Community Perceptions of Village Health Workers in Kisoro, Uganda

Abstract

Background: Village health workers (VHWs) can serve as a valuable resource to address public health needs in resource-limited settings such as Uganda. However, the successful implementation of VHW programs can be limited by poor acceptability among community members. Kisoro District Hospital (KDH) in Kisoro District, Uganda operates a VHW program and, at the time of the study, was expanding its services to 11 additional villages.Objective: The objective of this study was to evaluate community perceptions of VHWs in villages of Kisoro District with no prior exposure to the KDH VHW program in order to improve community acceptance when expanding the program to additional villages. Methods:We administered surveys to 658 community members from 11 villages to evaluate their perceptions of VHWs prior to receiving VHW services. Additionally, we conducted focus group discussions among 97 participants to explore perceptions of VHWs in further depth.Findings: Community members were generally accepting of VHWs. They preferred that VHWs provide both curative and preventive services across a broad range of health domains as opposed to a single disease. Expectations of the responsibilities of a VHW were influenced by agricultural occupational and household responsibilities, particularly for women. Participants expressed a preference to be actively involved in the selection and oversight of VHWs and that VHWs receive compensation.Conclusions: 1) Community members' expectations of VHWs are shaped by environmental, cultural, and social factors. 2) Active community engagement in the VHW program is key.3) Aligning a VHW program with community perceptions may improve acceptance, in turn influencing effectiveness and sustainability. These findings were used to expand the KDH VHW Program into the participating villages in a manner consistent with community preferences. Our findings may provide guidance on enhancing the uptake of communitybased VHW programs for VHW stakeholders and policymakers in other settings.

The longitudinal impact of an evidence‐based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: analysis of a cluster randomized trial from the SMART Africa‐Uganda scale‐up study (2016–2022)

“…These findings show that Ugandan families were equally receptive to receiving the intervention by community health workers and parent peers. This is important because a key component of a program’s success is acceptability by the community (Zheng, Anthonypillai, Musominali, Chaw, & Paccione, 2021), and poor acceptance is associated with low utilization of services (Druetz et al., 2015). In this case, community health workers were trusted local leaders who were associated with primary care clinics in the local community.…”

Perspectives of community and facility stakeholders on community health workers in rural Malawi

“… 1 , 17 , 18 Despite the community health worker playing a facilitating role, barriers have been reported to community-based PHC provision, including insufficient training for CHWs, supervision challenges, a lack of resources, inadequate confidentiality and community involvement, and poor motivation. 18 , 19 …”

“…While there are multiple studies from the CHW perspective, on enablers and challenges of their role, 1 , 2 , 15 there are fewer on the view of community members 6 , 8 , 18 and facility-based primary care workers. 20 In Malawi, community health care is provided through the Health Surveillance Assistants (HSA), who support village clinics household-level care, and facility-based tuberculosis (TB) and malnutrition programmes with many additional responsibilities through task-sharing from other health-facility staff.…”

“…14,15,16,17 Literature has demonstrated that CHWs are motivated by praise and trust from their facilitybased colleagues and benefactors, monetary and other economic benefits. 1,17,18 Despite the community health worker playing a facilitating role, barriers have been reported to community-based PHC provision, including insufficient training for CHWs, supervision challenges, a lack of resources, inadequate confidentiality and community involvement, and poor motivation. 18,19 While there are multiple studies from the CHW perspective, on enablers and challenges of their role, 1,2,15 there are fewer on the view of community members 6,8,18 and facility-based primary care workers.…”

“…1,17,18 Despite the community health worker playing a facilitating role, barriers have been reported to community-based PHC provision, including insufficient training for CHWs, supervision challenges, a lack of resources, inadequate confidentiality and community involvement, and poor motivation. 18,19 While there are multiple studies from the CHW perspective, on enablers and challenges of their role, 1,2,15 there are fewer on the view of community members 6,8,18 and facility-based primary care workers. 20 In Malawi, community health care is provided through the Health Surveillance Assistants (HSA), who support village clinics household-level care, and facility-based tuberculosis (TB) and malnutrition programmes with many additional responsibilities through task-sharing from other health-facility staff.…”