Re-thinking community health work in rural areas: Lessons from existing informal helping frameworks in Uganda

Government of Uganda has introduced many changes in the healthcare delivery in the last two decades. One such change has been the implementation of the decentralized healthcare delivery through community health volunteers (CHWs), known as village health teams (VHTs) in a bid to increase community involvement advocated for at the Alma Ata conference of 1978. Drawing from the natural helper model of health promotion, I show that community resources such as the VHTs can be approached through existing informal networks of helping relationships.
Ethnographic fieldwork conducted between July 2012 and March 2014 in the rural district of Luwero, Uganda. Findings suggest that programs such as the VHTs in Uganda have not harnessed informal helping networks effectively due to the top-down recruitment of CHWs (chapter 2 and 3). Also despite the availability of formal healthcare, community members continue to rely heavily on their informal helping networks for medical issues, sometimes resisting government policy pronouncements (Chapter 4). Finally, the results also show that CHWs such as the VHTs, their weaknesses notwithstanding, can benefit from motivational rewards both material and symbolic from those they help in the community if the dynamics of their operation are managed well (chapter 5)
Informal helping networks which rely on the ethos of social support, solidarity and reciprocity are an important resource that can be harnessed when implementing community-based health interventions. Understanding informal social resources facilitates the understanding communities’ negotiation and navigation of different terrains of problem solving and can be beneficial in strengthening CHW programs especially in the developing world where access to professional healthcare is dismal.