positive outcomes for populations to easily access care options. Although this project represents a success story in the space of HIV prevention and mental health support, relying on organizations to voluntarily and independently and remedies to otherwise neglected non-communicable diseases is neither a sustainable nor appropriate solution to tackle the issues within the non-communicable disease sector. With a mounting burden of non-communicable diseases on the global public health system, public health nancing must shift resources to support the non-communicable disease sector (or the dual programs already existing within it) to avoid reaching a point of irreversible strain on global health systems.

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