Mobile phones as “personal assistants” for Community Health Workers
Community Health Workers (CHWs) are relied upon in many remote areas to provide health education and services, such as antenatal visits to expecting mothers. But they often lack administrative supports to do their job - such as the ability to collect, compile, and act on patient data.
This solution is simple: (1) CHWs visit expecting mothers and text patient information to a central number; (2) Local data entry clerks (or an automated system) enter this information into a database; and (3) The database sends calendar-style alerts about follow-up visits to CHWs and patients.
This system would help CHWs keep track of their clients' diverse needs, as well as send health-related messages and alerts to the expecting mothers themselves. Finally, with enough community members registered in the database, the system could also facilitate the delivery of services to expecting mothers, such as motorbike ambulances for transport to a health facility.
Particularly in remote areas of developing countries where health care infrastructure is lacking, many women rely on Community Health Workers (CHWs) to provide health services, make antenatal visits, and respond to needs that arise. CHWs serve as resources and focal points for their communities, keeping tabs on the health status and needs of expecting mothers as well as other patients who require follow-up (HIV patients on ARVs, patients with chronic diseases, etc.) A number of governments, including that of my current home country, Rwanda, have taken initiative to educate and empower CHWs. Only through a trained corps of CHWs will Rwanda achieve its national goal of all mothers receiving at least four antenatal visits/consultations.
While CHWs in a number of countries are being integrated into the health infrastructure through training and equipment, they often lack crucial administrative and data management supports to keep track of all of the patients they visit. Why not take advantage of mobile technology as a means to give CHWs virtual “personal assistants”? Each time a CHW visits an expecting mother, he/she texts vital information about the patient to a centralized system, which enters the data into a personalized spreadsheet for the CHW. Data entry could be done automatically, or it could provide an opportunity to train and hire local employees as data entry clerks. Patient data could include expected due date, number of consultations received, vital signs, other health conditions, needed social supports, and basic contact information.
The collection and communication of this data via mobile phone would serve a number of purposes. First, the database would act as a personal assistant by sending automatic text/calendar alerts to CHWs reminding them of when next to visit each patient. Second, having recorded patient information, the system could send health alerts directly to expecting mothers or allow CHWs to mass-text their patients with vital messages. Finally, in villages with access to a computer, CHWs could receive and view computerized composite data on patients, thus building their skills in data analysis and patient tracking.
In reading through other entries, I was particularly interested in Sarah Fathaliah’s “Vending Machine” idea – having local community mothers sell health items along with airtime and other frequently sold goods. I think the personal assistant idea could dovetail nicely with the vending machine concept. CHWs’ patient databases could send alerts not just to CHWs and patients, but to other community members who could help get mothers what they need when they need it. Personal patient information would kept confidential, but urgent news – such as a mother’s going into labor – could be communicated to, say, local moto drivers.
Why moto drivers? A particularly grave problem in many rural areas is a lack of ambulances – and thus, the inability to transport patients in need of critical care to health facilities. Recognizing the correlation between maternal mortality rates and home deliveries, organizations like Riders for Health have invested in motorbikes for moto drivers around the world, so that they can provide ambulance services. Connecting moto drivers to the CHW/patient network would allow a swift response to the onset of labor, helping mothers get to health facilities on time.
What is the minimum level of mobile technology needed for this concept?
Each CHW would need a cell phone with which to text data to a central database. Somewhere, this database would need to be managed on a computer, with software that would enable automatic text alerts to be sent to CHW, patient, and other mobile users based on the data entered.
How could this work in a low-literacy context?
Users of the database system/network could have the option of receiving alerts through calls, rather than by text. CHWs could call a central number to record data, and educational materials and alerts could be delivered to both CHWs and patients via phone call.
Which partners could help realise and deliver this solution?