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Scaling Performance Management Tools that Work in Community Health

BY Living Goods • March 24, 2016

Last month, leaders from seven countries gathered at Wilton Park with their partners around a common vision: achieving universal access to healthcare and transforming maternal-child health through national scale-up of Community Health Workers (CHWs). These efforts hold the potential to transform the lives of millions and set a convergent course toward global health equity. However, they are not guaranteed to succeed – the success of CHW scale-up will depend on how well we support community health workers to become the leaders and change-makers they seek to be.

The Need for Community Health Workers

In Kenya, Uganda, and Mali where Living Goods (LG) and Muso operate, pregnant women and sick children typically walk long distances for care at under-resourced public health facilities. In turn, many patients often turn to the private sector where quality is poor and prices are high. These obstacles increase the time it takes for patients to get the critical care they need, and increase their chances of dying from common illnesses. Our organizations support CHWs who save lives by bringing door-to-door health care to every home, bridging the gap between health facilities and communities.

HealthAdvice A Living Goods CHW uses her mobile tools while providing health advice to a pregnant mother, Source: Gabriel Diamond

The case for investing in CHWs is clear. A recent report, released by a group of countries and leading health NGOs, estimated that scaled CHW programs could save millions of lives annually and provide up to a 10 times return on investment for every dollar spent.  We see a strong evidence base demonstrating that CHW networks can tackle these challenges and critically save lives at an incredibly low cost. Medic Mobile is a key partner for LG and Muso in our mission to end preventable deaths for women and children, developing human-centered web and mobile tools for CHWs and their supervisors. Together, our three organizations are rolling out technologies that can help leapfrog the kilometers separating supervisors and their CHWs, creating game-changing performance management systems that can be replicated by governments and implementers across the developing world.

MobileTools CHWs in Nepal learning to use mobile tools, Source: Medic Mobile

Key Takeaways from Our Collaboration:

The development community recognizes the need to replicate the most effective CHW models with evidence of impact. In February 2016, mPowering Frontline Health Workers convened implementers like Living Goods, Muso, and Medic Mobile with Ministry of Health officials from Guinea, Liberia and Sierra Leone at the Wilton Park Dialogue to share learnings to guide post-Ebola health policy development. Ministry representatives from Ghana, Malawi, Mali, and Rwanda were also actively engaged in the dialogue sharing experience from their national CHW programs.

These efforts by mPowering, with financial support from USAID, the Bill and Melinda Gates Foundation, and Vitol Foundation, are essential steps to enable country governments and their implementing partners to share the strategies that work as they develop their national plans for community health.

On the heels of the discussions, we came up with five key lessons to guide policy makers, donors, and implementers on effective management of CHW programs:
  1. Invest in CHWs: As a global community, we must invest in CHWs. Governments and donors should commit significant funding to scale up CHW programs in developing countries. Investments in well-managed CHW programs can vastly improve access to health care for hundreds of millions of people. However, these investments will only translate to impact if CHWs can get the ongoing support and supervision they need. With the right systems and tools, the investment case becomes stronger and CHWs can be the change makers their communities need. Our organizations are committed to building more evidence to show this clearly.

  2. Continuous support: Fulfilling a vision of well-managed community health systems will require a shift in how we think about supporting CHWs. Many organizations ‘deliver support to’ CHWs, and this must transition to ongoing support. Training CHWs must become continuous and must be complemented by decision-making support and performance management tools.

  3. Smart technologies: CHW programs can increase their impact by scaling new technologies for urban, peri-urban, and rural last-mile users. Medic Mobile has designed smart analytics dashboards for supervisors and Android mobile tools for CHWs with built in decision-making support. These tools have been designed alongside CHWs, and work for them in their context on familiar devices. Governments should seek to introduce similar technologies in their national CHW programs to empower their supervisors and CHWs with data to drive decisions.

  4. Integration of health services: The trend towards integrated, community-based health services is exciting and will lead to significant impact. Recruitment practices, rigorous training, in-stock supply chains, and technology tools are needed to maximize the effectiveness of this integrated approach.

  5. Cross-sector collaboration: High-level knowledge-sharing and case studies aren’t enough. We need deep, long-term collaboration between governments, NGO partners, and funders to operationalize the best practice methods for managing CHWs, taken from cost-effective models with evidence of greatest impact.

Driving Impact with Data Driven CHW Supervision & Training

Mali CHW Supervisors at work in Mali, Source: Muso

While there are differences between the LG and Muso models, such as the payment mechanism for CHWs – Living Goods’ CHWs earn income through product sales and Muso’s are salaried – there are significant similarities in the low-cost performance management methods for our networks that can and should be replicated by governments and implementers globally.

Both LG and Muso’s teams test strategies for improving CHW impact through rigorous research. In Uganda, researchers completed a 3-year randomized control trial (RCT) of Living Goods’ operations and found a dramatic 25% decrease in deaths of children under-five compared to control sites. In Mali, Muso’s CHW model demonstrated incredibly impressive impact results as well, where researchers documented a child mortality rate of 155/1000 at baseline and 17/1000 three years after the launch of Muso’s model – a ten-fold difference. LG and Muso are now completing RCTs to further investigate strategies to improve the impact of CHWs on the lives of women and children.

LG and Muso are utilizing Medic’s mobile app and customizable smart analytics tools to help supervisors identify each individual CHW’s strengths to nourish, as well as areas to improve. Supervisors are able to evaluate and support CHWs from multiple angles, balancing quantity and quality of care provided by CHWs to their communities. Medic Mobile's software is open source and free to use.

We believe that training and supervision for CHWs should not be a one-time or monthly event, but rather is based on an ongoing relationship between supervisors and their CHWs. This supportive supervision approach allows for individualized coaching to drive performance.

CHWs have potential to transform and save lives. We encourage governments, donors, and implementing partners to engage us to learn from our work. We hope to inspire others to incorporate scalable, best-in-class performance management techniques that drive results.

This post was co-authored by Jack Castle (Living Goods), Ari Johnson (Muso), and Josh Nesbit (Medic Mobile)


Learn more about partnerships with Living Goods.
Learn more about partnerships with Muso.
Learn more about partnerships with Medic Mobile.

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