Developing a Standard Community Health Worker To HIV/AIDS and TB Client Ratio for Uganda

The study sought to determine the ideal ratio by examining the current CHW footprint in the country, the services provided by CHWs, the number of people they saw daily, the frequency of their interactions, and the time spent providing a service. The study focused on five CHW cadres, including peer mothers, linkage facilitators, TB cough monitors, youth and adolescent peer supports, and key population peers. A total of 75 specialist CHWs were randomly sampled from 15 study districts and observed over a 2-day period using a customized time-observation tool. Qualitative data were collected through 45 key informant interviews and 5 focus group discussions with CHWs, their supervisors, and community members. The analysis revealed that CHW activities were organized around 11 major health activities, with an average activity time of 71 minutes. The most frequent activities were documentation/reporting and health education, while community mobilization and disease surveillance were the least frequent. The study found that 25 specialist CHWs were required per 1,000 HIV/AIDS/TB clients, representing a 50% increase over existing numbers. The largest number of required CHWs was TB cough monitors, while the lowest number was key population peers. Scaling the ratio to cater for all people living with HIV/AIDS (PLHA) revealed a national requirement of 33,048 specialist CHWs. The standard ratio has various policy and financial implications, including the need for increased investment in community health. The study also highlighted the importance of investing in a professional community health workforce, which can produce a 10 to 1 return on every dollar invested due to healthier populations, increased productivity, and job creation. The UHSS Activity also supported the Community Health Extension Workers (CHEWs) Pilot, which aimed to establish and strengthen CHEWs as part of the health system in Uganda. The pilot was designed to ensure effective programming and generate lessons, best practices, and implementation bottlenecks to inform country-wide scale-up of the CHEWs Program. The UHSS Activity supported resource mobilization efforts by the Ministry of Health (MoH) to address the funding gap for CHEWs implementation, finalized and validated the CHEW baseline study, and provided training and technical assistance to the CHEWs. A total of 332 CHEWs were trained and deployed in communities, and the UHSS Activity will continue to document learnings and best practices from the CHEWs pilot and track the progress of CHW programs. The study emphasizes the importance of investing in community health and highlights the potential of community health workers to improve health outcomes and achieve universal health coverage.