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Getting community health services out of survival mode: reflections from the 1st International Symposium on community health workers

“If one tells of a place where the rain met him, he is given a place to warm up by the fire”

Nigerian Ibo Proverb


Between 21st and 23rd February 2017, the Makerere University School of Public Health (MakSPH) hosted the first International Symposium on Community Health Workers (CHWs) in Kampala, Uganda. This symposium brought together over 450 delegates from over 20 countries across Africa, Asia, Europe and America. Themed “Contribution of Community Health Workers in Attainment of the Sustainable Development Goals”, the event comprised 3 keynote addresses, 5 plenaries, 127 oral presentations, 27 posters, 13 panel discussions, 2 capacity building workshops and a book launch. On the sidelines of this symposium, World Vision in collaboration with CHW Central hosted a blog series on CHW work. Alongside this, Healthcare Information For All (HIFA), with support from the Health System Global (HSG) Thematic Working Group on CHWs hosted an online thematic discussion on CHWs between 16th January and 24th February 2017. This editorial synthesizes the debates during the 3-day event in Kampala.

Opening speeches given by policy makers – the Honorable Minister of State for Primary Health Care and the Honorable First Deputy Prime Minister – were fairly gung-ho about how committed the government of Uganda is to ensure that CHWs programmes lead to the attainment of the health related SDG goal 3, and other health related SDG targets. These commitments are echoed in most policy statements in low and middle income countries (LMICs). So policy makers came up with flowery statements, as they usually do, but a somewhat different picture was painted in the presentations and panel discussions. Community Health programmes still face pervasive challenges, among others: insufficient supportive supervision, high attrition rates, lack of incentives and essential supplies, low morale. Therein lies the disconnect between the zealous policy statements on CHW programmes and reality in many LMIC settings. In the spirit of the Ibo proverb “If one tells of a place where the rain met him, he is given a place to warm up by the fire”, this symposium provided a platform for researchers and program managers (among others), to bring these issues to the surface and seek solutions.

As Dr Polly Walker – the community health programming advisor at World Vision, UK – aptly stated in her key note address, it’s time to move on from the same old discussions on performance and functionality. We need to get out of the survival mode. She added, “We need to shift focus in this SDGs era from vertical non-governmental organization (NGO) programs to Ministry of Health (MOH) driven multi-sectoral CHWs programs”.

For LMICs to achieve health related SDG targets and Universal Health Coverage (UHC), Professor Francis Omaswa from the African Centre for Global Health and Social Transformation (ACHEST) emphasized: “LMICs have lost ownership and have become cases of global pity needing money and ideas, they need to develop home grown ideas and technical leadership”. A common thread from the discussions was that there’s no need to reinvent the wheel, rather we should strengthen the existing community health structures. It is imperative for policy makers and Ministries of Health to deliberately allocate sufficient resources and political support to ensure the success of community health programmes.

All along, we have asked what community health workers can do for the health system. We feel it’s an opportune time now to ask what the health system is actually doing for the community health workers. We all know what to do, so let’s do it together!


About Charles Ssemugabo

Charles Ssemugabo is a Research Associate in the Department of Disease Control and Environmental Health, Makerere University School of Public Health; EV 2016; Consortium for Advanced Research Training in Africa (CARTA) fellow; and a UJMT Fogarty Global Health Fellow. Currently co-chair EV4GH

About Robinson Njoroge Karuga

Robinson Karuga is an EV from the 2016 cohort. He is a Research Fellow at LVCT Health and a PhD candidate at the Athena Institute, Vrije Universiteit, Amsterdam

About Dolorosa Duncan

Dolorosa Duncan is a Field Regional Manager for Pathfinder International in Tanzania. She manages projects that provide essential maternal, child, and reproductive health care services to women and families living in poverty, and supports service delivery innovations including using mobile phones to improve the quality of counseling and access to emergency maternal health care. Dolorosa is a 2017 Eisenhower Fellow and 2016 Emerging Voices for Global Health.
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