Infectious Diseases Institute (IDI)
The Infectious Diseases Institute (IDI) is a Ugandan not-for-profit organization whose mission is to strengthen health systems in Africa, with strong emphasis on infectious diseases, through research and capacity development. IDI has six operational areas through which it works to achieve its mission: Prevention, Care and Treatment, Training and Capacity Development, Research, Laboratory Services, Global Health Security and Health System Strengthening.
Learning and Documentation of the Community Health Extension Workers (CHEWs)
Programme in the Kampala Metropolitan Area: An Evidence Based Implementation
Documentation for Urban Communities
Terms of Reference/ SoW
1. Background and Context
Uganda introduced the Community Health Extension Worker (CHEW) cadre to address the
documented limitations of the Village Health Team (VHT) model, following evidence that a purely
volunteer cadre had become underfunded, undertrained and poorly coordinated. The 2018 CHEW
Strategy established a trained, supervised and remunerated community health cadre with defined roles,
a six-month training programme and a career pathway, and the National Community Health Strategy
2021/22 to 2025/26 situated CHEWs within a wider community health architecture spanning the
electronic Community Health Information System (eCHIS), community-based surveillance, supply
chain reform and the Parish Development Model.
The original design parameters were specific: a monthly stipend of about 150,000 shillings; recruitment
from within the home community; a minimum of an O-level certificate; a target of one male and one
female CHEW per parish; a six-month training period; attachment to health facilities; supervision
through facility and district structures; and a defined community health service package. The model
was piloted and, on the strength of early lessons, has been scaled to a growing number of districts,
with a national policy decision and further scale-up now approaching.
Evidence to date indicates that the model is sound and is trusted where it matters, that recruitment,
training and deployment have largely been implemented as designed, and that the principal constraints
lie in the operational backbone after deployment, above all the reliability of payment, supervision at
household level, commodity and equipment gaps, and uneven digital reporting. Much of this evidence,
however, comes from rural and mixed districts.
