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      Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts

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          Uganda’s national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda.


          A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged.


          VHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting.


          Supporting and retaining Uganda’s VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12939-017-0619-6) contains supplementary material, which is available to authorized users.

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              Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?

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                Author and article information

                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                20 July 2017
                20 July 2017
                : 16
                [1 ]ISNI 0000 0004 1936 9510, GRID grid.253615.6, , George Washington University School of Medicine & Health Sciences, ; 2300 Eye St. NW, Washington D.C., 20037 USA
                [2 ]Omni Med, 81 Wyman St #1, Waban, MA 02468 USA
                [3 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Department of Paediatrics and Child Health, , Makerere University College of Health Sciences, ; P.O. Box 7072, Kampala, Uganda
                [4 ]ISNI 0000 0004 1936 9991, GRID grid.35403.31, , University of Illinois at Urbana-Champaign, School of Social Work, ; 1010 W. Nevada Street, Urbana, IL 61801 USA
                [5 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, , Warren Alpert Medical School of Brown University, ; 222 Richmond St, Providence, RI 02903 USA
                [6 ]Omni Med Uganda, Kisoga Town, Mukono District Uganda
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: Lazarus Family Scholarship in Health Care Delivery
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                © The Author(s) 2017


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