COVID-19 has disrupted public health service delivery with communities bearing the greatest brunt as the disease burden continues growing exponentially. Governments are rapidly interrupting and adapting against the sporadic disease spread. Social distancing has been adopted as a mitigation measure in the spread of the disease across persons further influencing the reach to which community health workers are able to interact with caregivers, supervisors, health trainers, and program officers to a minimal or no touch at all. In response to this limitation hindering effective service delivery, Living Goods, in support of MOH, re-engineered processes, systems, and tools for continuity of services and mitigation of increased mortalities.

Interrupt and Adapt

Through bi-directional SMS messaging, caregivers are walked through a COVID-19 case screening algorithm that assesses exposure to COVID-19 risk factors based on the following parameters; main symptoms, travel history, interaction with persons of suspected or confirmed COVID-19. The output from this decision tree will trigger actionable tasks that will be escalated to CHWs, program supervisors and disease surveillance officers for further investigation.

In case management, diagnostics are being carried out by caregivers directly with readings being shared with CHWs through phone calls or verbally from a safe distance for input onto the service delivery app, SmartHealth, to initiate the case assessment process. For example, temperature checks and in other instances, diagnostic features have been introduced on Smart Health app such as respiratory count mechanism for pneumonia diagnosis. In-app messaging triggers and event tasks flag cases that require follow up by CHWs of which can be reached out to via phone calls.

COVID19 has also been integrated into the iCCM assessment protocol on the app as a routine health check in addition to the other common illnesses such as malaria, pneumonia, and diarrhea.

With CHWs now, more than ever, being acknowledged as a catalytic influence in the effective health service delivery at the community level through health education, awareness generation, case management, and health facility referrals, governments are spearheading efforts in enacting bills that will foresee CHWs integrated as essential human resources for health. This will grant them easier access to benefits such as listing in the human resources for health registry, remuneration packages, equipping with tools and equipment as well as optimal technical training on health service delivery.

With the shifting focus from the conventional classroom-based training to remote modes of training through eLearning interventions for on-demand access to self-paced training material, Living Goods ventured into the process of collaborative stakeholder engagement that includes the program officers, supervisors and CHWs to understand training needs in designing a robust platform that addresses these needs. Living Goods customized the Moodle-based tool LMS with emphasis on standardizing digital training practices and delivery of simplified interactive instructional content that is interoperable with other technologies.

Using data to predict and making informed decisions, Living Goods customized SORMAS (Surveillance Outbreak Response Management and Analysis System) to support the Ministries of Health in the early detection, tracking and escalation of case outbreaks through the health system cascade from the community to the national level for timely action by health program surveillance officers. Integrating with RapidPro for SMS based updates, the data harvested from the bi-directional SMS screening is processed in SORMAS and visually presented in program dashboards further integrated with the national reporting tools such as DHSI2.