By: David Musoke, Joviah Gonza, Rawlance Ndejjo, Amanda Ottosson, Elizabeth Ekirapa-Kiracho
Four-member Community Health Worker teams in Uganda provide home visits and health management services for local communities. Limited funding prevents these workers from receiving regular and consistent supervision. However limited their supervision, the impact of each team has enabled the country to achieve reductions in morbidity and mortality among children.
Community Health Workers in Uganda work as members of Village Health Teams (VHTs). The VHTs Program was established in 2001 as a cost-effective way to link communities with health services. VHTs support the Ministry of Health (MOH) to bring health services closer to the population.
In Uganda, each village is mandated to have four VHT members, at least two of whom provide integrated community case management (iCCM) of childhood illnesses.
The main role of VHTs is to mobilize communities for better health services, hence bridging the gap between communities and health facilities. Other specific roles of VHTs include: conducting home visits, managing malaria, diarrhea and pneumonia among children under five years, distributing health commodities, and conducting referrals to health facilities.
All VHT members must be above 18 years and able to read and write, preferably in the local language. Initial training is provided to all VHT members, with those involved in the provision of iCCM receiving additional training. Refresher trainings are conducted by the MOH and implementing partners as needed although on an irregular and non-standardized basis.
VHTs are supposed to report to a health facility within their community where a health worker supervises them. A parish coordinator often offers support to all VHTs within a parish, and the District Health Educator is mandated to oversee the work of all VHTs in the district. However, due to limited funding and human resource capacity, supervision of VHTs is often irregular and inconsistent.
Incentives and remuneration
According to the MOH VHT strategy, VHT members are community-selected volunteers who do not receive financial payment for their services. However, they may receive non-monetary and sometimes ad hoc monetary incentives from the MOH or from their implementing partners that work with them in communities. These incentives are not standardized and vary throughout the country, and mainly depend on the implementing partner that is supporting the VHTs.
VHTs have made a significant contribution to increasing access and utilization of health services as well as improving health outcomes in communities, including reduction of morbidity and mortality of children younger than five years of age.