Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts

Abstract

BackgroundUganda’s national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda.MethodsA mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged.ResultsVHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting.ConclusionsSupporting and retaining Uganda’s VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0619-6) contains supplementary material, which is available to authorized users.

Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda

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Volunteering Hierarchies in the Global South: Remuneration and Livelihoods

“…Here, we focus less on the specific needs of a community and instead consider the broader implications of using a livelihoods frame for volunteering and its remuneration in diverse settings. Research suggests that offering even a small financial incentive or stipend increases the likelihood that people will engage in volunteering in their local communities (Wig 2016;Mays et al 2017). However, financial incentives are not the only motivating factor for volunteers, and indeed, it is unhelpful to isolate any one factor or ignore how they may interact with each other and the wider context in which people live their lives.…”

“…However, most volunteers working in humanitarian and development contexts, often characterised by widespread and persistent poverty, come from the very communities experiencing inequality and marginalisation. While some research does address local volunteering in the global South, notably in relation to community health workers (Jenkins 2011;Mays et al 2017), and volunteering by low-income individuals in the global North (Benenson 2017), conceptualisation of volunteering in the context of development activities is dominated by the experiences of volunteers from the global North temporarily placed in global South settings (Devereux 2008; Laurie and Baillie Smith 2017). Consequently, we lack a significant empirical or conceptual base for understanding how community-based volunteering articulates with inequalities in global South settings (Graham et al 2013).…”

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