Disruptive Digital Tools for CHWs

The Problem 

Most health data in Africa is still collected on paper in processes that are both slow and notoriously unreliable. While governments are increasingly moving towards digitizing facility-level care, most community health worker programs rely on paper tools that are easily lost or destroyed. Among these same community health worker programs, there is generally no standardized quality of care, follow-ups rarely happen in a timely manner, and there’s no integrated longitudinal medical record for individuals and their families, all of which limits the ability of public health officials to monitor disease outbreaks, quantify what medicines are needed at the community level, or effectively budget for their population’s health care needs at the last mile. 

The Solution 

Living Goods aims to ensure all levels of the health system are digitized and effectively speak to one another. We started our work at the community level, digitally empowering thousands of government community health workers (CHWs) to provide accurate care and prompt follow-ups with a smartphone app that details every patient contact, enables near real-time performance management of health workers in outlying villages, and detects early outbreaks. Based on our expertise in strengthening community health systems in our work with CHWs, we are now key strategic advisors to multiple governments to develop the policies, budgets and information architecture needed to transform their national community health systems. 

Digital tools for CHWs 

The core of Living Goods’ digital toolset is our Smart Health app. Built in partnership with Medic and Dimagi, the app uses a basic clinical decision support system (CDSS) to ensure consistent and accurate diagnoses and smart workflows for pregnancy care, childhood diseases, nutrition, family planning, and immunization tracking.  

Using the World Health Organization (WHO) standards, the Smart Health app’s simple algorithm enables reliable diagnoses of malaria, diarrhea, and pneumonia. It incorporates a breath timer and helps to triage the severity of an illness that may trigger a health facility referral. The app sends automated texts to parents each day to reinforce adherence to treatment protocols. For cases in which the app refers a patient to a facility, the CHW gets a follow-up reminder to ensure that the patient was seen and treated. CHWs must also log and respond to follow-up tasks, ensuring end-to-end care is delivered on a timely basis and with high quality. 

 The app also allows CHWs to collect data that is compatible and integrated with government District Health Information Software 2, an open-source software platform for reporting, analysis, and dissemination of data for many national health programs that support decision-making for better and more targeted service delivery.  

 Living Goods’ approach to building digital solutions for CHWs is technology platform agnostic. For example, the CHWs that Living Goods supports in our Kenya and Uganda Learning Sites use the Smart Health app, while theCHWs in our Burkina Faso Learning Site use a solution with similar workflows built on Dimagi’s CommCare platform.  

Digital Tools for Supervisors 

Comprehensive monitoring and supervision of CHWs is an essential component of effective community health programs. Because the app we use immediately captures every patient touchpoint—providing names, mobile numbers, GPS locations, and timestamps—any supervisor or government official can see CHW and regional metrics plotted against targets in near real-time, while user-friendly dashboards automatically flag low- and high-performing CHWs and regions. 

To ensure effective supervision for the CHWs we support, we set clear targets for key performance indicators such as pregnancies registered, and sick children assessed and treated. Supervisors, including Living Goods managers and government health supervisors, have access to real-time data, performance dashboards, and checklists. Supervisors also conduct regular in-person supervision of community-level services, which enables supervisors to identify potential service anomalies, spot disease outbreaks, recognize high-performing CHWs who can mentor other staff, and prioritize which CHWs need the most support. We also conduct periodic client satisfaction surveys to ensure effective, high-quality care. 

 Our focus on defining clear performance metrics and real-time data ensures accountability and high performance. Our digital tools—such as prioritized daily task lists—help CHWs optimize how they spend their time. Supervisors also have daily task lists and can easily track the work and status of individual CHWs as needed. When gaps are noted—such as an insufficient number of postnatal care visits happening within the first 48 hours of life—supervisors can provide CHWs with individually tailored support. Similarly, those who consistently meet or exceed targets can be tapped to mentor other nearby CHWs on best practices. 

Digital Health Advisory for Governments   

We have significant experience helping governments to meaningfully transform health outcomes in Sub-Saharan Africa by improving CHW performance and strengthening the systems in which they work. We develop digital solutions as part of our national electronic community health information system (or eCHIS) programming with governments guided by community health policy.  In addition to ensuring that community digital health strategies enable community health policy directives, we also support government partners to scale and operationalize digitization policies by providing hands-on support to governments to professionalize CHWs and co-finance the costs. Governments bear increased responsibility over time as they learn to implement their own digital solutions. This work includes:

 Development and Implementation of DH and HIS strategies & investment plans   

LG has rich experience supporting the development and implementation of national digital health strategies for community health in Kenya, Uganda, and Burkina Faso. In all three countries, we are the lead advisors to the MoH and their ICT teams to achieve their vision for digital transformation of their community health systems and support the design, development and roll out of national eCHIS.  

• Kenya: We’re a lead technical partner to the Kenyan government’s efforts to identify, develop, and test an eCHIS as part of the national digital health ecosystem. Modeled on the Smart Health app, Kenya’s eCHIS was piloted in Kisumu County, and will ultimately be rolled out to all 95,000 CHWs in the country. 
• Uganda: Supported by the Rockefeller Foundation and UNICEF, we led the implementation of the intelligent community health systems (iCoHS) activities geared towards the achievement of results in the areas of Reproductive, Maternal, Newborn, Child & Adolescent Health & Nutrition in 2019. In partnership with BRAC, Medic, and DataKind, we assessed bottlenecks in the availability of data, use of data for decision making, leveraging community voices during program planning processes, and ensuring quality and effective service delivery.  
• Burkina Faso: Since 2020, Living Goods has been providing support to Burkina Faso’s MoH to strengthen their community health performance management approach and digital tools with an eCHIS that will link community and facility levels of care. We are guiding the government in the design, development, and rollout of an eCHIS built on the CommCare platform and will test it with CHWs in our Learning Site. 

Digital Health Enabling Environment; regulations, policies & guidance  

We work to strengthen the enabling environment in the countries where we work by helping governments develop the policies, implementation guidelines, management, and financial frameworks that allow CHWs to reach their full potential. As part of enabling sustainable digital solutions for community health, we contribute to key policy shaping, standards and toolkit creation, data interoperability, defining ICT curricula, and supporting the learning journey for governments among other strategic activities.    

Digital Health Evaluation: Maturity Model   

In collaboration with Health Enabled, Ministries of Health, Johnson & Johnson Foundation, and other stakeholders, Living Goods co-designed a digital health maturity model  to help governments and other community health implementers grow effective digital health programs for the community level. The model evaluates three domains: (1) community health programs; (2) policy, funding & technical Infrastructure and (3) existing health technologies, positioning health systems on a maturity level based on a 5-staged continuum scale. Using this model and the tool kit (“how-to-guide”), programs can identify areas of priority that inform strategy development, investment cases and a structured pathway to implementing a scalable sustainable digital health program for community health.