Bridging the gap: Understanding the needs of community health volunteers to enhance palliative care delivery

Abstract

Background Community Health Volunteers (CHVs) serve as lay providers who deliver essential health services and bridge the gap between underserved populations and formal healthcare systems. In Uganda, these volunteers act as the primary point of contact and a vital intermediary between rural communities and health facilities. They facilitate community-based care, manage referrals, and provide health education, offering a cost-effective strategy to mitigate human resource shortages in low-income health systems. Although CHVs constitute the backbone of primary healthcare, systemic barriers such as poor integration, high attrition, and insufficient training frequently undermine their effectiveness. These challenges particularly stifle service delivery in rural districts where formal infrastructure is limited. Objective This study aimed to explore the specific needs of CHVs to inform targeted interventions that strengthen capacity building and improve palliative care outcomes in community settings. Design & Methods This qualitative study employed semi-structured interviews with eight CHVs from Mutungo Parish, Wakiso District, selected through purposive sampling. The interview transcripts underwent rigorous thematic analysis following Bingham and Witkowsky (2021) structured five-step analytical framework, with data management and coding procedures implemented in Microsoft Excel to maintain methodological consistency and analytical transparency. Results Four key themes were identified through thematic analysis. First, regarding training and education, CHVs reported insufficient palliative care training and specifically requested competency-based refresher courses. Second, concerning resources, participants identified critical shortages in tangible, operational resources which includes medical supplies, transportation funds and material support in providing care. Third, in communication and coordination, there was a demonstrated need for smartphones with data plans to facilitate care coordination. Finally, on the workforce sustainability, analysis revealed excessive patient loads stemming from workforce shortages that compromised service delivery. Conclusion The findings reveal urgent, context-specific gaps in Uganda’s community-based palliative care system. Addressing these through tiered training, resource provision, and workforce expansion could significantly improve care quality.