Laban Musinguzi

Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion

BackgroundCommunity health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.MethodsAs part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.ResultsThe VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.ConclusionAs the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.

Fishers’ perceptions of climate change, impacts on their livelihoods and adaptation strategies in environmental change hotspots: a case of Lake Wamala, Uganda

Fisheries resources support livelihoods of fishing communities but are threatened by over-exploitation, habitat degradation, pollution, invasive species and climate change. Unlike the other threats, climate change has received limited consideration and reducing its risks requires appropriate adaptation strategies. This study used quantitative and qualitative methods to generate knowledge on fishers’ perceptions of climate change, changes in climate variables and their impacts on livelihoods, adaptation strategies, constraints to adaptation and required interventions to promote adaptation strategies that would enable fishers to build resilience to sustain their livelihoods. We found that fishers were aware of changes in climate conditions manifested by unpredictable seasons, floods and droughts. Fishing remained the main livelihood activity. However, the dominance of fishes had changed from Nile tilapia (Oreochromis niloticus L.) to the African catfish (Clarias gariepinus Burchell). Floods and droughts were associated with damage to gears, boats, landing sites and changes in fish catches and sizes, income from fishing and fish consumption. The fishers adapted by increasing time on fishing grounds and changing target species and fishing gear among other things. Some innovative fishers diversified to high-value crops and livestock. This increased their income beyond what was solely earned from fishing which provided an incentive for some of them to quit fishing. Livelihood diversification was enhanced by use of communications technology, membership of social groups, increasing fishing days and fishing experience. Adaptation was, however, constrained by limited credit, awareness and access to land, which require interventions such as improving access to credit, irrigation facilities, appropriate planting materials and awareness raising. We identified adaptation strategies, which if promoted and their constraints addressed, could increase resilience of fishers to the influence of climate change and sustain their livelihoods.

Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital

BackgroundCommunity-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services.MethodsData were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis.ResultsThe ability of VHTs to link communities with formal health care was affected by the stakeholders’ perception of their roles. Community members perceive VHTs as working for and under instructions of “others”, which makes them powerless in the formal health care system. One of the challenges associated with VHTs’ linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not “experts”. For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health services. Having received training and initial support from an NGO, VHTs suffered transition failure from NGO to the formal public health care structure. As a result, VHTs are entangled in power relations that affect their role of linking community members with formal health care services. We also found that factors such as lack of money for treatment, poor transport networks, the attitudes of health workers and the existence of multiple health care systems, all factors that hinder access to formal health care, cannot be addressed by the VHTs.ConclusionsAs linking social capital framework shows, for VHTs to effectively act as links between the community and formal health care and harness the resources that exist in institutions beyond the community, it is important to take into account the power relationships embedded in vertical relationships and forge a partnership between public health providers and the communities they serve. This will ensure strengthened partnerships and the improved capacity of local people to leverage resources embedded in vertical power networks.

Implications of climate warming for hydrology and water balance of small shallow lakes: A case of Wamala and Kawi, Uganda

Climate variability and change that have been intensifying since the 1970s are accompanied by changes in hydrology and water balance of inland aquatic systems. These changes, however, have not been well documented with regard to small and shallow aquatic systems that are more vulnerable. Changes in temperature, rainfall and wind speed around Lakes Wamala and Kawi (Uganda) were examined to provide insight on how the increasing variability and change in climate affect water balance and lake water levels. Around Lake Wamala, average air temperature has increased by 0.018°C y−1 since 1980. Rainfall increased by 9.01 mm y−1 since 1970 and accounted for 79.5% of the water gain during 2011 and 2013 period. However, the gains were exceeded by losses as a result of evaporation that accounted for >85% of the water loss. Despite the increase in rainfall, the mean lake depth of Lake Wamala decreased by 0.015 m y−1, apparently due to high evaporation rates. Around Lake Kawi, average air temperature has increased by 0.036°C y−1 since 1980. Rainfall, however, has decreased, although it still dominates the water inflows, accounting for 83% of the total water gains. Interviews with local fishermen on Lake Kawi indicated that the lake shoreline has receded by ∼50 m over the last two decades. These results suggested that most of the water in small shallow lakes is gained through direct rainfall, but more is lost through evaporation. Therefore, increase in rainfall around these lakes is no longer sufficient to sustain normal lake water levels and lake surface area as long as temperature and wind speed, which enhance evaporation, continue increasing. This has implications for lake productivity processes and needs to be understood and incorporated in management of fisheries and the catchment areas as climate warming intensifies.

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda

BackgroundSince the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.MethodsThis study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.ResultsContrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.ConclusionIn this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.

The Female Genital Mutilation Economy and the Rights of the Girl Child in Northeastern Uganda

The practice of female genital mutilation (FGM) generally persists in the northeastern belt of Uganda in spite of legal and other socio-economic mechanisms at national and local levels geared towards curbing it. FGM constitutes one of the foremost violations against the rights of girls and young women and significantly affects their welfare later in life. This study established that FGM was driven and sustained by commercial gains resulting in commoditization of girls, forced/early marriage and child bearing, impacting the reproductive health rights and the right to education for the girl child. The beneficiaries who form a chain involving elderly women, families of victims and other cultural leaders present FGM as a cultural practice simply to legitimize it and shield it from legal and other opposition forces. We recommend that actors rethink current interventions in addressing FGM with a view to developing more unique interventions to provide varied alternative sources of income for the actors, improving the livelihood options of those involved and also paying due attention to community attitudes. It also raises policy and programming issues that need to be considered in prevention of FGM and in mitigating its harmful effects on the girl child and the community at large.

Building Capacity for Climate Change Mitigation and Adaptation Through Mainstreaming Climate Change in Curricula of Tertiary Training Institutions in Africa

Climate variability and change, which intensified since 1970s, are threatening natural resources and livelihoods in Sub-Saharan Africa where people depend on climate sensitive natural resources, such as agriculture and fisheries, but have limited capacity to adapt. Increasing human and institutional capacity to address threats posed by climate change to natural resources and livelihoods requires building capacity to generate and disseminate information and knowledge on climate change, its impacts, adaptation and mitigation through research, education and raising awareness by tertiary training institutions. Most tertiary training institutions in Africa have curricula covering basic and applied natural resources management but most of them do not include climate change. This paper presents a training curriculum and manual that was developed to fill this gap. The purpose of the paper is to provide in-depth information on how Climate Change can be integrated into the fisheries and aquaculture curricula of tertiary training institutions. It also provides students, scientists, practitioners, and policy makers with an understanding of key concepts and approaches to climate change mitigation measures, adaptation strategies, and policies. The aim is to mainstream climate change in fisheries training. The specific objectives are to facilitate introduction of climate change in fisheries training in Uganda that can be developed further and adopted by other countries in Africa and elsewhere; Equip students with scientific and technical capacity to anticipate and evaluate changes in climate and its influence, communicate information to stakeholders, design, and test adaptation strategies and mitigation measures; and Increase human resource capacity to address climate change issues through reviewing and strengthening of the national education system. The curriculum consists of seven modules covering: Major threats to natural resources; Introduction to climate change; Implications of climate change on aquatic productivity processes and fisheries; Implications of climate change on aquaculture; Livelihoods, impacts, adaptation and mitigation; Aquatic ecosystem modeling in relation to climate change; Principles, policies, regulations and institutions required to address impacts of climate change. The modules will be delivered through lectures, discussions, case studies and field visits. It is recommended that the curriculum and manual be incorporated into training programs of tertiary training institutions to build the capacity required to address climate change challenges particularly for fisheries in Africa.