The contribution of community health workers in promoting health equity in Bukomansimbi district

Abstract

Most existing research on Community Health Workers (CHWs) has focused largely on evaluating their performance in delivering essential health services, often overlooking the broader logistical, socio-economic, cultural, institutional, and systemic constraints that shape their work in marginalized settings. This study addresses that gap by investigating the contributions of Village Health Teams (VHTs) to advancing health equity for children under five in Bukomansimbi District, Uganda. Guided by the Social Determinants of Health theory and the Health Belief Model, the study employed a convergent parallel mixed-methods design, integrating data from 337 mothers of under-five children, 208 VHTs, 17 key informant interviews, and four focus group discussions. The findings underscore the critical contribution of VHTs in narrowing health access gaps in underserved communities. Community awareness and engagement are notably high; 97% of households know their VHT, 89% are willing to seek their services, and 78% can identify their assigned VHT. VHTs are widely recognized for delivering essential services; 95% provide health education, 92% conduct community mobilization, and 86% manage childhood illnesses like malaria and pneumonia. Their contributions to maternal and child health are evident, with 84% of households reporting home visits and 89% acknowledging service delivery. However, VHT effectiveness is hindered by systemic and logistical barriers. Only 47% report receiving sufficient supplies, 72% cite inconsistent training, and just 29% feel integrated into the health system. Transport limitations are acute; only 19% own motorcycles, while 83% cite long distances to households as a major challenge. Financial hardship is also widespread; 85% face economic difficulty, and 88% rely on alternative income sources. Despite these constrains, VHTs remain deeply trusted (94%), intrinsically motivated, and firmly rooted within their communities. Notably, 64% are women, and 63% have resided in their communities for over a decade; factors that augment their credibility and effectiveness. These strong relational ties foster greater service uptake, promote health-seeking behaviours, and strengthen the delivery of culturally appropriate health messaging. Their rootedness enables them to navigate social and cultural nuances with a degree of trust and persuasion that external actors often lack. The study concludes and recommends that sustaining health equity in low-resource settings demands reforms that leverage this trust and embeddedness. Specifically, formal integration of VHTs into the health system, regular and standardized training, reliable supply chains, fair and adequate compensation, and transport support are critical to unlocking their full potential. Implementing these measures will not only enhance the performance of VHTs but also ensure that children under five in rural communities gain equitable access to lifesaving health services.