In 2006, the World Health Organization (WHO) highlighted the lack of skilled human resources for health as a major barrier to achieving Universal Health Coverage (UHC) [
1]. As a result, the World Health Report then proposed task-shifting strategies as a potential solution to deliver new interventions and basic curative and preventive care, especially in low-income countries. This strategy includes the use of Community Health Workers (CHWs) to deliver primary health services in their communities, particularly in low- and middle-income countries (LMICs). ‘Community Health Worker’ is an umbrella term, broadly used to describe lay people who live and work closely with local communities, provide basic health care services, and have the potential to act as change agents [
2‐
4]. They can be men or women, literate or illiterate, young or old, and paid or unpaid depending on the country or context they work in [
2]. The specific roles and activities assigned to CHWs vary across LMICs [
5]. Historically, CHWs have predominantly been involved in the provision of primary health care (PHC), with a strong emphasis placed on health promotion, disease prevention, collection of health data, and management of maternal and child health challenges [
6]. Specific activities performed by CHWs are comprehensive and include home visits, promotion of safe water and sanitation, first aid, treatment of simple and common ailments, health education, nutrition promotion, disease surveillance, supporting maternal and child health, enhancing family planning, communicable and non-communicable disease control, community development, referral of patients, record-keeping, and collection of data on vital events [
7]. An increased focus has been placed on the role of CHWs in supporting and strengthening health systems in recent years, yet challenges affecting their work are yet to be fully explored and addressed. If we consider them as major stakeholders in attaining the Sustainable Development Goals (SDGs), particularly SDG 3 of “Ensuring healthy lives and promoting well-being for all at all ages”, it is important to understand the challenges affecting them. However, the stakeholders that have majorly been involved in making decisions concerning CHWs include policy-makers, academics, and non-governmental organisations (NGOs) working with them. Although evidence exists regarding the challenges affecting CHWs including those related to training, supportive supervision, remuneration, data collection, availability of supplies, and community engagement [
8‐
10], there is a pressing need to explore the concerns that have received less attention, specifically from the perspective of CHWs themselves. These concerns include the heavy workload imposed on CHWs by several stakeholders, dealing with religious and cultural practices during the course of their work, and gendered barriers of care in the community. Understanding these challenges provides subsequent opportunities for designing interventions to address them, in order to improve performance of CHWs as they contribute to achieving UHC.
Our interest in CHWs as a recognised workforce comes from over ten years of implementing projects in Wakiso and Mukono districts in Uganda. The focus of most of our interventions have been on enhancing the capacity of CHWs through supporting their training, supervision and motivation [
11]. Building on the measured success of our interventions, the projects have been rolled out to other areas using a peer-to-peer approach as a way to build evidence for scale up and sustainability. The CHWs we support have been key contributors to local and national stakeholder events where they have shared their own first-hand experiences of supporting community health. Indeed, they have participated and spoken at several events including the first international CHW symposium held in Kampala [
12] during which their voices were heard by various stakeholders including local and global policy-makers. In recent years, the CHWs have developed in confidence in relation to their roles, diligently delivering health care, and grown in status within their communities but also, increasingly, within the health system. Opportunities of hearing CHW voices in the past has given us the opportunity to understand the importance of investing in them as a workforce, but also appreciate the need to have their perspectives inform decisions at local and international levels. This commentary therefore highlights some of the contested and unexplored notions of the challenges affecting CHWs in LMICs informed by the Silences Framework.