Panacea or pitfall? The introduction of Community Health Extension Workers in Uganda (2)

31 August, 2020

This is a very interesting post from David Musoke. Thanks for sharing.

We are thrilled to read that Uganda plans to introduce Community Health Extension Workers to its PHC. Members may recall that when we discussed the WHO policy on CHW last year leading to the Global Symposium in Dakkar Bangladesh, I mentioned that Nigeria has had the cadre of Community Health Practitioners (CHPs) since the 1990s (i.e. Junior Community Extension Workers (JCHEW); Community Health Extension Workers (CHEWs) and Community Health Officers (CHO activities from the higher). Each cadre has a curriculum guided training in the College of Health Technology (the CHO are trained in the University); they have career structure to rise from JCHEW to CHEW to CHO, post graduation, and they manmost of the PHCs especially with the very real shortage of Doctors and Nurses / Midwives, made worse by Brain Drain. Nigeria in 2014 also published its Taskshiftng amd Task Mixing policy to guide cadres as they take up delegated functions from the cadres above.

I was also interested to read David's comment that ' ----- But there are foreseeable concerns that could affect the CHEW programme. Just like VHTs, CHEWs would require support systems: performance management, regular refresher trainings, supervision from health practitioners, and availability of necessities and supplies', because to overcome similar challenges in Nigeria, in 2017, HRI West Africa in partnership with BMJ and KTU, University of Cape Town successfully piloted a decision support tool to great acclaim - it is called PACK (Practical Approach to Care Kit for PHC), which enabled all the cadres in Nigeria's PHC to work from one tool ( JCHEW, CHEW, CHO/Nurse/Midwife and Medical Officer). (ref: Awotiwon A, Sword C,Eastman T, et al. Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria. BMJ Glob Health 2018;3:e001079. doi:10.1136/bmjgh-2018-001079).

Who am I to suggest to Ugandan Authorities, but permit me to say that it might be that integrating the VHT into the CHEW plan in Uganda might mitigate the challenges that David highlighted above.

Joseph Ana.

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT