Village Health Workers Stand at Center of COVID Fight

WAKISO, UGANDA — When Faridah Nabukeera walks through the streets of Mutungo Central, residents often pop their heads out of a crowded row of houses to greet her, waving hello and calling out questions about their health and treatments. As a Village Health Team member, Nabukeera has provided frontline medical support for this sprawling residential area of Wakiso district in central Uganda for 20 years.

“Faridah is our nurse; she is always a call away when one of my children fall sick,” says Mutungo Central resident Violet Nabukenya.

Nabukeera’s efforts grew all the more essential a year ago when the Ugandan government enlisted these workers to fight COVID-19 using a single tool: home-based care. The group played a key role in containing the disease by managing cases at the community level, where they are the primary health workers, and urging residents to follow such guidelines as wearing masks.

But even as they stand as central figures in the battle against the disease’s ferocious spread, workers continue to lack personal protective equipment, such as gloves, as well as medication, thermometers, pulse oximeters and other materials essential to caring for their patients.

“Since the outbreak, [the] Ministry of Health gave us one box of disposable masks and a bar of soap,” Nabukeera says.

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Dr. Jane Ruth Aceng, the health minister, has acknowledged the importance of adequate support. She told Parliament in September that a COVID-19 task force had found a strong need for personal protective gear, medication and transportation to support the home-based care system.

To address these needs, the government has agreed to provide 20 billion Ugandan shillings (about $5.6 million) to distribute a home-based care tool kit to each village throughout the country. The kit includes protective gear, a thermometer and a pulse oximeter. The government also issues a 100,000-shilling ($28) monthly allowance to health team workers.

Sarah Alibeera Namutebi, the Ministry of Health’s health inspector for the municipality of Makindye-Ssabagabo, where Mutungo Central is located, agrees that Village Health Team members — also referred to as VHTs — need personal protective gear and other resources.

She says that the funding for protective gear and additional training for village health workers was disbursed to local governments at the end of 2021. But some village health workers say they have yet to receive the promised supplies or allowance.

More than 58,000 people had recovered from COVID-19 by the end of July with the help of home-based care, according to the Ministry of Health’s Department of Community Health. The country has registered more than 159,000 COVID-19 cases and more than 3,400 deaths.

Nabukeera says health team members like herself play a crucial role in containing the coronavirus because community members trust them.

“I get distressed calls from COVID patients,” she says. “I know that [I] am the closest to them for relief, and it hurts when I cannot help. We need personal protective equipment. People are dying in their homes.”

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In Uganda, where geographical access to health care facilities is limited to only 49% of households, health team members serve as the closest source of medical attention for many residents. They are the first responders not just for COVID-19 but also for malaria, HIV, tuberculosis and other illnesses and medical issues.

First established in 2001, the Village Health Team program recruits volunteers and provides them with an initial four days of medical training, with continued training available afterward. More than 179,000 health team members had been trained as of 2017, and work in each of Uganda’s 112 districts.

That figure has remained constant, says George Dugum Upenthyo, a commissioner with the Department of Community Health at the Ministry of Health. Once a health team member leaves the program, he says, another member from the community takes that person’s place.

But records show that a lack of funding and a high turnover rate have severely impacted the program. A 2015 Ministry of Health assessment reported that 30% of health team members eventually abandoned their position because they moved out of the area they were working in, married, experienced a death, were employed elsewhere or lacked motivation to continue.

For Nabukeera, the plight of people in her community and her passion for the job continue to motivate her, despite the pandemic’s uncertainty.

“I only ask for a bicycle,” she says, and “protective gear so that I can help people in my community.”