Why Mozambique and Uganda?
Issues of high attrition and low performance among community health workers (CHWs) creates challenges for implementing governments, which are attempting to scale up community based health delivery.
Mozambique and Uganda were selected for implementation as both countries have demonstrated the ability for regional influence and a willingness to make a firm commitment to community based care as a way of reducing mortality and morbidity in children under five. The Ugandan Ministry of Health has, for example, pioneered a nationwide programme for home-based management of fever, demonstrating to the international community what can be achieved through community-based programming at scale and its impact on the disease burden. Integrated community case management (iCCM) became a nationwide strategy for reducing childhood mortality in 2010, and the Government has shown a firm commitment to the programme.
The APE (agentes polivalentes elementares, or community health workers) programme in Mozambique has been in existence for over 30 years. APEs were regarded as one of the key community level actors who could help extend primary healthcare to rural communities. After the ruptures caused by the civil war, the programme is now being revitalised and community based care of children with diarrhoea, pneumonia and malaria through APEs is now part of the national Public Health Strategy.