In Mozambique and Uganda inSCALE is giving community health workers (CHWs) phones with which they can send their weekly reports, receive immediate automated feedback on performance and access a closed user group with their supervisors in order to increase communication and support. Every month a motivational performance related SMS is sent out, and supervisors receive weekly automated actionable SMS for CHWs who are performing at high or low standards. Through the use of this mobile health (mHealth) application, community health workers are expected to feel an increased sense of connectedness to the health system and to their CHW peers. Through the increased support they will be receiving, CHWs will hopefully feel appreciated for the work they do and have an improved sense of status within their community.
The closed user groups are also expected to address some of the potential drawbacks in supervision, increasing frequency of communication between the CHW and their supervisor but also reducing the cost of travel where potentially unnecessary. Supervisors will be able to provide more targeted face to face supervision based on performance and conduct over the phone supervision on a more regular basis.
In Mozambique CHWs are provided with smart phones (Samsung Galaxy Y) programmed with a inSCALE CommCare tool for decision support, immediate feedback and multimedia audio and images to improve adherence to protocols. The tool also allows CHWs to send patient data to a server and to keep a register of patients who can be tracked over time. The indicators submitted can be used to monitor the performance of CHWs by providing automated, timely, digestible reports with targeted follow-up actions for CHW supervisors.
inSCALE APE CommCare Application by Malaria Consortium is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
In Uganda, CHWs are given a Java enabled mobile phone (Nokia C2-00) through which they can send their weekly reports on patients seen and deaths in the community, receive immediate performance related feedback based on data submission and monthly motivational messages to reinforce topics that need reminder and refresher training. These messages are designed to impact positively on CHW performance and motivation. Automated messages will be sent to supervisors flagging any problems and strengths identified in the data submitted by the CHWs using the provided phones, and alerting supervisors as to which individuals require targeted supervision.
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The applications are intended, in both countries, to focus on CHW performance. Immediate feedback messages after data submission and the monthly motivational messages provide normative, formative and restorative reminders and key information for improved diagnosis, treatment and prompt referral. In Mozambique specifically, software guidess the CHW through the consultation steps to make sure that no symptom or sign is missed, while providing treatment guidance when all steps are complete. Images, audio and videos are included in the software to refresh the skills in illness identification and treatment, and strengthen health education. Helpful, innovative applications on the phones such as a respiratory timer facilitate pneumonia diagnosis and are also expected to improve performance in both countries.
The data sent to the district health information system allows for integration of the electronic data with the national health information system for wider use and can provide valuable information on health patterns at village level. This use of data is also intended to motivate the CHWs and improve their feeling of being part of the health system.
Finally, CHWs are also provided with solar lamps and chargers which they can use for treating sick children in the evenings as well as a method of revenue collection for charging phones in their villages.