Strengthening Uganda’s Community Health Workforce: Impact from the West Nile.

Amref Health Africa in Uganda, with support from the pfizer foundation in partnership with the Ministry of Health, implemented the “Strengthening Community Health Workforce in Uganda” project across five West Nile districts; Moyo, Adjumani, Arua, Zombo, and Terego aligned to Uganda’s 2021/22–2025/26 National Community Health Strategy (NCHS).

Through this initiative, the DESC (Digitize, Equip, Supervise, and Compensate) model was rolled out in Moyo District to improve the performance of Community Health Workers (CHWs). In Moyo, 472 Community Health Workers (CHWs) and supervisors including 10 District Health Team members and 18 Health Assistants were trained on the electronic Community Health Information System (eCHIS), equipping them with digital tools to improve service delivery and data accuracy. A quasi-experimental study comparing Moyo’s intervention and Adjumani demonstrated the model’s effectiveness:

• CHW performance and reporting improved significantly, with Moyo achieving an average monthly reporting rate of 86%, compared to Adjumani’s 50.4%.
• Child health interventions increased, while neonatal and under-five mortality rates dropped in Moyo.
• Vaccination coverage improved markedly, especially for measles and rubella.
• Performance-based pay boosted CHW motivation and accountability, while digital tools enhanced efficiency in service delivery and reporting.
• Regular training and supervision in Moyo addressed capacity gaps and strengthened health system linkages, in contrast to the limited support in Adjumani.
• Sanitation and hygiene practices improved, resulting in better household health indicators.

Historically, West Nile has struggled with low immunization coverage, largely due to underfunded EPI (Expanded Programme on Immunization) activities and poor coordination between health workers and VHTs. The DESC model reversed this trend. By providing training, supportive supervision, and modest incentives, the project revitalized CHW engagement and strengthened collaboration with health facilities.

Community feedback highlighted increased trust and collaboration between CHWs and health facility staff. CHWs were not only providing health services but also mobilizing communities for broader development initiatives such as savings groups and livelihoods.

Notably, two CHWs from Moyo were nominated for the Heroes in Health Awards (HIHA), and one of them, Rose Mary Tani, won the award for CHW of the year, marking a historic first for the district and signaling the growing recognition of CHWs’ role in the health system.

Rose Mary Tani receives her award for Community Health Worker of the Year at the 2024 HIHA awards.

Despite minor challenges, the DESC model proved to be a transformative approach. The “Strengthening Community Health Workforce in Uganda” project has proven that with the right investments, digital tools, supervision, and compensation, CHWs can transform the health landscape of even the most underserved regions.

Amref Health Africa

Amref Health Africa teams up with African communities to create lasting health change.