Table 5.

Themes defining VHT roles in HTN and DM care

Limited scope of VHT responsibilities related to health care

We have not taken the role of managing the diseases [HTN and DM] yet, so we refer anyone we discover to the hospital. (Male VHT, Nakaseke town council, VHT 9) I don’t diagnose such patients, but if I find them in their homes I urge them to go to a health facility. I do follow up on them. (Female VHT, Nakaseke town council, VHT 11) We encourage that they [patients with DM] […] get tested to know their blood sugar levels to ensure that they are well and that it doesn’t continue rising. (Male VHT, Kasangombe, VHT 1) [We take care of patients with HTN and DM by] Visiting them and telling them to take their medication. And going back for review to hospital on due day. (Female VHT, Kasangombe, VHT 2) I have never been there personally to see how it is done [diagnosis of HTN and DM] but we advise them to go to hospital when they have symptoms. (Female VHT, Nakaseke sub-county, VHT 4) We refer patients with DM straight to the hospital when we identify them (Male VHT, Nakaseke sub-county, VHT 6) We find these patients and refer them and even do follow up encouraging them to take their medication. (Female VHT, Nakaseke town council, VHT 11)

Concerns about VHT role in HTN and DM care from the perspectives of patients and HCPs

I personally don’t believe that they can do it [manage DM]. It [knowledge on DM] is hard. (HTN and DM, Female, Nakaseke sub-county P7) They [VHTs] don’t help us in any way, and they have no role in this disease. I would request that it is the patients that should be trained. […] Their importance is weak, it cannot benefit us in any way. They [VHTs] could be beneficial to other patients such as those with malaria but our disease is so complicated. (DM only, Male, Nakaseke sub-county, P10) They [VHTs] have roles in other diseases but not concerning diabetes and hypertension. I do not fully certify them. I don’t think [VHTs can play a role in HTN and DM] maybe malaria and child health. I doubt their abilities. (HTN and DM, Female, Kasangombe, P21) I don’t talk with VHTs. They used to treat malaria back then and I have never seen them help patients with hypertension. They are necessary to help children under 5 years old by dispensing malarial drugs but they are not helpful to us the elderly. They do not give out drugs for hypertension and diabetes. They are not trained, they simply help people. The good thing is that we have village clinics even if they [VHTs] are not available. (HTN only, Female, Nakaseke sub-county, P16)

I don’t know their role, but I think HTN and DM are a bit complicated for them. They can only handle the simple diseases like malaria, diarrhea. […] they are trained for HIV but not HTN and DM. And because they have very little knowledge about HTN and DM that most of those people in the villages [with HTN and DM] do not even have relationship with village health team members. They are always trained and given special courses [in HIV], but I never heard any about DM and HTN. (Male, Pharmacist at Nakaseke Hospital HCP6) They [VHTs] do a lot of work in the villages, but for HTN and DM, it is above their standard. […] They don’t know enough to convince the patients with HTN and DM. What drug to get, what to eat, and what to drink. (Female, Pharmacist at Nakaseke Hospital, HCP 5)