“Heat is a danger to my health even though I said I am used to it”: Qualitative insights of workplace heat among community health workers and health promoters in Kenya

Climate change is one of the most prominent environmental and health challenges of the 21st century. Variations in extreme temperature and weather events intensify occupational heat exposure and place workers at increasing risk of heat-related illness (HRIs) and injury. Healthcare workers, especially those in resource-limited, community-based, or mobile settings, face significant occupational risks from rising temperatures, yet these challenges remain largely overlooked and insufficiently studied. This qualitative study, based on semi-structured face-to-face interviews, explores the experiences of Community Health Workers (CHWs) and Community Health Promoters (CHPs) in Kenya, examining how extreme heat affects their personal health, livelihoods, and the delivery of community-based health services. We conducted 41 in-depth interviews with CHWs and CHPs (Mombasa County, n = 19; Tana River County, n = 22). Data was managed using NVivo 14 and analysed drawing on tenets of reflexive thematic analysis. We identified a pattern of intersecting vulnerabilities shaped by experiences of economic inequality, work conditions and pressures, HRIs, and challenges of accessing healthcare, effects of changing weather patterns on community health work and livelihoods, and gendered experiences of extreme weather and work challenges. Our findings show that these domains are not discrete but reinforcing, with overlapping effects that not only shape the daily experiences of CHWs and CHPs but also constrain their resilience and the effectiveness of community health service delivery. Our findings highlight the urgent need for climate-resilient health systems that not only improve the working conditions or protect CHWs and CHPs from extreme heat but also address the structural inequalities, such as economic disparities and the challenges of gendered burdens, that heighten their vulnerability.