Friday, February 8, 2019

Uganda rescinds Community Health Extension Workers policy

By Esther Nakkazi

After 17 years of engaging Village Health Workers or Teams or VHTs, Uganda was to switch to Community Health Extension Workers or the CHEW strategy by June 2017. The policy for CHEWs was passed on January 14, 2019.

About a month later, the Cabinet decided there was no return on the investment, no financial structure, and no sustainability plan and it would distort equity so the policy was rescinded.

The government was supposed to employ 15,000 CHEWs and pay each one of them Ushs 370,000 per month ($100) as well as offer them regular training but none of these seemed feasible. If they were paid $100 per month they would earn more than the lowest paid health worker and primary school teacher who are paid $60-$90.

The CHEWs were also supposed to be between 18-35 years and with a minimum education (senior 4) and their roles were to be defined by the Ministry of Health leadership but among them was conducting baseline and other important surveys.

They were to be supported by a proper governance structure and not left in isolation. There were other great plans for the CHEWs too - who would 'reorient' the minds of Ugandans towards healthy living, they were to focus on the household as a totality promoting good hygiene, standard health practices like immunization and most of all promote the use of less alcohol which is causing Ugandans numerous health issues.

They would also be strongly monitored, supervised and with detailed accountability and would be under a harmonized structure. The deadline for switching from VHTs to CHEWs was June 2017. It came and passed. But by August 2018, the programme started in 13 districts with the highest disease burden in Uganda. All they awaited was Cabinet approval of the policy.

On January 14th this year the CHEWs policy was passed but of course, as usual even the basic funding was not available and sustainability was an issue. It was rescinded a month later.

Experts suggest the government should instead focus on on-job training, effective supervision and non-monetary incentives for the VHTs. Currently, Uganda has 180,000 VHTs working as volunteers but only 60,000 have been trained.

The profile of the VHTs that I have met in the communities- most of them are community-based, elderly or retired, very popular (they call them 'musawo' - meaning health worker), they are cheerful, ready to work, good mobilizers and seem to enjoy their jobs. I support that they should be trained, supported and appreciated. Let Uganda settle for what it can chew certainly NOT CHEWs at this moment if the funds are not available.


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