Buikwe District: Uganda CHEW Scope of Practice Limits Defined

• Uganda's Ministry of Health deployed 134 new Community Health Extension Workers (CHEWs) to Buikwe District to improve local health services.
• Buikwe District Vice Chairperson Nakintu Afuwa explicitly warned CHEWs against performing medical procedures reserved for qualified professionals, such as injections or surgeries.
• CHEWs are tasked with community-level duties including disease prevention, health education, patient referral, and reporting unexplained deaths.
• The District Health Officer highlighted critical infrastructure gaps in Buikwe, including a lack of ambulances and government health facilities in key areas.
• The United States is supporting the training of over 14,000 CHEWs across Uganda, emphasizing their role as a bridge between communities and health facilities.

Ms. Afuwa explicitly outlined activities that fall outside the CHEW mandate, including administering injections, performing surgical procedures, and admitting patients for treatment within their homes.

The Ministry of Health in Uganda recently deployed 134 newly trained Community Health Extension Workers (CHEWs) to the Buikwe District. This initiative aims to enhance local health service accessibility and improve early disease detection and prevention efforts across communities. These workers are tasked with operating at the community level, serving as a vital link between residents and established health facilities, while also promoting disease prevention, health education, and the timely referral of patients for more advanced care.

However, the introduction of this new workforce was immediately accompanied by explicit warnings regarding the precise limits of their professional duties. Nakintu Afuwa, the Buikwe District Vice Chairperson, specifically cautioned the CHEWs against exceeding their authorized mandate. She emphasized that certain medical procedures are strictly reserved for qualified health professionals, and CHEWs must not attempt to perform them.

The clear directive from district leadership underscores the critical importance of adhering to the defined scope of practice for these Community Health Extension Workers in Buikwe. Ms. Afuwa explicitly outlined activities that fall outside the CHEW mandate, including administering injections, performing surgical procedures, and admitting patients for treatment within their homes. She reiterated that such interventions are the sole responsibility of licensed medical professionals, highlighting a potential area of legal exposure if CHEWs overstep these boundaries.

Further emphasizing the need for strict adherence to roles, Dr. Richard Kabanda, Commissioner for Health Promotion, Education and Strategic Communication, also issued a caution. He warned district health officers against redeploying CHEWs to formal health facilities to compensate for staffing shortages caused by absent medical personnel. Dr. Kabanda specifically advised the CHEWs themselves to resist any pressure to fill such gaps, reinforcing the principle that their role is community-based and distinct from facility-based clinical work. The Director General of Health Services, Prof. Charles Olaro, added another key responsibility, tasking the new workers with reporting any unexplained deaths observed within their communities.

The deployment of these health workers is particularly pertinent for Buikwe District, which faces unique health challenges. Dr. Allan Katamba, the District Health Officer, welcomed the program, noting the timeliness of bringing health services closer to households given the district's specific demographic and geographic characteristics. Buikwe's criticality stems from its lakeshore areas, industrial presence, and its role as a transit point for truck drivers from neighboring countries, all of which contribute to distinct public health needs.

Despite the readiness to support the new CHEWs, Dr. Katamba highlighted significant deficiencies in the district's health infrastructure and emergency response capabilities. He informed the Ministry of Health that Kawolo Hospital currently lacks an ambulance, following an accident involving its previous vehicle, which severely impacts its capacity for emergency interventions. Additionally, Kiyindi Town Council, despite its growing population around a landing site, remains without a single government health facility, leaving a substantial population underserved. These infrastructural gaps could inadvertently create pressure for CHEWs to operate beyond their intended roles, making the warnings about scope of practice even more crucial.

The initiative to train and deploy CHEWs is bolstered by international collaboration, with significant support from the United States. Dr. Cate Godfrey, representing the United States, underscored the vital role of community health workers as a crucial link between local populations and formal healthcare systems, particularly in disease detection. She stressed the importance of the CHEWs performing their duties with integrity, humility, and compassion, acknowledging the direct impact their work will have on the health and wellbeing of the communities they serve.

This recent graduation event was recognized by Dr. Godfrey as a testament to the robust partnership between Uganda and the United States, symbolizing the strength of their collaborative efforts. The United States has further committed to supporting the training of over 14,000 community health workers across Uganda, indicating a sustained investment in this model of public health delivery. While acknowledging potential community resistance due to a lack of understanding of the CHEW role, Dr. Richard Kabanda urged the workers to remain focused on their responsibilities, reinforcing the long-term vision for their integration into Uganda's public health strategy.

Lawyers advising healthcare providers in Uganda, particularly in the Buikwe District, should review the defined scope of practice for Community Health Extension Workers (CHEWs) to ensure their clients are not exposed to liability from CHEWs performing unauthorized medical procedures. Compliance officers must ensure clear guidelines are in place to prevent CHEWs from exceeding their mandate, as explicitly cautioned by district officials.

Source: Reporting based on local coverage from Uganda.