Reaching rural communities through ‘Healthy Entrepreneurs’: a cross-sectional exploration of community health entrepreneurship’s role in sexual and reproductive health

Abstract

The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30–3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81–21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14–3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18–2.85). The association between exposure to community health entrepreneurship and communities’ comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97–1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.

Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study

“…The telehealth approach in this study was designed in specific circumstances, which allowed for rapid implementation and scale-up. In Uganda there was a well-functioning network of active CHWs, equipped with a smart phone, and supported during monthly cluster meetings [ 14 , 19 ]. At the start of the pandemic, many in the public health sector were very concerned about the predicted wave of critically ill patients and decision makers were ready to support telehealth as a solution for informing and supporting CHWs.…”

“…In Kampala, a call-center was set up with a team of nurses and doctors who supported a network of approximately 3,500 community health workers operating in 23 rural districts. These CHWs were part of the regular public health system and were simultaneously supported by a non-profit organization called Healthy Entrepreneurs (HE) [ 18 , 19 ]. HE uses an approach that draws upon the principles of micro entrepreneurship to support CHWs who are active in rural and remote communities [ 19 ].…”

“…These CHWs were part of the regular public health system and were simultaneously supported by a non-profit organization called Healthy Entrepreneurs (HE) [ 18 , 19 ]. HE uses an approach that draws upon the principles of micro entrepreneurship to support CHWs who are active in rural and remote communities [ 19 ]. These CHWs continued their standard community health activities within the public system, while making a modest income from selling basic health products such as malaria medicine, ORS, contraceptives and soap.…”

Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda

“…In this study, we focus on a novel approach aimed at making CHW programmes more effective and sustainable, by using the principles of microentrepreneurship. In this approach, regular CHWs are trained to become community health entrepreneurs (CHEs) who continue their standard community health activities within the public health system, while making a modest income from selling basic health products, such as antimalaria medicine, oral rehydration salts (ORS), soap and fortified foods 12. The CHEs thus become microentrepreneurs and purchase these products through a social enterprise and earn a margin on each product sold.…”

“…The first study is a large randomised controlled trial, which showed a substantial reduction (27%) in child mortality in (semi)urban setting 13. A second, cluster-randomised cross-sectional cohort study showed higher use of modern contraceptives and more knowledge about sexual and reproductive health in communities in rural areas 12. A recent scoping review which included nine other studies recommends social enterprise as a viable model for providing primary healthcare in resource poor areas 14…”