Thanks Maurizio! That's really helpful, and seems like CommCare has worked really well for you. We run into similar challenges related to phone usage, but like you said, the CHWs are getting better with training and as they get used to their phones.
We can definitely learn from each others' experiences. Thanks again and keep in touch!
Dear Maurizio, Thank you for clarifying your questions and sharing your experience. It is always interesting to see how similar problems are being solved in other contexts as they can provide valuable insights.
When it comes to transportation, the topography of this area is such that there is no option but to walk (up or down) the steep terraced hills to the nearest "roads". Instead, our focus has been on improving quality of healthcare and providing counseling at the local health posts (HP), where group pediatric care would be conducted, so that:
a. Fewer patients need to be referred to the hospital b. Patients are referred before complications arise
In addition to introduction of innovative interventions like group ANC at the local HPs, we currently have a HP strengthening project underway. There are 4 components to our structured quality improvement HP strengthening intervention: 1. infrastructure 2. technology (integrated EMR, optimized solar systems) 3. structured mentorship and on-site training 4. integration of CHWs into routine follow up to identify/reduce risk for further health exacerbations at clinic and home level, where much of the burden and challenges for, eg, chronic disease management and behavior change lie.
We also prepare a monthly "HP Readiness Scorecard" that looks at how well stocked each of the 14 HPs in our catchment area is, and if it has basic health systems in place. (The average “HP readiness” last month was 81%.)
In the community health program, we have introduced an additional tier of Community Health Worker Leaders (CHWLs) who are full-time paid staff that work closely with the Community Health Workers (CHW) who are volunteers. We do compensate our networks of volunteer CHWs for their time; indeed, we think this should be the norm for all healthcare workers to avoid the romantic poverty notion that women engaged in healthcare work should do so voluntarily, as inspiring as this Alma-Ata-based "barefoot" HCW idea was. This unique structure has helped us mobilize our community health workers more effectively and efficiently.
Also, patients are not necessarily escorted to the hospitals, especially when they are capable. When patients need immediate advanced care, we do have ambulances that when called go as close to the patient’s locations as they can (just last week an ambulance had a bent axle from driving on rough seasonal roads to get a patient).
It is great to hear that you are using CommCare. We will very likely be moving to that platform as well, and would be interested in hearing about your experience with it. And thank you again, keep pushing us to refine our idea!
Great idea, Aung! I agree that hospitals can be a especially stressful experience for patients from low-resource areas who have had limited exposure to such facilities. I am curious about what led you to settle on tablets as the way to provide support and reassurance. Have you been able to prototype this? Since the resources are primarily videos, would a television work? This could be made interactive by use of buttons that pull up specific videos. One advantage could be that the videos are viewable by a bigger group of people. Good luck!