Carol Namata is an Environmental Health Officer at Makerere University School of Public Health in Uganda. Professional interests: Health promotion in communities.
I am a member of the HIFA working group on CHWs and I serve as facilitator for communication between HIFA and a Uganda CHW WhatsApp group. This work builds on the success of two other members of the HIFA working group on CHWs, Kavita Bhatia and Sunanda Reddy, who previously set up WhatsApp groups in India. To our knowledge these activities are unique in bringing together a global health community of practice (HIFA) with local health communities of practice.
Why we set up a WhatsApp group
Community health workers are increasingly seen as the backbone of primary health care in low- and middle-income countries, and vital to the realisation of universal health coverage and the right to health. However, they are underrepresented on the HIFA forums because of language and connectivity issues. To address this, we set up a WhatsApp group of CHWs in Uganda, in the local language, and facilitated local-global-local communication between it and the global HIFA forums. A global thematic discussion was held on the HIFA forums, supported by The Lancet, Health Systems Global, REACHOUT Consortium at the Liverpool School of Tropical Medicine; USAID ASSIST; and World Vision International, linking with WhatsApp groups in Uganda and India. Six questions were explored in depth over six weeks, in the run-up to the 1st International Community Health Workers’ (CHWs) symposium at Makerere University, Uganda, 21st to 23rd February 2017. An overview of responses to these questions was provided by the July 2017 HIFA Blog together with a Narrative Summary, providing further evidence of the vital role which CHWs play in a range of settings.
These questions were also explored simultaneously on the WhatsApp groups.
The Uganda WhatsApp group included CHWs, colleagues from Makerere University, School of Public Health (MakSPH) Uganda, CHW mobilisers and coordinators, together with health workers from Kajjansi Health Centre (a small hospital on the outskirts of Kampala).
Our #1 question on HIFA was: When listening to CHWs needs and priorities, what do they say is needed to enable them to do their work more effectively?
The voices of CHWs
Here is how they responded:
We need respect, recognition, appreciation
"I work gladly. My only dream is to be treated respectfully by the full time staff" CHW1, Uganda
"We want health centres to invite us for their planning meetings as some of the issues discussed during these meetings are of our concern such as community outreaches." CHW2, Uganda
We need information and training
"We should have regular refresher training sessions at least twice a month to improve our skills and knowledge." CHW3, Uganda
"We should be provided with reading booklets written in our local languages." CHW4, Uganda
We need mobile phones
"All Village Health Teams (VHTs) should be given mobile phones. These phones can ease our work when mobilising community members and during follow up of patients." CHW5, Uganda
Local benefits of the WhatsApp group
In addition to the opportunity to give a voice to local CHWs at a global level, the WhatsApp group has proved to have many local benefits and continues to grow and thrive. CHWs have used the group in many ways:
- Through the WhatsApp group, CHWs are able to consult with their fellow colleagues and from health workers based at the health facilities. They ask for advice regarding health issues, such as how to offer first aid in their communities. Through this, they get to help communities using the information obtained from the group.
- Besides their work, CHWs use the group to inform members of any personal problems, such as a loss of a loved one, and in return get emotional support through consoling messages and sometimes financial support.
- There are also good moments that are shared by members on the group. For instance one of the CHWs was supported by MakSPH to attend a conference in UK. He shared his experience and what he had learnt with the WhatsApp group and this was a motivation to other CHWs.
- CHWs also use the group to discuss issues going on in the country. Some of these are political, economic and work related. Currently there is an ongoing national discussion about enrolment of Community Health Extension Workers (CHEWs) at the parish level. The group has therefore acted as a platform for CHWs to express their views about the issue.
- Since the group comprises health workers from health facilities, besides advising CHWs on related health issues, health workers also mobilise CHWs to deliver their monthly reports to their facilities. They also advise CHWs involved in Integrated Community Case Management (ICCM) to pick drugs from the facility when they are available. CHWs also use the platform to inform health workers in case there is a problem with drug stockouts.
- CHWs have a saving group where they contribute money on a monthly basis for income- generating activities. The WhatsApp group is used as a forum to discuss issues concerning their saving group.
- CHWs also have their fun moments where they post interesting messages and pictures. These help them relax and brings them closer together.
The WhatsApp group has therefore been of great use to CHWs in Uganda.
We have shown that it is possible for a diverse global health community (HIFA) and local CHW communities to work together to better understand needs and priorities for primary health care. These needs and priorities were subsequently presented and explored further at the Kampala Symposium.
Our aim in 2018 is to strengthen these global-local links. The benefits in terms of collective understanding at global level are obvious to the global health community. But it is critically important that CHWs themselves see the benefits, particularly at the local level. For too long CHWs have not been listened to, and local mechanisms are needed to translate their expressed needs and priorities into action. We should no longer be hearing the words:
"We have spent a long period of time asking for… but nothing has been done so far." (CHW6, Uganda)