Introducing David Musoke: Use of photovoice to explore gender and ethics in health systems by community health workers in rural Uganda

David Musoke is a recipient of a RinGs’small research grant and currently works for the Department of Disease Control and Environmental Health at Makerere University School of Public Health, in Kampala, Uganda as an Assistant Lecturer, in addition to being a part of the Future Health Systems Research Consortium(FHS). His project is titled: Use of photovoice to explore gender and ethics in health systems by community health workers in rural Uganda.

My background is in Environmental Health with postgraduate training in International Primary Health Care from the University of London. I am currently doing a PhD at Cardiff Metropolitan University, UK where I am exploring practices, perceptions and challenges of integrated malaria prevention by households in rural communities in Uganda. Besides teaching, student supervision and consultancy work, I am involved in a number of research projects in Uganda. Part of my research is on diseases (malaria, HIV, cancer), environmental health (water, sanitation, hygiene), and health systems (health seeking behaviour, maternal health).

My current research work includes use of photovoice in health systems research. Photovoice is a process by which people can identify and represent concerns through photographs and through their discussions enhance their community. I have previously used photovoice to explore the perspectives and contribution of youth in improving maternal health in rural communities in Uganda. This research resulted in learning about the various challenges affecting maternal health by youth in their communities, the social determinants and multisectoral concerns affecting maternal health, as well as broader dissemination through community sessions, conference presentations, articles and publications.

The experiences of my first photovoice project led me to explore other opportunities to use the methodology in health systems research. The RinGs small grant programme was therefore a perfect opportunity for me to use photovoice to explore gender and ethics by community health workers (CHWs) in rural Uganda. Although some research has been done among CHWs in Uganda in recent years, these studies have mostly been on CHWs, with minimal participatory involvement by CHWs in the process. CHWs are an important community resource in Uganda, particularly in rural areas, as they are the population’s first contact with the health system. They are therefore important in exploring issues that not only concern them, but also the communities in which they serve. My study will therefore use photovoice as a means of exploring the perspectives of CHWs as seen by them on gender and ethics related to their work in rural communities.

In Uganda, particularly in rural areas, there are distinct gender roles within society. This is likely to play a significant role in the selection and performance of CHWs, as well as the communities’ health seeking practices. CHWs, although not formally trained health professionals, are involved in providing healthcare, particularly treatment of children under 5 years of age against malaria, diarrhoea and pneumonia. It is therefore important to establish the ethical concerns they face particularly in their primary care work. This study will be able to answer many of such questions so as to inform policy and practice in countries that utilize CHWs.

The findings from the study are expected to be useful to local, regional and global audiences and could inform policy decisions regarding the perspectives of CHWs on their gendered positioning within health systems, as well as their ethical concerns. Local stakeholders, including local leaders and policy makers, could utilize the results to put in place measures to address gender inequalities and ethical issues in health service delivery within communities. As photovoice has not been used extensively in Uganda and other developing countries, the study will also provide more evidence on the methodology in community-based participatory research.

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