In Africa, mobile phones were widely adopted before land lines, and mobile money outpaced the spread of retail banking. Now, Living Goods is leveraging the disruptive power of that mobile technology to help Africa rapidly reinvent health systems.
We aim to digitally empower thousands of government community health workers (CHWs) to provide accurate care and prompt follow-ups by using a smartphone app that details every patient contact, enables real-time performance management of health workers in outlying villages, and detects early outbreaks.
Working in partnership with Medic Mobile, Living Goods created the Smart Health app that 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. 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.
Often, a lack of accountability impedes effective health delivery. The vast majority of health data in Africa is still collected on paper in a process that is both slow and notoriously unreliable. In contrast, our mobile tools digitally capture a mobile number and GPS location for every patient visit and provide supervisors with dashboards that show the performance of every health worker against targets in real-time, advancing performance management in distant villages from an era of bicycle-powered delivery of health data to lightspeed dissemination. This system also eliminates labor-intensive, costly, and inaccurate paper-based data entry while exponentially increasing the scope of data available to improve performance.
Digital technology is integral to our vision for effective community health and we can only reach the scale we seek through partnerships—particularly with governments. Consequently, while Living Goods will continue using Smart Health in our direct operations in Uganda and Kenya, we are building up our internal capacity to support governments and partners that choose to use any robust mHealth application that supports the effective and sustainable delivery of community health services. We are focused on continuing to develop easily customizable technologies that can be integrated with existing systems and support timely and informed decision-making.
Introducing the Maturity Model, a digital tool strengthening community-level digital health programs
In collaboration with HealthEnabled, Ministries of Health and other stakeholders, Living Goods has 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:
- Community health programs
- Policy, funding & technical Infrastructure
- Existing health technologies, positioning health systems on a maturity level based on a 5-staged continuum scale.
Through the use of this model and the tool kit (“how-to-guide”), programs are able to 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.
Automated Diagnosis for Childhood Diseases:
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 also 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 clear follow-ups, ensuring the full cycle of care is complete. Learn More about the health issues we help address.
Real-Time, Tech-Enabled Performance Management:
Comprehensive monitoring and supervision of CHWs is an essential component of effective community health programs. Because the app immediately captures every patient touchpoint—providing names, mobile numbers, GPS locations, and timestamps—any manager or government official can see CHW or regional metrics plotted against targets in real-time. User-friendly dashboards automatically flag low- and high-performing CHWs and regions. Learn More about our approach to performance management.
Data-Driven Task Lists – Optimizing CHW Performance and Supervision
Often, data travels a one-way route that is fine for generating reports, but doesn’t actually drive performance. At Living Goods, we use data to improve performance every single day: We call this “Data to Action.” The Living Goods system uses live patient data to create “Daily Data-Driven Task Lists” for CHWs that help them optimize their time with those patients at the highest risk. To improve supervisors’ performance, simple algorithms turn real-time data into daily action lists for them such as CHWs falling short of targets, field offices low on stock, or missed follow-ups on acute cases. Some of the uses of our tools include:
- Pregnancy Registration, Triage, and Reminders: Our mobile tools also enable CHWs to register pregnant mothers and assess risk factors to triage cases in need of immediate referral or follow up. CHWs get daily task lists to follow up with mothers, tailored to each pregnancy’s risk profile. This allows personalization of care and ensures each mother receives an appropriate number of visits. The system sends stage-based text messages to remind mothers what to do each week to stay healthy.
- Family-Planning Tool: The Smart Health app captures the family-planning status of every woman of reproductive age and facilitates a guided discussion for counseling. The app helps guide personalized referrals for long-term options, sends automated refill reminders for short-term methods, and tracks referrals to family-planning clinics.
- Immunization Targeting Tool: With support from the Global Alliance for Vaccine Initiatives (Gavi), Living Goods created a tool to help CHWs pinpoint under-immunized children. Both CHWs and parents will receive reminders until the child is up-to-date on all immunizations.
- Facility Referral Linkage: With support from the Bill & Melinda Gates Foundation, Living Goods is testing a tablet-based system at local health facilities that link to the Smart Health app, alerting facilities about incoming high-risk referrals. These facilities can then digitally notify the referring CHW when their patient received care and how best to follow up.
- Predictive Analytics: Using the vast collection of patient-level data and outcomes, Living Goods develops tools that accurately identify individuals at the highest risk of health problems who can then receive priority care. In certain cases, our algorithms can predict with 80 percent accuracy which pregnancies are likely to lead to a low-birth-weight baby.
- Health Census/Electronic Medical Records: For the first time, health systems can take advantage of the power of patient-level data at the community level. Living Goods-supported CHWs register household members, including their basic demographics, to track and manage the equity in service provision across populations with different socioeconomic backgrounds. In the process of treating sick children and supporting pregnancies, the system creates a simple longitudinal medical record for each family.
- Works Anywhere: In areas that lack stable mobile coverage, we can employ Bluetooth handoffs to upload data whenever supervisors visit their CHWs.