Community Health Workers (CHWs) are the backbone of primary health care, bridging the gap between hard-to-reach areas and essential health services. Their pivotal role in preventive and primary care and their unique rapport with communities call for innovative solutions to enhance their effectiveness.
Digital tools can provide transformative solutions to empower CHWs. Equipping CHWs with technology can streamline data collection: enabling rapid data entry and automated calculations to minimize errors and enhance efficiency. Digital tools can also facilitate easier and faster communication between CHWs, their supervisors, and healthcare facilities and provide access to vast amounts of healthcare information, allowing CHWs to stay updated on best practices, new treatments, and protocols, ultimately improving the quality of care they provide.
Additionally, digital tools can provide CHWs with job aides and decision support systems, helping them make informed decisions about patient care and treatment options based on available data, protocols, and best practices. These advancements not only streamline their work but also instill a sense of empowerment and motivation, fueling their continued dedication to improving community health outcomes.
In November 2023, VillageReach organized a side meeting at the Global Health Supply Chain Summit (GHSCS) in Nairobi Kenya, to explore the experiences, lessons learned, and key success factors for designing and deploying effective digital tools for CHWs to track their health supplies and realize the benefits that technology offers. This event brought stakeholders from government, community health, supply chain management, funders, and technology partners together to discuss the deployment of digital solutions for CHW supply chains and share lessons learned and success factors based on their experiences and perspectives. We were joined by participants from various organizations, including AMREF, USAID, Lwala Community Alliance, Living Goods, Medic, Medtronics Labs, Ona and the Government of Liberia.
The workshop featured several short discussion sessions, each focused on one of the perspectives represented by the participants: community health programs/service delivery; supply chain; technology; and government. These discussions aimed to surface key considerations and success factors to ensure that digital supply chain tools for CHWs are designed, developed, and deployed effectively. The key items identified in the discussions will be grouped into various categories related to the intervention itself or the enabling environment. A framework was adapted for this initiative from the WHO Recommendations on Digital Interventions for Health Systems Strengthening (see Figure 1).
Designing the Future Digital Tools for CHWs-What did we learn?
While the participants universally agreed that a follow-up discussion was needed to refine and categorize the key takeaways to guide future efforts, several major themes came up throughout the discussion on how to ensure effective digital tools for CHW supply chains.
Designing effective digital CHW supply chain solutions requires putting end-users at the center. Implementing and technology partners need to consider the crucial question: Whose problem am I solving? A user-centric approach, immersing those developing the tools in the daily lives of CHWs, centers the usability and benefits of the tool on the primary end users. An agile development approach with continuous iteration was also identified as a critical element. Ongoing user feedback and input throughout the design and development process – not just at the outset – is vital to user-centered design.
As many digital health tools have multiple users or stakeholders, participants also noted the importance of defining each type of user to address the distinct needs of national and local government officials, supervisors, and others as well as the CHWs. In addition, considering the local environment is paramount: tools must be designed to function in the intended context, such as areas lacking connectivity or regular access to electricity. Digital solutions must be appropriate for the context and user; they should not burden CHWs with complex tools or additional responsibilities, but rather provide support and streamline their tasks so they can spend more time on patient care.
Integrated, not siloed
Stockouts of essential health commodities pose a significant challenge for CHWs and limit their ability to provide critical health services to their communities. While digital supply chain tools for CHWs can help address these challenges, community-level supply chain tools and processes must be integrated into the facility, district/county, provincial, and national-level tools and processes. In addition, it is critical to ensure CHWs are trained in commodity management and supply chain processes and receive regular supervision and support. Too often CHWs are expected to manage commodities, but training, resources, and processes are isolated from their main responsibilities (delivering services to patients).
Currently, data related to community health supplies is often either lacking or inaccessible because it is not documented, limited by inefficient, paper-based processes, or not linked with national data reporting systems (eLMIS, HIMS, etc.). Thus, ensuring that data collected at the community level integrates with other systems was noted as a prerequisite for success. To facilitate high-quality, timely data collection, digital tools for CHW should streamline and be integrated into commodity management and reporting processes. Further, ensuring that only necessary and relevant data is collected and that the data is used to inform resupply decisions will ensure that the CHWs see the impact of the data they collect.
Government-led sustainable solutions
Government leadership, starting from the design stage, is necessary for the sustainability of digital solutions. Government involvement in the development process is critical to ensure alignment and coordination among partners and digital tools to avoid duplication and incompatibilities. In Liberia, for example, the government set up a technical working group to facilitate cooperation and communication among partners working on digital solutions for the CHW supply chain.
Policies and strategies to establish basic requirements for interoperability with existing systems safeguard against future issues and set the stage for an integrated digital health infrastructure. In addition, setting priorities on essential supply chain system requirements and integrating sustainability considerations from the development phase lays the foundation for solutions to be transitioned and sustained in the long term.
The Way Forward
Digital solutions for CHWs have the potential to support improved service delivery, enhanced health outcomes, and more robust health care systems. To realize that potential, however, tools need to be designed, developed, and deployed effectively. The insights shared at the 2023 GHSCS side event identified some key factors for effective digital tools: they must be user-centered, integrated, and government-led.
We are incredibly grateful for the collaboration of all those organizations who attended this gathering to share their knowledge, experiences, and insights to help us reach our common goal. To take this work forward, VillageReach will coordinate with the participants for further refinement and consolidation of the inputs into a technical brief to summarize the best practices from the group. This guidance will be available to inform future development and improvement of digital solutions for CHW supply chains to ensure that CHWs have the supplies they need to deliver critical services to their communities.
For more information about digital solutions for community health workers, contact Christine Lenihan (firstname.lastname@example.org)