Experts have urged the government not to phase out Village Health Teams (VHTs) in favor of Community Health Workers (CHEWs).
Dr. David Musoke a researcher at Makerere University School of Public Health says that having two community health workers replace a parish of over thirty VHTs is impractical especially since there is evidence that once well facilitated, laypeople can work efficiently as volunteers.
The Ministry of Health had in 2018 started a push to establish a National Community Health Extension Workers (CHEWs) Policy and Strategy which proposes deploying and paying two senior four leavers trained in basic healthcare at every parish in the country to act as the first point of care before referrals are made.
Aliyi Walimbwa, a Senior Health Planner in the Ministry told health development partners attending their retreat where national health priorities for the next financial year 2022/23 were shared that they are still contemplating whether to retain VHTs or drop them when they finally roll out CHEWs.
Already, the ministry had embarked on a pilot study in 2019 to establish how effective CHEWs can be in disease control and prevention interventions currently being done by the VHTs. But, this idea has always received criticism in parliament because of the wage burden this will come with since initially, the proposal was, to begin with, 15,000 of them and roll them out slowly for a period of five years.
Matia Lwanga Bwanika, the LCV Chairperson Wakiso says it is rather laughable that government can think of paying community health workers when they struggle to pay one-off facilitation to VHTs once they assist in government programs.
Bwanika who was attending a meeting organized by Makerere University where VHTs were given identity cards and motorcycles cited the just concluded house to house polio vaccination where VHTs were promised 10, 000 Shillings each but none of them in Wakiso have received funds.
While their exact number countrywide is not known, as there are limits or follow-ups of how many can be in each village, Bwanika says that there are more than 7,000 in Wakiso.
Other than phasing these out, Musoke says the government should retain them as volunteers but keep re-engaging them with training and offer work tools to keep them interested as they have done as the University through the UK funded strengthening community health project which has been going on in Wakiso for the last ten years.
The VHTs programme was started in 2001 as an innovative approach to empower communities to participate in improving their own health, and to strengthen the delivery of health services at the community and household levels.
Peter Jjemba, a VHT coordinator in Zinga Island, says that many of his colleagues that embraced the programme at its launch have since lost interest. Jjemba who joined the teams in 2010 says those that still do some bit of work are those under donor-funded programmes.
He says while they continue focusing on key areas of malaria, pneumonia, and diarrhea, it’s long since they attended refresher training by the government.
Meanwhile, in an earlier interview with URN, Prof. Francis Omaswa, the Executive Director of the African Centre for Global Health and Social Transformation (ACHEST) expressed sustainability of care fears when relying on VHTs.
“They don’t have mandates and can’t be held accountable”, he says adding that the idea of CHEWs is not new since it was first proposed way back when he still was the Director-General of Health Services in the Ministry of health.
“The design we had proposed was to use local councils where the chairman is made the leader. He would work with an executive of nine members and we said let 30% of these be trained, given uniforms, and be given a village health register to keep track of what happens. But donors said we have no money for that let them volunteer”.
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