In Bukedea district, a new generation of health workers is stepping into Uganda’s rural communities — trained, equipped, and paid — to change how healthcare reaches families in the remotest corners.
At least 304 Community Health Extension Workers (CHEWs) are currently undergoing training in Bukedea as the government officially rolls out the new program. The initiative marks a turning point from the long-standing reliance on volunteer Village Health Teams (VHTs) toward a more professional, sustainable community health system.
For years, volunteers have been the first point of contact for millions of Ugandans — delivering medicines, advising mothers, and tracking disease outbreaks. But with limited training and no pay, their capacity has been stretched thin. The new CHEWs, officials say, are meant to bridge that gap.
“These workers are our frontline soldiers. They will change how families experience healthcare at the grassroots,” said Hellen Grace Tino, LC5 councilor for Kabarwa.
The CHEWs program is part of a national pilot being implemented in eight districts — Bukedea, Bunyangabu, Kakumiro, Kalungu, Kassanda, Kisoro, Mbale, and Mitooma. It aims to tackle persistent public health challenges such as risky home births and self-medication, which continue to threaten lives despite decades of progress.
According to the Ministry of Health, nearly one in four births in Uganda still takes place outside a health facility — a key driver of the country’s maternal mortality ratio of 189 deaths per 100,000 live births (UDHS 2022).
Dr. Eve Wabule, a Ministry of Health trainer, says CHEWs are explicitly trained to discourage home births and refer expectant mothers to health facilities. “We lose mothers and babies to preventable causes like bleeding and infection. CHEWs are being prepared to identify danger signs early and guide women to safety,” she said.
Beyond maternal health, the CHEWs will also confront one of Uganda’s silent epidemics — self-medication. Studies in rural areas show that up to 70% of people treat themselves using drugs from shops or friends, often without diagnosis. The result is widespread misuse of antibiotics and a rising threat of antimicrobial resistance (AMR).
The CHEWs are being trained to promote safe medication practices, encourage testing before treatment, and sensitize communities about the dangers of drug resistance.
Each trainee undergoes a six-month course, including two months of practical fieldwork. They are also provided with essential tools — a bicycle for transport, a smartphone for data collection, and medical equipment such as blood pressure machines, glucometers, and MUAC tapes for nutrition screening.
The model draws inspiration from Ethiopia’s successful community health program, which has significantly improved health outcomes through a similar network of trained workers.
As Uganda pilots this new approach, the government and partners such as The AIDS Support Organization (TASO) are optimistic that the CHEWs will bring lasting improvements in maternal health, disease prevention, and trust in the formal healthcare system.
In villages like Kabarwa, residents are already hopeful. “We have always depended on volunteers who sometimes had no medicine or time,” said Grace Akol, a mother of three. “If these new workers can help us reach the hospital when we need to, it will save many lives.”
