From 21st to 23rd February 2017, Uganda hosted the first international symposium on Community Health Workers (CHWs). The three-day event brought together more than 450 participants from 22 countries with the theme “contribution of CHWs in attainment of the Sustainable Development Goals (SDGs).” Attendees included researchers, academics, practitioners, policy makers, donors and students.

With major funding support from the UK Department for International Development through the Tropical Health and Education Trust – and organized by the Makerere University School of Public Health (Uganda) and Nottingham Trent University (UK) in collaboration with Uganda’s Ministry of Health – the symposium provided a platform for various stakeholders interested in CHWs to learn, share and network.

In the build-up to the symposium, there were several online discussions on CHWs, including a thematic discussion on CHWs organized by Healthcare Information for All (HIFA). This discussion included voices of CHWs from around the world, including accredited social health activists from India and village health teams from Uganda. World Vision also held an essay competition related to the symposium theme as well as a blog series entitled, Visions of the future: Building Tomorrow's Community Health Workforce. In addition, there were robust conversations about the event on Twitter and Facebook.

 

In all, the symposium featured three keynote addresses, more than 140 oral and poster presentations, 13 panel discussions, and 2 workshops – as well as 15 local and international exhibitors. A highlight included sessions in which CHWs themselves talked about their work, including the benefits and challenges they face.

Several sub-themes regarding CHWs were presented and discussed at the symposium, including:

  • History and current state of CHW programs;
  • Community level innovations;
  • Mobile health;
  • Gender and ethics;
  • Training models;
  • Human resources for health;
  • Performance, motivation and satisfaction;
  • Leadership, governance and accountability;
  • Multi-sectoral collaboration;
  • Financing;
  • Sustainability;
  • Challenges and lessons learned; and
  • Research priorities.      

 In addition, delivery of services among CHWs was discussed, including specific areas such as: maternal, newborn and child health; HIV/AIDS and TB; malaria, diarrhea and pneumonia; and nutrition.  

From the deliberations of the symposium, several issues emerged that touch on multiple SDGs: CHWs not only contribute to health and wellbeing (SDG 3), but also ending poverty (SDG 1) and hunger (SDG 2), reducing inequalities (SDG 10), and improving water and sanitation (SDG 6) and global health partnerships (SDG 17). Indeed, it became clear that CHWs should be appreciated by all stakeholders – at the community level, health professionals, and policy makers – and their voices should be heard more often. Moreover, structures are needed to ensure the needs and concerns of CHWs reach the necessary authorities.

Discussions revealed that incentives are crucial to motivating CHWs, but may vary according to culture and contexts across countries. The need to manage CHW roles and responsibilities also emerged as a way to avoid work overload and exhaustion. With this in mind, particular attention should be given to voluntary CHW programs.

CHWs perform better if they are part of the formal health system and recognized for their work, and programs should be regularly evaluated for areas of improvement. And while countries can learn from each other’s successes and challenges, it was evident that local context must always be considered when considering CHW programs. To further improve worker performance, systemic health system challenges that have affected CHW programs for years must be addressed, particularly before new CHW programs are introduced.

 

The symposium attracted several local and international partners including USAID, UNICEF, Pathfinder International, Healthcare Information For All, CHW Central, REACHOUT Consortium, Health Systems Global, World Vision, AMREF Health Africa, Malaria Consortium, Living Goods, Advancing Partners and Communities, Makerere University Centre of Excellence for Maternal Newborn Health Research, Healthy Child Uganda, FHI 360, and The AIDS Support Organization.

 

The highlights of the symposium were presented at the Institutionalizing Community Health Conference held in Johannesburg, South Africa in March 2017. And with more than 90% of symposium participants expressing a desire to have such an event every two years, the Makerere University School of Public Health and partners (including the Health Systems Global Thematic Working Group on Supporting and Strengthening the Role of Community Health Workers in Health System Development) are already beginning to plan the next event! 

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