Enhancing Performance and Sustainability of Community Health Worker Programs in Uganda: Lessons and Experiences From Stakeholders

Background: Community health worker (CHW) programs in Uganda have contributed to improved health outcomes in recent years. However, opportunities for engaging the various stake-holders supporting CHW programs have been limited. This article presents workshop findings where several stakeholders shared their lessons and experiences that can enhance performance and sustainability of CHW programs in Uganda. Methods: We collected qualitative data from stakeholders from government, private, and community organizations, as well as CHWs, involved in CHW programs in Uganda during a 1-day workshop. The workshop involved plenary presentations and group discussions on critical aspects of CHW programs. All pro-ceedings from the workshop were audio-recorded, transcribed, and analyzed by thematic content analysis. Results: Four major themes emerged from the workshop: lessons learned in implementing CHW programs, challenges affecting CHW programs, performance of CHWs, and ensuring sustain-ability of CHW programs. Key lessons learned related to 3 main subthemes: capacity building and use of technology, supervision and motivation, and stakeholder engagement and collaboration. Challenges affecting CHW programs identified included poor co-ordination, fragmented data collection systems, high program expectations, inadequate support mechanisms, and high dropout rates. Mechanisms for improving the performance of CHWs em-phasized the need to: strengthen recruitment, training, and reten-tion strategies; improve motivation; streamline coordination mechanisms; and develop and strengthen community health poli-cies. The sustainability of CHW programs requires institutionali-zation; sustainable funding; economic empowerment of CHWs; local ownership; and a strengthened research agenda. Conclusion: To improve the performance and sustainability of CHWs programs, stakeholders such as policy makers and imple-menting partners need to consider CHW needs, existing struc-tures and policies, as well as local support.