Uganda community case management

Community Health Services

Uganda adopted the integrated community case management (iCCM) strategy in 2010, which is built on the National Village Health Team (VHT) strategy. [1]

Through the Global Fund support, 33 districts are currently implementing community care services such as integrated community case management for malaria, TB, HIV and antenatal care and the plan is to scale up to more 30 disease burden districts to cover in total about 27,000 VHTs and other community resource persons.  The training of VHTs has been planned under the different disease programme grants. [2]

VHT: [3]

  • In the public sector, approximately 65,000 village health teams (VHTs) implement iCCM in 68 of 128 districts, in addition to engaging in health promotion activities such as education of households on net use, registration of household members, and mobilization for immunization.
  • VHTs serve an average of 100 households of approximately 500 people
  • Each VHT has five community health workers selected by community members
  • Community leaders are responsible for coordination, overseeing VHTs and administrative supervision of VHT activities in their areas.
  • VHTs remain volunteers with varying incentives and retention strategies that include a quarterly stipend of about nine U.S. Dollars as a transport refund, meals during their quarterly meeting, training and supervision, items such as t-shirts, bags, name tags and recognition by their district and sub county leadership.

iCCM: [2]

  • Health facilities to track clients referred and supervise the VHT and the private drug shops within their catchment area

Community Health Extension Workers (CHEWs): [1]

  • In development: Community Health Extension Worker (CHEW) model, likely to be implemented in 2-3 years.
    • CHEWs positioned at the parish level (about 10 villages, 1000 households and 5000 people) and will have conventional health posts.
    • Will be paid and will receive comprehensive training prior to deployment
    • VHTs will remain at villages and will receive supervision from CHEWs
    • Implementation of iCCM will continue to be at the village level by VHTs

Private sector: [1]

  • Several NGOs (including BRAC, Living Goods) have community case management projects that employ various models, some providing monetary incentives to community health workers including opportunities to sell products for a profit.

Training: [1]

  • By the end of 2017, ~4,000 health workers were planned to be trained in integrated management of malaria (IMM) by PMI, which includes management of severe malaria.


Challenges of poor quality of routine data, lack of visibility and accountability at the service delivery points for essential medicines and health supplies from the National Medical Store despite. There is need to investin the sourcing, storage and distribution of blood. [3]

Stock [3]

  • VHTs continue to face challenges obtaining commodities from health facilities because of inadequate transport and delayed travel reimbursement.
  • Supporting facilities with stock not willing to redistribute facility commodities to VHTs citing policy barriers and accountability challenges.

Other [1]

  • High attrition of the VHT members due to lack of incentives
    • Efforts are ongoing to motivate VHTs (short term: bicycles, T shirts, medicine boxes and torches; long term: government is negotiating stipends)
  • Mainstreaming iCCM: Currently supported by partners, limited in coverage
    • In the Uganda Malaria Reduction Strategic Plan (UMRSP), funding will be mobilised from government and partners to scale up and improve national ownership
  • Supervisory system and reporting from the VHTs including supervisory visits, data quality and reporting tools, transmitting and incorporation of data in HMIS
    • Efforts for provision of VHT registers, incorporation VHT data into HMIS and increased supervision to strengthen the reporting systems.