Service in Isolation: How CHW Agripina Used Her Smartphone to Save Lives During a Health Crisis

Going into isolation after testing positive for COVID-19 during a routine health worker test, was one of Agripina Adema’s lowest moments in 2020.

But having volunteered as a community health worker (CHW) in Kakamega County, Kenya for the past 12 years, Agripina knew that the more than 100 families she served needed her even more amid the COVID-19 pandemic. So, even though she was unable to physically visit her clients for a while, she didn’t intend to abandon them — even if it meant that she could only reach them over the phone.

“Thankfully, I had no symptoms but despite the anxiety and discomfort of restricted movement and having to stay apart from my family, the one thing that kept me going was that I could still be there for my clients,” says the 43-year-old mother of four. “It was comforting to know that even in isolation, all I needed was my smartphone to continue saving lives,” she beams.

Agripina is among 3,000 government CHWs in Kenya who are supported by Living Goods and equipped with essential medicines, training, supportive supervision and a smartphone loaded with an m-Health application. This enables them to effectively provide ante and post-natal care for pregnant women, to asses and treat young children for common but deadly illnesses like pneumonia, diarrhea and malaria, and to provide immunization and family planning counselling, referrals and follow ups.

While Agripina and her fellow CHWs have always used digital tools to deliver health services since they began receiving support from Living Goods, with the emergence of COVID, some adjustments were needed to ensure that even amid lockdowns and limited availability of personal protective equipment, CHW services could safely continue remotely or with adjusted in-person protocols. Living Goods received funding from the Foreign Commonwealth & Development Office (FCDO) and other funders to modify the workflows on the Smart Health app in the CHWs smartphones to incorporate these ‘no-touch’ and ‘low-touch’ protocols that allowed Agripina to continue working in a context that was not initially possible. Although working remotely has had its challenges, Agripina has been using her mobile phone to continue checking on her clients, assessing and referring sick children for facility-based treatment when necessary and following up as needed.

“Sometimes there are network issues and because I couldn’t make physical contact to treat or provide patients with medicines, I mostly referred all cases needing treatment to health facilities,” says Agripina. “However, Living Goods doubled my airtime allowance helping me to maintain regular contact with clients, follow up on referrals and ensure they received ongoing health education.”

CHW services were especially critical at a time when many families were facing pandemic-related economic hardships. Consolata Khaleji, 37, a hairdresser, delivered premature twins right before the pandemic. She says the support she received from Agripina was lifesaving especially because both she and her husband initially lost their jobs.

“Agripina has walked with us from the beginning visiting me during my pregnancy and even in hospital after delivery,” she says. “My children would not be where they are without her support. Even when she could not visit, she made it easy for me by assessing my babies over the phone and advising me so that I go to the hospital only when necessary,” she adds.

After 21 days of isolation, Agripina was happy to get a clean bill of health which finally allowed her to mingle with family members and resume physical contact with her clients. She now combines remote services and in-person visits that she says have improved her effectiveness and motivation.

“When someone calls me because their child is sick, I screen myself for COVID and then rush there. My phone guides me in screening my clients as well and then in assessing and treating the sick child. If I need to make follow ups on antenatal visits, immunizations or family planning referrals I can do that over the phone or go there physically depending on the need,” shares Agripina.

“Whenever Michelle, my 2-year-old daughter falls sick, Agripina is always my first call even before COVID-19. She listens attentively and visits us to check up on and treat the sick child,” says Caroline Minayo. “She also calls to follow up on how the child is doing and educates me on family planning and how to prevent COVID infection.”

CHWs like Agripina have contributed to maintaining health services and filling a critical gap during a pandemic as families increasingly turned to CHWs for health care given their increased difficulties and fears around visiting facilities. In 2020, Living Goods-supported government CHWs saved an estimated 17,000—19,000 lives, nearly doubling 2019 results due to the use of these adjusted digital health workflows as well as the provision of free essential medicines, a revised CHW compensation structure and remote CHW supervision.

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