Stepping Up or Stepping Down? Gendered Labour in Kenya
Why men are taking up 'feminine' work in pastoralist Kenya
Community health work is often portrayed as the face of grassroots care – and that face is usually female.
Across Africa, around 70 per cent of community health workers are women, performing unpaid or poorly paid labour that has long subsidised global health. Yet in Isiolo County, northern Kenya, the picture looks very different. Here, almost half of community health promoters (CHPs) are men, and in rural areas two-thirds are male. Why do men take on a role widely framed as women’s work?
Researchers Kathy Dodworth and Brenda Mukungu offer a compelling answer in their recent study of Isiolo’s ~760 CHPs. They historicise the shift from pastoralist livelihoods to precarious, semi-waged labour and introduce a useful lens: the step up – step down – step out framework.
Step up, step down, step out
In remote and conservative areas, where income opportunities are scarce, CHP work is seen as a step up – a rare chance to gain status and a modest stipend. Men dominate here, despite tensions with pastoralist norms that prize autonomy and self-sufficiency.
Conversely, in urban and urbanising settings, CHP work is derided as a step down. Men exit for better-paid roles, leaving women to fill the gap. Meanwhile, women who do ‘step out’ into this public-facing role often face domestic pushback and even violence, alongside security risks in conflict-prone areas.
This framework captures the complexity of gendered labour in Isiolo, but the lived realities are even more nuanced.
Frustration and fragile gains
For rural men, CHP work initially promised influence and self-betterment. Some spoke proudly of being seen as local leaders or even ‘doctors’:
“We’ve gained strength. For example, if a child is sick, they can’t go directly to the dispensary; they must pass through me… People see me as a doctor, even call me ‘doctor’.” (FGD6, rural male)
Yet the financial reality quickly undermined these aspirations. Monthly stipends averaged just KES 2,000–2,700 (around £13–£18), often delayed for months:
“Two thousand shillings barely covers daily expenses… The payment doesn’t align with the workload.” (Interview, rural male)
“We believed our money would come every month, but they delay for 8 or 9 months… You start to lose hope.” (Interview, rural male)
Urban men, by contrast, treated CHP work as a temporary side hustle. Many left for jobs in the army, police or NGOs. In focus groups, the term ‘volunteer’ emerged as a flashpoint:
“The letter ‘v’ is what troubles us most. Volunteering is the reason we are paid so little.” (FGD6, rural male)
“The word volunteer is killing us… They force us to work and demand reports – clearly, that’s work, not volunteering.” (FGD2, urban male)
Women’s experiences reveal another layer of inequity.
While CHP work offers them absolute gains – income, mobility, skills – these come at a cost. One long-serving CHP described being attacked by her husband for continuing the work, even after he confiscated her stipend.
Beyond Isiolo: what’s at stake?
Community health work in Isiolo is not just about healthcare – it is a window onto the wider dynamics of insecure labour in rural Kenya.
For men, the shift from pastoralist autonomy to ad hoc, feminised work has triggered frustration and even shame. For women, the promise of empowerment remains circumscribed by patriarchal structures and security risks.
Recent reforms under Kenya’s Primary Health Care Act, including a new stipend of KES 5,000, may change the calculus. If pay becomes reliable, CHP work could masculinise further, potentially displacing long-serving women. Policymakers must tread carefully to avoid reproducing inequities in the name of progress.
At heart, this story is about more than gender – it is about the costs of development models that rely on unpaid or underpaid labour. In Isiolo, stepping up has too often meant stepping into insecurity.
Note: Community Health Promoters were called Community Health Volunteers (CHVs) at the time of research.
Read more:
Dodworth, K., & Mukungu, B. N. (2025). Step up, step down, step out: the gendering of community health work in pastoralist Kenya. Third World Quarterly, 1–20. https://doi.org/10.1080/01436597.2025.2576789
Watch the video abstract:
Dr Kathy Dodworth is a Research Fellow in the Department of International Development. Her two key areas of expertise are non-state actors and voluntary labour in development, with a recent interest in the unwaged production of data for development.