Those were taken away and given money': Power and reward expectations' influence in the selection of village health teams in rural Uganda

Abstract

Introduction: With the renewed call for community participation in health interventions after the Alma Ata Declaration, interest has been raised in volunteer community health workers (CHWs) acting as representatives of local communities. The present study interrogates the dynamic interface between local communities and the government in the selection of CHW volunteers in a rural community. Methods: Data were collected through participant observation of community events, 35 in-depth interviews, 20 focus groups and 15 informal conversations. A review of documents about Luwero district was also an important source of data. Results: Ambiguous national guidelines and poor supervision of the selection process enabled the powerful community leaders to influence the selection of village health teams (VHTs). Intended to achieve community involvement, the selection process produced a disconnect in the local community where many members saw the selected VHTs as having been 'taken away'. Conclusions: Community involvement in the selection of VHTs took a form that, instead of empowering the local community, reinforced the responsibility of those in power and thus maintained the asymmetrical status quo.