Govt embraces community health system, over 3,000 CHEWs deployed

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The Government has embarked on an innovative approach of preventing disease through empowerment of community health extension workers (CHEWS).

To date, 3,246 CHEWS have been trained and deployed in 23 districts across the country. The districts include Kyotera, Kazo, Namutumba, Maracha, Koboko, Ngora, Amudat, Kitgum, and Arua. Others are Kyenjojo, Buliisa, Rubirizi, Kalangala, Kwania, Nakaseke, Luwero Nakasongola, Lwengo, Butalejja, Kween, Lira city, Lira and Mayuge.

Health ministry permanent secretary, Dr Diana Atwine, says the programme aims at establishing a strong community health system through training, equipping the CHEWs with knowledge and skills to look out for symptoms or danger signs in the community.

CHEWs are given tools such as blood pressure machines, glucometers, rapid test kits, thermometers to take vitals. In addition, the bicycles facilitate their movement while they use gadgets (tablets) to capture information (data).

The well-equipped CHEWs move house-to-house checking people for diseases such as blood pressure, diabetes, and malaria before they progress to life-threatening stages, an approach she defined as integrated. Their additional roles include deworming children, giving contraceptives to women of childbearing age and encouraging pregnant women to go and attend antenatal care.

Those found to have signs and symptoms are referred to health facilities for treatment.

"It does not matter how many people you find in the community with the disease, if they are not linked into care then there is no work done," she says.

Atwine notes that if focus is put on the households, the country will be able to detect diseases early, 'then we can reduce the burden'.

According to her, given that Africa’s life expectancy is increasing now estimated at 63 years, it makes non communicable diseases (NCDs) a reality now than before.

The start

Assistant commissioner health services, in-charge of health promotion and strategic health communication at the Health Ministry, Dr Ronald Ocatre, said the training of community health workers (CHEWS) started in Lira city, Lira and Mayuge district as a pilot project about two years ago.

After securing funds, in March last year, the health ministry embarked on a six months learning programme, Ocatre said.

Additionally, the health ministry is also focusing on improving tertiary care through upgrading the health facilities and equipping them so as to match the number of patients going to seek care.

How CHEWS are recruited

Individuals recruited as CHEWS should have basic minimum qualification of an S4 or S6 certificate. They should be in the age bracket of 18 to 35, should be Ugandan, acceptable by local communities and are willing to volunteer.

The CHEWs study theory for three months and are later sent to the field to practice for two months. Later, the CHEWs go to their parishes and are attached to particular health facilities and supervised by health facility in-charges, assistant/ health inspectors, health educators and national educators. Upon completion of the field practice, they write a report and then attend one month of class work, before they are passed out.

Two CHEWs; one male and the other female from each parish or ward are trained.

They are deployed and paid a stipend of about sh150,000 every month for one year.

Approximately 70% of the work that CHEWS do is centred around disease prevention, health promotion, community awareness and surveillance. The remaining 30% is in the health facilities, he said.

“The CHEWs need to know what is happening at the facility, so that when they are in the community and they see people with danger signs, or pregnant women, they are able to refer them for further management at health facilities".