CHW Symposium Statement

Kampala, Uganda

23 February 2017

Introduction

From the 21-23 February 2017, Kampala hosted the first International Symposium on Community
Health Workers. The symposium theme was Contribution of Community Health Workers in
attainment of the Sustainable Development Goals. The symposium generated an impressive
amount of attention, with over 300 abstracts received from researchers, practitioners, donors, and
students from around the world. Various stakeholders came together to give presentations
highlighting how different successful models, methods, and approaches have been used to
strengthen Community Health Worker programs. The Symposium had an attendance of over 450
participants from over 20 countries who took part in the in-depth discussions, knowledge sharing,
and networking.
Background
The idea for the Symposium began when Makerere University School of Public Health and
Nottingham Trent University realised there were limited opportunities for sharing knowledge on one
of the most important elements of human resources for health in the health system, Community
Health Workers. Through further conversations with multiple stakeholders, it was discovered that
the demand for an event of this kind was necessary. The idea to host a Symposium, to share best
practices, lessons learned, and brainstorm innovative solutions through cross-country
collaboration, was born with funding support from the UK Department for International
Development (DFID) through Tropical Health and Education Trust (THET). The two Universities
engaged many partners, locally and globally, to make the Symposium a possibility. The theme was
chosen due to the timing of the recently launched sustainable development goals (SDGs), as many
countries were planning and implementing programmes to achieve these international targets.
Through outreach, engagement, and mobilization of partners, the Symposium gained momentum.
Healthcare Information for All (HIFA) organised an online thematic discussion that took place over
six weeks in the build up to the Symposium. In addition, World Vision with support from CHW
Central, Makerere University, and Nottingham Trent University hosted a blog series with the theme
a Vision of Tomorrow’s Community Health Workers to kick start conversations. The success of the
Symposium illustrates the strong need for future meetings that address Community Health Workers
and associated programmes and policy.
Key takeaways
During three days of over 140 oral and poster presentations, as well as 3 key note addresses, 13
panel discussions and 2 workshops, the following key takeaways emerged:
 Through systematic planning and multi-sectoral collaboration, Community Health Worker
programmes can be a huge driving force to attain at least seven SDGs, namely SDGs 1
(ending poverty), 2 (ending hunger and ensuring food security), 3 (health and wellbeing), 5
(gender equality), 6 (clean water and sanitation), 10 (reduce inequalities), and 17
(partnerships for global health).
 Successful Community Health Worker programmes have policy and national level support.
This support is provided through strong leadership, governance, and country ownership and
buy-in.

 Institutionalization and integration of Community Health Workers into the formal health
system structure is crucial. There is a clear need to address systemic challenges, including
structural, social, economic, and political determinants of health, before considering
introducing a completely new solution to any health system.
 Community Health Worker programmes must be tailored to meet needs and priorities that
are culturally and contextually appropriate. Successful programmes can be replicated from
one setting to another, and cross-country learning should be encouraged. However,
interventions need to be moulded to take account of the local realities.
 Community Health Worker programmes should be subject to regular evaluation and review
to ensure that they are working optimally. Community Health Workers collect and hold the
data, which should be fed into national information systems for decision making. They must
be supplied with the tools and analytical frameworks to understand this information to
inform their communities and continuously improve quality.
 Attention must be paid to Community Health Worker workload and the feasibility of the roles
and responsibilities they are asked to take on. If Community Health Workers are over
worked and required to complete unachievable tasks, they will become demotivated and
exhausted. Programmes must also be structured to enable Community Health Workers to
become empowered.
 Community Health Workers should be supported and incentivized. This may vary according
to context and it is important to incentivize in culturally and contextually appropriate ways.
 It is important to factor issues of equity and gender, as well as reproductive health among
adolescents into Community Health Worker programmes and policy.
 Community Health Workers must be cherished, their ideas and concerns heard. Programs
should be established to ensure that Community Health Workers feel comfortable
expressing their concerns and ideas openly. They should continue to help lead future
Symposia.
Actions
Through the extensive discussions and knowledge sharing at this Symposium, it is clear that all
stakeholders make important contributions, providing support that Community Health Workers
need to be successful in their role in attaining the SDGs. Some future actions are broken down
below:
1. Donors and research funders
Donors must prioritize funding Community Health Workers programmes that are evidence-based,
and with strong country ownership and leadership. Research funders must prioritize the monitoring
and evaluation of CHW programmes and their impact on SDG achievement. Funders should also
prioritize their investments around host country government priorities and needs and try to avoid
fragmentation and poor coordination which undermines Community Health Workers.
2. Researchers/academics
Researchers and academics must continue to study motivation and incentives of Community
Health Workers, governance structures, and linkages to improve existing and upcoming
programmes. They should also prioritize rigorously researching existing Community Health Worker
programmes’ impact in relation to achieving the SDGs. Further, researchers and academics must
look to disseminate their findings widely through open access peer-reviewed and grey publications
and in formats which are legible to Community Health Workers and the people that they serve.

Methods that enable Community Health Workers to research their own realities and set the
questions that should be reviewed are encouraged.
3. Policy makers
Leadership, ownership, and buy-in are essential for successful Community Health Worker
programmes. Policy makers should acknowledge the importance of Community Health Workers
across sectors and ensure the necessary support is in place. Policy makers should conduct
frequent mapping of partners and existing programmes to avoid overburdened and disempowered
Community Health Workers, as well as programmes that are not in line with country priorities.
Through mapping exercises, facilitation of partnerships and knowledge sharing can be easily
conducted. Proper accountability, and monitoring and evaluation mechanisms should be in place
and maintained frequently. Policy makers should make time and space to give thanks to
Community Health Workers for the contribution that they make to their nations’ health.
4. Practitioners and communities
Practitioners must prioritize partnership with the above-mentioned actors, as well as with other
stakeholders and the communities themselves. Through partnership and continued dialogue,
practitioners will be able to avoid duplication of efforts, overloading and disempowering Community
Health Workers, and increase impact and health outcomes. Practitioners and communities should
also work together to conduct asset mapping as well as determine the existing (informal and
formal) structures when designing programmes. Further, practitioners and communities have the
advantage of working with people in most need of services.
5. All
Above all, stakeholders must work together to support Community Health Workers so that they feel
empowered, recognized, successful, and have an impact in their roles. Conversations and
knowledge sharing should happen on a frequent basis across all sectors.
Conclusion
It became apparent that there is a strong need to continue the dialogue between local, national and
global stakeholders involved in Community Health Worker programmes. It was proposed at the
Symposium that such events should be held every two years. The organisers of the first
Symposium are committed to supporting this in conjunction with other partners such as the Health
Systems Global Thematic Working Group on Supporting and Strengthening the Role of Community
Health Workers in Health System Development and other interested networks and projects.
Countries/institutions interested in hosting the second Symposium should therefore be ready to
explore this opportunity.
Stay involved in the discussion and ongoing cross-country collaboration. The following platforms
are available to continue discussing and learning:
 Healthcare Information for All (HIFA) – www.hifa.org
 Key resources and discussions can be found and contributed to CHW Central –
www.chwcentral.org
 Become a member of the Health Systems Global Community Health Workers Thematic
Working Group (HSG TWG) and receive important updates on latest health systems
research and knowledge translation, as well as contribute to the dialogue. Email
faye.moody@lstmed.ac.uk for more information on how to join. For questions or more
information, please contact chwsymposium@musph.ac.ug.