Working through community structures:

Continuity of care for chronic conditions such as diabetes and hypertension remains a significant challenge for refugees in Uganda. This study investigates the role of community health workers (CHWs) in facilitating access to formal health services and supporting self- and social care among refugee populations. Despite limited institutional support and resources, CHWs engage in three interrelated domains of practice that are essential to sustaining chronic disease care: 1.Relational Work – CHWs establish and maintain communication pathways between refugee communities and health facilities, acting as intermediaries and patient advocates to re-engage individuals with care services. 2. Clinical Support Work – CHWs conduct screenings, refer complex cases, deliver medications, monitor treatment adherence, and follow up with patients who have discontinued care. 3. Community Engagement Work – CHWs assess community health needs, conduct sensitization activities, and mobilize participation in health initiatives. These practices are foundational to maintaining care continuity. To enhance their effectiveness, CHWs require structured training, adequate equipment, transportation, and fair compensation. Strengthening chronic disease care further necessitates integrated community engagement strategies and systemic improvements at higher levels of the health system, including increased funding, workforce development, diagnostic capacity, and robust monitoring and evaluation mechanisms.