Community health knowledge and access to care in post-conflict Northern Uganda: Perspectives of community health workers in Pader District

Northern Uganda continues to experience high disease burdens and poor health outcomes shaped by poverty, geographic isolation, and long-standing health system constraints. Community health workers (CHWs) play an important role in rural districts by linking households to formal health services. In this study, CHWs refer to Village Health Team (VHT) members trained through the Laro Kwo Project in Pader District. However, limited research has examined how CHWs perceive community health priorities, barriers to care, and gaps between health knowledge and access. Understanding these perspectives is essential for designing responsive and sustainable community health programs. A qualitative descriptive study guided by interpretive principles was conducted across Pader District, Northern Uganda. Six focus group discussions were held between July 15 and 22, 2024 with 46 CHWs from six sub-counties, using a semi-structured guide covering eight domains related to community health, prevention practices, and program improvement. The guide was adapted from prior CHW-focused work and refined collaboratively with local partners. Data were documented through detailed field notes, translated, and analyzed inductively through iterative coding and thematic synthesis. Three overarching themes emerged: (1) experiencing health burden and community need, (2) barriers to access and systemic constraints, and (3) bridging health knowledge and everyday practice. CHWs identified malaria, maternal and child health complications, and a growing burden of non-communicable diseases as major community concerns. Persistent barriers to care included long distances to health facilities, medicine stockouts, and limited transportation. While communities demonstrated substantial knowledge of disease symptoms and prevention strategies, financial hardship and service limitations often prevented timely care-seeking and preventive action. CHWs' perspectives highlight a persistent gap between local health knowledge and access to care. Their recommendations emphasized priority health concerns and underscored the need for interventions that better align community knowledge with reliable and accessible services.