Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom.
Glob Health Sci Pract. 2021 Dec 21;9(4):855-868. doi: 10.9745/GHSP-D-21-00260. Print 2021 Dec 31.
Community health worker (CHW) programs in Uganda have contributed to improved health outcomes in recent years. However, opportunities for engaging the various stakeholders supporting CHW programs have been limited. This article presents workshop findings where several stakeholders shared their lessons and experiences that can enhance performance and sustainability of CHW programs in Uganda.
We collected qualitative data from stakeholders from government, private, and community organizations, as well as CHWs, involved in CHW programs in Uganda during a 1-day workshop. The workshop involved plenary presentations and group discussions on critical aspects of CHW programs. All proceedings from the workshop were audio-recorded, transcribed, and analyzed by thematic content analysis.
Four major themes emerged from the workshop: lessons learned in implementing CHW programs, challenges affecting CHW programs, performance of CHWs, and ensuring sustainability of CHW programs. Key lessons learned related to 3 main subthemes: capacity building and use of technology, supervision and motivation, and stakeholder engagement and collaboration. Challenges affecting CHW programs identified included poor coordination, fragmented data collection systems, high program expectations, inadequate support mechanisms, and high dropout rates. Mechanisms for improving the performance of CHWs emphasized the need to: strengthen recruitment, training, and retention strategies; improve motivation; streamline coordination mechanisms; and develop and strengthen community health policies. The sustainability of CHW programs requires institutionalization; sustainable funding; economic empowerment of CHWs; local ownership; and a strengthened research agenda.
To improve the performance and sustainability of CHWs programs, stakeholders such as policy makers and implementing partners need to consider CHW needs, existing structures and policies, as well as local support.
近年来，乌干达的社区卫生工作者（CHW）项目为改善健康结果做出了贡献。然而，让支持 CHW 项目的各种利益相关者参与的机会有限。本文介绍了研讨会的发现，其中几位利益相关者分享了他们的经验和教训，这些经验和教训可以提高乌干达 CHW 项目的绩效和可持续性。
我们在为期一天的研讨会上收集了来自政府、私营和社区组织以及乌干达 CHW 项目中的 CHW 的利益相关者的定性数据。研讨会涉及关于 CHW 计划关键方面的全体会议介绍和小组讨论。研讨会的所有会议记录都被录制下来，转录并进行主题内容分析。
研讨会产生了四个主要主题：实施 CHW 计划的经验教训、影响 CHW 计划的挑战、CHW 的表现以及确保 CHW 计划的可持续性。关键经验教训涉及 3 个主要子主题：能力建设和技术应用、监督和激励以及利益相关者的参与和合作。影响 CHW 计划的挑战包括协调不力、数据收集系统分散、项目期望过高、支持机制不足和高流失率。提高 CHW 表现的机制强调需要加强招聘、培训和留任策略、提高激励措施、简化协调机制、制定和加强社区卫生政策。CHW 计划的可持续性需要制度化、可持续资金、CHW 的经济赋权、地方所有权和加强研究议程。
为了提高 CHW 项目的绩效和可持续性，政策制定者和实施伙伴等利益相关者需要考虑 CHW 的需求、现有结构和政策以及当地支持。
