Panacea or pitfall? The introduction of community health extension workers in Uganda

Abstract

Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement All data relevant to the study are included in the article.

Understanding Factors That Support Community Health Worker Motivation, Job Satisfaction, and Performance in Three Ugandan Districts: Opportunities for Strengthening Uganda’s Community Health Worker Program

“…Without concerted efforts to address the lack of harmonized support for VHTs, there is a high possibility that the relationship between the VHTs and a new paid cadre would not be cordial, further undermining community health. 12 The Ugandan government has stipulated various forms of monetary and non-monetary incentives for VHTs; however, it lacks clarity on what combination could best support VHTs, how it should be administered, and by whom. 6 A complementary study conducted by this research team in Uganda recommended that VHTs are willing to accept a decrease in salary of USh 31 240 (US $8.5) in exchange for identify badges.…”

“…13 Uganda's MoH sought to address this through the CHEW strategy, by bringing together local and global stakeholders to facilitate multi-stakeholder dialogue and commitment. [12][13][14] Plans to strengthen the community health workforce in Uganda must include the importance of a harmonized and uniform incentive package for all CHWs, such that it is equitably structured across cadres of healthcare workers and standardized across all CHWs, as well as accountability mechanisms to ensure it is systematically and consistently implemented in practice.…”

“…6 Critical gaps in the VHT program, including inadequate government funding, limited opportunities for training, lack of supervision and other support have resulted in sub-optimal performance of the program. 6,[10][11][12] The assessment resulted in a plan to roll out a new cadre of CHWs called the community health extension workers (CHEWs) at an estimated cost of US $102 million over 5 years. 13 CHEWs would be based at the parish-level, serve as the supervisors of VHTs, would receive six months of formal training provided by the Ugandan MoH, and would be salaried.…”

“…13 CHEWs would be based at the parish-level, serve as the supervisors of VHTs, would receive six months of formal training provided by the Ugandan MoH, and would be salaried. 12,13 Given the anticipated CHEW rollout, this study planned to better understand existing issues related to VHT compensation, so that it could inform the compensation plan for the new CHEW cadre. However, there was significant concern around the introduction of CHEWs, anticipated tensions between the two cadres, and the potential risk of further demotivating the existing VHT cadre.…”

COVID-19 information dissemination in Uganda: Perspectives from sub-national health workers

“…This structural strategy, which places decision-making at the district level, was endorsed at the WHO's "Health for All" conference in 1987 as a way to achieve more equitable health care access by localised, adaptive approaches to intervention and service delivery [2]. In a similar vein, Uganda adopted the Community Health Worker programme in 2001, which was a formalised system of village health teams (VHTs), comprised of volunteers with a basic training in relevant health issues mandated with implementing community-based interventions [3]. Accordingly, Uganda's response to the coronavirus (COVID-19) pandemic has been centred on the COVID-19 District Task Forces and District Rapid Response teams established in all 135 districts [4].…”