Paper short abstract:

We provide a gender lense on the ‘spectrum of voluntariness’ in Kenya’s community health. We examine the unpaid labour demands community health volunteers experience and how this has been enjoined over years through existing structures.

Paper long abstract:

Unpaid community labour has been a cornerstone of foreign interventionism since the late colonial period (Rossi 2017). In health, Community Health Workers (CHWs) have been promoted as core to delivering primary services, in particular since the 1978 UN Declaration of Alma Ata. While originally trumpeted as a revolutionary, pro-poor approach to realising the right to health, over time unpaid community labour has been coopted by public and private actors to their own ends. Drawing from life story interviews and ethnography with Community Health Volunteers (CHVs) in Isiolo, Kenya (2022-2023), we unpack how historical, intersecting forms of ‘expanding dispossession’ (Bin 2018) have exacted unpaid labour over decades. CHVs, who sign contracts and are accountable for such, remain legally volunteers without any labour protections. Indeed, the notion of ‘voluntarism’ has restricted avenues for CHVs to organize for change, encapsulated by a failed strike in 2021. While the majority of CHWs are women globally, in Isiolo it is an even divide, suggesting egalitarianism. However, we explicate how such labour remains gendered to the extreme within this one county. Specifically, where such work is seen as a ‘step-up’, in rural areas with no opportunities for self-improvement or where patriarchal norms restrict women’s movements and activities, the majority are men. Where such work is a ‘step-down’, of no material or symbolic value as in urban areas, the majority are women. We conclude with our reflections on this gendered ‘spectrum of voluntariness’, where autonomy is discernible but conditioned by past dispossession, which we understand as violence.