We realized early on that CHWs would be increasingly vital to communities due to the strain COVID-19 was placing on health systems. So, we needed to find creative solutions that enabled CHWs to work safely and continue delivering essential health services. Within Living Goods, we also needed to adjust to our own safety concerns and learning to work in new ways—almost all remotely, and at a distance from frontline supervisors and support staff.
We quickly adjusted all our workflows to be no-touch or low-touch, which bought us time to procure PPE and understand supply constraints. Given the severe economic hardship lockdowns were placing on families in Kenya and Uganda, we promptly made the strategic decision to move to free medicines to remove that barrier. Needing to ensure CHWs were highly motivated and willing to take on extra tasks, we simplified and slightly increased their compensation structures so they knew what income they would be earning.
We also ensured all supervisors and CHWs had protocols in place to enable remote supervision and provided them with airtime and data to facilitate working remotely whenever possible. We found creative solutions in the new ways to safely train CHWs on these new protocols, using WhatsApp and SMS, while also trialing some other e-learning approaches. In addition to providing CHWs with essential PPE and providing CHWs and households with information, education and communication (IEC) materials and SMS-based information, we donated substantial amounts of PPE, handwashing stations and triage tents to governments. In the first half of 2021, we will continue to implement these adaptations while evaluating which of these adjustments, if any, will evolve into our core programming as a best practice. Some highlights of what we did and learned:
|What We Did||Key Learnings|
|Adjusting Digital Health Workflows||We adjusted digital health workflows on both CHW and Supervisor apps to incorporate COVID-19 protocols. These included no/low-touch guidelines for the safe delivery of health services during the pandemic.
|Digital technology is a critical driver for successful remote health care delivery and quickly rolling out program adjustments. Digital tools are also essential in empowering frontline health workers, supervisors and governments with the information and data they need to deliver high-quality services remotely. Managing multiple changes to mobile app workflows has been accompanied by some challenges and has reinforced the importance of strong design and testing protocols before rolling out changes.|
|Coordinating with Government||We supported governments to think about their protocols and to come up with guidelines that enabled CHWs to continue delivering high quality essential health services.||We sometimes worked faster than government protocols were being established, so we had to balance supporting governments to think through their guidance while wanting to adjust rapidly. This was particularly challenging at times in Kenya, given the complexity of its devolved health system and the need to align with each county on new protocols. This resulted in creating more than one new workflow for the app, which meant many of our program adjustments in Kenya were not rolled out until early June.|
|Free Medicines||Living Goods has covered the costs of distributing free essential medicines to reduce preventable deaths in light of the economic hardship communities are experiencing due to the pandemic.|
|Revised CHW Compensation Structure||We slightly increased and vastly simplified the CHW incentive structure to account for the increased risk and work that CHWs were taking on.||This has been a key driver of CHW motivation, as CHWs are earning more on a consistent basis.|
|Remote Supervision||We provided supervisors with airtime and data bundles to facilitate regular phone check-ins with CHWs in the absence of physical visits.||We found that remote capabilities have increased the frequency of CHW supervision. Supervisors report feeling more efficient and better able to dig into performance management issues remotely. They now have multiple touchpoints with CHWs each month—versus monthly in-person visits before the pandemic.|
|Tech Innovations||We deployed SMS text messages as a simple, cost-effective way of quickly reaching clients. This was completed through one-way SMS blasts, two-way interactive messaging, and AI-assisted self-assessment messaging known as CIHA. Our SMS solution delivered life-saving prevention information and COVID-19 self-assessments to 13,886 unique users and elicited a 92% response engagement in users for COVID-19 screening, and 100% of users on COVID-19 prevention knowledge. CIHA self-assessment was completed by approximately 70% of users reached, identifying about 10% with likely symptoms of COVID-19 and linking them to follow-up testing and quarantine.
|We used RapidPro as the message transport system for CIHA. While it was a more complex system, it had limited errors. Meanwhile, the SMS platforms provided a fast and cost-efficient means of performing self-assessment triages and general health campaigns. Challenges included platform limitations for those without mobile phones as well as issues with workflow scalability and ease of data use.