1 Roles and Responsibilities for Community Health Workers
2 Challenges for Community Health Workers
3 National-Scale Community Health Worker Initiatives
4 Evidence for Community Health Workers
5 Community Health Workers with Mobile Data Collection
Mobile tools can increase the scope and quality of CHW services
Community Health Workers and Mobile Technology: A Systematic Review of the Literature
“Evidence suggests mobile technology presents promising opportunities to improve the range and quality of services provided by community health workers.”
A literature review of 25 studies on the use of mobile technology for community health worker programs found the prevalence and effectiveness of mHealth technology to be growing around the world: “Small-scale efforts, pilot projects, and preliminary descriptive studies are increasing, and there is a trend toward using feasible and acceptable interventions that lead to positive program outcomes through operational improvements and rigorous study designs.” The studies also reviewed the different uses of technology for CHW programs, as well as the various sectors that use them. Uses include data collection, notifications, education, two-way communications, and protocol adherence, while the broad range of health sectors highlighted maternal and child health, HIV/AIDS, and sexual and reproductive health. Studies that reviewed the effectiveness of mobile-enabled community health workers saw these tools “improve the quality of care provided, efficiency of services, and capacity for program monitoring.”
mHealth apps can strengthen health systems and improve quality of care
Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review
“By harnessing the increasing presence of mobile phones among diverse populations, there is promising evidence to suggest that mHealth can be used to deliver increased and enhanced health care services to individuals and communities, while helping to strengthen health systems.”
A review of information from peer-reviewed journals, websites, and key reports found that “with partnerships forming between governments, technologists, non-governmental organizations, academia, and industry, there is great potential to improve health services delivery by using mHealth in low- and middle-income countries.” In this review, the mobile tools’ most common uses were to support CHWs with notifications, job aides, decision support, data collection features, and instant feedback. This report also includes some discussion of the need to scale the community health worker pilots into full, national-scale programs.
Mobile tools can improve CHW knowledge and client management skills
Large-scale implementation of electronic Integrated Management of Childhood Illness (eIMCI) at the primary care level in Burkina Faso
“The use of [a mobile tool for health delivery] was widely accepted and perceived as a powerful tool guiding daily practice. Findings suggest that it has positive effects on the health care system beyond the quality of consultation.”
A study from the Swiss Tropical and Public Health Institute reviewed community health workers’ reactions to the support and usability of a mobile tool for health education and protocol compliance. According to their interviews, users were highly satisfied, as the application helped improve their level of knowledge and ability to manage patients. They also reported a “positive change in health facility organization” and decision-making, using the application as a learning tool to improve their ability to provide primary care in Burkina Faso.
Mobile job aides can improve worker performance and authority
Mobile-izing health workers in rural India
“The creation and use of videos did help engage village women in dialogue, show positive effects toward health worker motivation and learning, and motivate key community influencers to participate in promoting the health workers.”
A study carried out by researchers from UC Berkeley examined how mobile tools helped community health workers overcome challenges associated with their limited education, training, and status, as well as resistance to change in the village. In the end, the mobile-based job aide increased the motivation and performance of the workers, while also giving leaders in the community a reason to promote the work of the CHWs.
Mobile tools can improve health outcomes while reducing costs
Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India
A study published in BioMed Central evaluated the cost effectiveness of Catholic Relief Service’s Reducing Maternal and Newborn Deaths (ReMiND) program by looking at the incremental cost per disability adjusted life year (DALY) averted as a result of the intervention as compared to routine maternal and child health programs without ReMiND. In summarizing their findings, the study explains that if the program were scaled state-wide, it could save 312 maternal and 149,468 neonatal lives. They also found the program to be “a cost saving intervention from societal perspective,” saving a projected $2,569 for every death averted.
more studies on the effect of mobile tools for CHWs
6 Community Health Worker Case Studies
7 What Community Health Workers Have to Say
Working on the largest mHealth program in the world
The responsibilities of a CHW vary by program
A recent study of CHWs in Kenya included interviews with the workers themselves, where they had an opportunity to discuss their responsibilities:
The relationship between me and the facility is that I bring patients from the households to the facility. If there is an expectant mother or a mother who has had a home delivery I send them to the facility as quickly as possible and if it is a sick person I refer. We have a very good relationship which must be there. I am a link between the community and facility.
Community health worker from a rural county in Eastern Kenya discussing their role as a liaison between communities and the health system
I teach and help them construct dish racks and leaky tins, I show them the importance of mosquito nets so that they don't fall sick as they spend a lot of money in the hospitals. I also emphasis on hygiene and sanitation in the household and we make refuse pits and specific ones for disposal of sharps… Now I am happy that I have taught them and they are uplifting their health status.
Community health worker from a rural county in Eastern Kenya discussing their role as a health educator
On a daily basis as a CHW I go to my households which [I] am allocated and I pass not only on health matters. For those mothers who have school going children I also advise them to take their children to school. Also as a CHW I see to it that my structures are clean so that the environment is comfortable for everyone. Sometimes maybe once or twice in a month I organise a cleanup, so we clean the area surrounding my structures with the community not alone.
Community health worker in Nairobi, Kenya discussing the scope of their educational role
I inquire from the household member available. There is a section for pregnant women, children under five years, for referrals I have made, check up for the elderly, whether the household has Information Education and Communication materials, whether the CHEW/CHC has visited the household, whether the household gets heath education through me, TB, and immunisation and vitamin A supplementation for the under fives, MUAC for assessing nutritional status of children.
Community health worker from a rural county in Eastern Kenya discussing her data collection responsibilities
Within my schedule of work, I am a teacher by profession, a hotelier, and also an engineer; all those are my professions. What [I] am doing in my community is that I have allocated specific time as a volunteer within my community.
Community health worker in Nairobi, Kenya
Besides being a CHW, I am [a] housewife, I do farming, I do the rest of the work in the house. I usually wake up very early in the morning and I take breakfast. I have some cattle so I get food for them.
Community health worker in Eastern Kenya
8 Additional Resources on Community Health Workers
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