I looked over the edge of the bridge and then back to my team.
Looking at the faces of my colleagues, it was clear they would prefer to turn back. Who could blame them? We had been traveling for hours through rough rainforest terrain before our path was intractably blocked by a river. We disembarked from our vehicle and continued on foot, and we came to the bridge.
Made from just a few clear-felled trees, braced over a significant drop, this simple handmade structure was the only pathway to reaching the community health worker (CHW) in remote Bomi County, Liberia, whom we had come to meet for beta testing of the Electronic Community-Based Information System (eCBIS).
I smiled back to my team and started weaving my way across, the following thought in my mind: if a CHA crosses here daily to provide primary health care services to clients, nothing should stop us from doing the same.
The only way we can co-create innovative solutions to deliver health products and services is by understanding the daily challenges that health workers face. There is no better way to understand them than putting yourself in their shoes, literally walking the same paths they walk.
CHWs play a vital role
Liberia has over 4.8 million people, many of whom live in remote areas. They often have to travel long distances and perilous paths to reach a health center. That is why CHWs are so crucial here – they are often the first point of contact with the health system, playing a vital role in preventive care and primary care, and leveraging their rapport with communities to refer patients to other sources of care.
To increase and improve access to community level health care data, the Government of Liberia has partnered with VillageReach, Last Mile Health (LMH), and Ona to build a digital solution to support Liberia’s community health workers. The eCBIS is a digital platform to aid CHWs routine service delivery, reduce error and enhance reporting.
Building the eCBIS
The eCBIS is built up from the Vaccine Tracker System (VTS) launched by UNICEF in 2018 and iterated by LMH in 2020 to track vaccine delivery in Rivercess County. The Open Smart Register Platform (OpenSRP) is what is being used to develop eCBIS. This tool has developed key workflows such as routine service delivery, community event-based surveillance, supervision and supply chain management for both the Community Health Assistant (CHA) and Community Health Service Supervisors (CHSS) which are needed to improve quality and provide visibility for evidence-based decision making. The application has an integrated service delivery and supply chain modules that track commodity consumption during service delivery and aid resupply decision through in-app reports.
The eCBIS will be integrated with other health systems, including DHIS2 and the Electronic Logistics Management Information System (eLMIS). The supply chain data collected by CHWs (including CHAs) will be aggregated and reported directly into the eLMIS, eliminating the current requirement for manual aggregation and entry by CHSSs.
In March 2023, the Ministry of Health supported by VillageReach and Last Mile Health conducted beta testing of the eCBIS in Bomi and Rivercess Counties. During the beta testing, fifty CHAs, six CHSSs, District Health Officers, Community Health Focus Persons, County Health Promotion Focus Persons, and County Monitoring and Evaluation Officers were trained on using the application. The training was followed by one-week field testing and feedback from the beta testing was noted for the iteration of the application.
The CHWs and County Health Teams were excited and acknowledged the benefits of the digital application to the National Community Health Program of Liberia.
Hawa Coleman, a CHW in the Clean Town community, Bomi County, told us, “The eCBIS is a great tool that will help me to do my job better. I am excited to use it to improve the care that I provide to my community.”
This feedback was reaffirmed by CHSSs, including Hope Ehibor from the Jenneh #3 Clinic, who said, “The eCBIS is very user-friendly and easy to use. I was able to learn how to use it quickly and easily.”
The eCBIS has a number of benefits for community health workers and the health system as a whole. First, the eCBIS will help improve the quality-of-care CHWs provide. The application will allow CHWs to track their progress and identify areas where they need to improve. Second, the eCBIS will help to reduce errors in data collection. The application will automate many of the data collection tasks that CHAs currently do manually, which will help to reduce errors. Third, the eCBIS will help to improve the efficiency of the health system. The application will allow CHAs to access information and resources more easily, which will help them to do their jobs more effectively.
“The eCBIS will help us to collect data more accurately and efficiently. This will help us make evidence-based decisions to improve the quality of care that we provide,” said Irene Mabande, Community Health Department Director, Bomi County Health Team.
eCBIS: a bridge to the future?
It is an exciting time for community health services in Liberia. This application is launching in the wake of late March’s 3rd International Community Health Worker (CHW) Symposium, hosted in Monrovia, where digitizing community health data collection processes took center stage and the Africa CDC highlighted CHWs as a key health workforce for its Digital Transformation Strategy (2023-2030) to accelerate the delivery of quality health care in Africa.
The eCBIS innovation aligns with this digital transformation strategy, providing a new mobile tool for service delivery at the last mile with the capacity to include improving the quality of care, reduce errors in data collection, and improve the efficiency of the health system. The eCBIS currently in the beta testing phase is expected to be rolled out to all community health workers in Liberia in the coming months.
We are confident that this in-depth community beta testing will make the application more user friendly. As for any glitches we do find? We will cross that bridge when we come to it.