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Commentary
Potential challenges of implementing the Community Health Extension Worker programme in Uganda
  1. James O’Donovan1,2,
  2. Christina Elise Stiles2,
  3. Deogratias Sekimpi3,
  4. Isaac Ddumba4,5,
  5. Niall Winters1,
  6. Edward O’Neil Jr2
  1. 1 Department of Education, University of Oxford, Oxford, UK
  2. 2 Department of Research, Omni Med Uganda, Mukono, Uganda
  3. 3 Uganda National Association of Community and Occupational Health, Kampala, Uganda
  4. 4 Department of Community Health, District Health Office, Mukono, Uganda
  5. 5 Department of Research, African Research Centre on Aging and Dementia, Mukono, Uganda
  1. Correspondence to Dr James O’Donovan; james.odonovan{at}seh.ox.ac.uk

https://doi.org/10.1136/bmjgh-2018-000960

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    Summary box

    • The proposed roll out of the Community Health Extension Worker (CHEW) programme is due to take place in Uganda in 2018 at an estimated cost of US$102 million over a 5-year period.

    • Although this is a welcome move towards supporting the existing Village Health Team (VHTs) cadre of community health workers, several challenges and potential solutions are raised in this article.

    • Uncertainties remain around potential tensions that may arise between current VHTs and the new CHEWs, the logistical implementation of the programme and financial sustainability.

    • Prior to roll out of the CHEW programme, greater attention must be given to the practical, logistical and financial challenges of the proposed strategy, taking a health systems strengthening approach towards implementation.

    Uganda faces a significant shortage of trained healthcare professionals, especially in the public sector and rural areas.1 As a result, the Ministry of Health (MoH) have supported delivery of the Village Health Team (VHT) model since 2001.2 VHTs are lay people, working in a voluntary capacity, acting as a link between the formal health sector and their communities.3 They are given basic training on major health issues, including childhood diarrhoea, malaria and pneumonia, and play a role in disease surveillance through activities such as data collection and reporting.3

    Although the exact selection process for those wishing to become a VHT member varies depending on location, individuals commonly undergo selection starting in their own communities. After a period of sensitisation and consensus building among local stakeholders, a popular vote is held. To be selected as a VHT member, an individual must meet several criteria. He or she must be ‘above 18 years of age, a village resident, able to read and write in the local language, a good community mobiliser and communicator, a dependable and trustworthy person, …

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