Uganda: Tech Stability Enables Record Performance for CHWs

CHW Fatuma tests Gladys’s son for malaria using a rapid diagnostic test in a village in Mayuge district, Uganda.

Ugandan CHWs in our Learning Site registered their highest performance on record in 2022 Q1. They exceeded targets on antenatal care (ANC) visits and facility deliveries and made nearly half a million U5 treatments and referrals in Q1—the highest in a year. Notably, they also exceeded U1 sick child treatments and referrals, a critical indicator given this demographic’s high mortality rates. CHWs also did an outstanding job ensuring full vaccination against early childhood diseases for 93% of children in their catchments, against the target of 65%.

Ugandan CHWs made nearly half a million U5 treatments and referrals in Q1.

Family planning performance was also strong in Q1, resulting in about 900 more unintended pregnancies averted than last quarter; a key driver was refresher trainings provided to 530 CHWs, which we resumed following the government’s recent lifting of COVID-19 restrictions. We also scaled new family planning trainings to an additional 336 CHWs. We saw an improvement in family planning follow-up visits, which grew by 37% in Q1 thanks to increased focus on driving uptake through this activity. However, there is still room for improvement.

Strong Q1 performance on all metrics was driven in large part by technology improvements, including splitting Smart Health into two instances to reduce the amount of data stored on the phones. This has led to an improved user experience, higher stability, and better app performance, along with fewer issues around timely data syncing and forced logouts. We also fixed supervisor app logouts in Q1. Given the tremendous volume of data in Uganda, we’re working with our partner Medic to roll out a more stable version of the app by Q3 across Uganda and Kenya. Improved medicine distribution and weekly data reviews have also strengthened CHW performance and motivation.

As a result of these improvements, we’re seeing better-quality supervision by both peers and Living Goods supervisors. Active supervision of CHWs was at 93% against the target of 75% and the CHW attrition rate in Q1 was low, at only 1.8%.

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