'Those were taken away and given money': power and reward expectations' influence in the selection of village health teams in rural Uganda.
BACKGROUND
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.
University of Amsterdam, Amsterdam. tbenoni@gmail.com.
Emmanueil B
EB
Turinawe
D003150:Community Health Workers / Q000458:organization & administration*; D003256:Community Participation; D004338:Drug Combinations; D035082:Federal Government; D005476:Fluphenazine; D006077:Government Agencies / Q000458:organization & administration*; D006801:Humans; D009111:Local Government; D009661:Nortriptyline; D011057:Politics; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D014454:Uganda; D014838:Volunteers
D004338:Drug Combinations; C028045:Motival; D009661:Nortriptyline; D005476:Fluphenazine
Africa; Community Participation; Community-Controlled Health Services; Health Service reform; Postgraduate; Primary Health Care; Qualitative Research