Despite Hard Times, CHWs Continued Trend of Good Performance

We saw generally strong performance in Uganda, our longest-standing area of operations with more than 4,200 CHWs reaching 2.5 million people. CHWs again demonstrated their value in closing the gap in the provision of essential health services, especially during hard times.

An outbreak of Ebola in September led to lockdowns in three districts. We instituted a response plan including remote working in districts neighboring the epicenter of the outbreak. CHWs played a key role in backstopping the outbreak and continuing to provide essential lifesaving services. For example, they registered nearly 80,000 new pregnancies and provided over 1.8 million sick child treatments during the year. This shows what is possible at scale when a strong network of CHWs is well-supported to continue providing services, even during times of crisis.

Ugandan CHW Mary educates a woman about healthy feeding in pregnancy in Mayuge, Uganda.

We constantly innovate in our learning sites to figure out how to drive optimal community health programs. For example, we scaled a peer supervision experiment to 100% of our operations in June. Under this model, high performing CHWs in close geographic proximity mentor their peers instead of relying solely on supervisors. This has increased supervision touchpoints and effectively reduced the supervisor-to-CHW ratio from 1:35 to 1:70. CHWs have expressed preference for this approach because of the weekly peer-led group meetings where they can raise and solve problems amongst themselves, and for the opportunity for career progression. Peer supervision is an example of an experiment that can be adopted at scale across contexts, reducing costs and increasing CHW motivation and retention. We plan to test this approach in Burkina Faso once the learning site is fully established.

Unverified data halved from 23% in January to 11.5% at the end of the year, owing to resumption of physical quarterly in-service trainings in 2022 after being remote during COVID. This provided an opportunity to close gaps around some areas like referral follow-up and antenatal care visits.

We also scaled family planning to all CHWs in 2022. However, low stock levels of methods, which we receive from the government prevented many newly trained CHWs from performing optimally. We are actively engaging government stakeholders at all levels to ensure a more stable supply chain, procured some buffer stock and are encouraging CHWs to refer women to health facilities for longer-term methods.

We worked to mitigate some persistent tech issues, including logouts, system crashes, syncing and data flow challenges. We significantly upgraded our digital platform to ensure it was stable and user friendly at significant scale, which led to an improved user experience, higher stability, and better app performance. However, we continue to experience some issues but are working with Medic—developer of the Community Health Toolkit (CHT) platform which the SmartHealth app is built upon—to resolve them. This is imperative as more governments are requesting our support to realize their ambitions for digital solutions at national scale.

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