Re:inforce

Reinforcing community health systems in Uganda

Community Health Workers, also known as CHWs, are key to primary healthcare delivery in low- and middle-income countries and are recognised by the World Health Organization. They receive training in a range of preventative and curable health conditions and are linked to health facilities, acting as a bridge between formal healthcare providers and underserved communities.

In 2001, the Ugandan Government established a CHW programme as part of its Uganda National Minimum Health Care Package, to address the high level of disease and critical shortage of health professionals in the country. The programme aimed to ensure that every village in the country would have several community volunteers to help provide health information, primary healthcare support, and links to health services. However, many challenges affected the programme and its effectiveness in serving the community.

In partnership with Makerere University School of Public Health in Uganda, over a ten-year period, Professor Linda Gibson and Dr David Musoke and their teams developed research into the strengthening of the CHW programmes there. Their first project aimed to improve the CHW programme across Ssisa sub-county, a semi-rural community of 64 villages in Wakiso District.

Their research identified many gaps in the government’s CHW strategy. Although CHWs received training at their initiation and were expected to conduct home visits for health education and treatment of childhood illnesses, their interventions were limited by out-of-stock medicines, inaccessible public transport, and lack of basic resources such as gumboots and raincoats. They were also provided limited ongoing training on how to diagnose and treat childhood illnesses such as diarrhoea, pneumonia, and malaria, and they also worked voluntarily, with little support or incentives, which led to low morale amongst the CHWs.

The NTU Makerere Partnership therefore helped to deliver specialised training to 75 CHWs in rapid testing and treatment of diarrhoea, pneumonia and malaria in children. They also provided gum boots, umbrellas and solar equipment to enable CHWs to visit homes in any weather conditions, and motorcycles for supervisors to help increase the availability of essential medicines, and to improve access to supervision and support for CHWs in the field. The team also gave leadership and management training to 24 supervisors, and in total 263 community health workers received additional training in this sub-county.

Having significantly widened access to healthcare for the local population through these interventions, the NTU Makerere Partnership was given additional funding to scale up the programme to three other sub-counties in Wakiso, and to ensure its long-term sustainability by designing a ‘train the trainer’ model, helping to strengthen the health system at grassroots level. A total of 222 CHWs and 34 supervisors from the new sub-counties were trained.

As a result of the successful scale-up of the CHW programme, the Partnership was awarded funding by the Fleming Fund, a UK aid programme managed by the Department of Health and Social Care, to co-design a training programme on antimicrobial resistance, antimicrobial stewardship, and infection prevention and control using a One Health approach. Subsequently, training was delivered to 86 health practitioners and 227 CHWs in the Busiro South Health Sub District in Wakiso.

By addressing the barriers of limited training opportunities and low morale in the communities they work with, the Partnership’s research-led interventions have upskilled the health workforce, improved CHW retention and competency in treating childhood illnesses, and significantly widened access to health care services for the people of Uganda.

The supported community health worker programme has resulted in the delivery of health care to more than 215,000 people in underserved communities who previously had limited access to health services. In addition, more than 25,000 children under five years of age were treated for illnesses including diarrhoea, pneumonia, and malaria.

Professor Linda Gibson

Linda has over twenty years of experience in health promotion and working with local communities in the UK and internationally. She has led the partnership with the School of Public Health, Makerere University, Uganda since 2012.

Dr David Musoke

Dr. David Musoke is a Senior Lecturer in the Department of Disease Control and Environmental Health at Makerere University School of Public Health (MakSPH).