Counting on community health workers for attainment of SDGs
An important landmark has just been concluded in Kampala, Uganda. We are talking about the first international symposium on community health workers held from February 21 through February 23. This symposium attracted over 400 participants from 20 countries globally and was particularly timely at a time when universal health access is mandatory if we are to achieve the Sustainable Development Goals.
Whereas Uganda is experiencing a demographic ‘tsumani’, the health system is still fragile and facing budgetary constraints. This has certainly put a great strain on the health system and ultimately the care provided; with the marginal and vulnerable groups facing the brunt of the effects. To mitigate some of these effects, for the last 17 years, Uganda has been implementing the Village Health Team (VHT)/ Community Health Worker (CHW) strategy. However, the disease cause structure for maternal, newborn and child health has remained the same despite the fact that over 75% of the disease burden in Uganda is preventable through community interventions. Furthermore, the Ministry of Health has taken the initiative to encourage the communities to take care of their own health through various platforms including media. For over 10 years, radio spot messages such as “Health is made at home and only repaired in the health facilities when it breaks down. Be clean, eat well and do not share accommodation with animals” have been on the Ugandan airwaves. So what is it that we are not doing right?
Therefore this symposium came in at a critical time for Uganda to look at the available evidence on several aspects of the CHW strategy; reflect on the CHW contribution towards ensuring health for all; and share lessons from other countries as we prepare for the new Community Health Extension Worker (CHEW) strategy. The CHEW strategy will use a model household approach as opposed to the original VHT strategy that utilized a health program approach; and in this way promote community health.
We need ownership of our health and must implement home grown solutions. CHWs without a doubt are a very critical workforce that can contribute to achieving this by ensuring access to health for all and more especially the marginalized groups. This is through their increasing role in adoption of reproductive health behavior, maternal, newborn and child health promotion and prevention; and in some cases curative.
These CHWs are agents of social change therefore it is very important that we provide an enabling environment for them to do so. Critically, the health facilities must also be ready to provide the required quality and range of services so that the efforts of the CHWs is not watered down. In this way, we will build a health system that leaves no one behind. But how do we support CHWs to provide the desired quality of care? How do we ensure that they are motivated? What can the health system do for the CHWs rather than what can the CHWs do for the health system? Perhaps in answering these, we will have the magic bullet in setting up a wellness future health system that is resilient.
*** Blog by Dr Monica Okuga of CMNHR