Innovating Mobile Tools to Improve Community Health Care Delivery in Africa

Globally, 3.7 billion people lack access to health care and six million children in developing countries die needlessly each year from diseases that are easily preventable or treatable. The African continent puts up with 24% of diseases burden and have only access to 3% of medical human resources in the world.
Because of these shortcomings, CHWs are often the first and only link to health care for hundreds of millions of people across the developing world. CHWs are trusted, knowledgeable, frontline health workers with basic health training who often come from and live in the communities they serve. While they don’t have the same highly skilled training as a nurse or doctor, CHWs bridge cultural, geographical, and linguistic barriers and still effectively address a wide range of their community’s basic and preventative health needs. CHWs expand access to health care and education by proactively bringing essential health services to their neighbors’ doorsteps at a fraction of the cost of facility-based care. A recent assessment of the Kenyan community health strategy, for example, found that high workloads, lack of accountability, lack of pay, and lack of supervision render government-managed CHWs ineffective. Despite heavy reliance on CHWs in places like Sub-Saharan Africa and South Asia, the status quo is that CHWs are typically unpaid, poorly managed, and poorly equipped. They often exist on paper, but not on the ground. Many CHWs in existing networks do not have access to mobile health tools, ultimately decreasing the visibility, transparency, and standard of care provided.

Over five years ago, Living Goods co-developed the SmartHealth™ app platform with its longstanding mobile technology partner Medic Mobile in order to better equip CHWs to deliver health care in their communities. The SmartHealth™ app is a cost-effective, scalable, and open-source mobile platform that, when put in the hand of a well-trained and supported CHW, guides high-quality community health delivery integrated with facility-level care.
Living Goods supports 1,890 CHWs in Kenya and arms them with a smartphone loaded with the SmartHealth™ app, gives them continual training and tech support to ensure its proper use. CHWs go door-to-door registering and tracking pregnancies, diagnosing and treating childhood illnesses on site. Through the app, CHWs can easily follow up with clients and manage critical health actions with each household through a workflow reminder tool, helping CHWs manage their time well to provide efficient and consistent care. In addition, Living Goods utilizes a best-in-class performance management system that enables it to relay real-time data from the field to performance dashboards to guide CHW supervision and improvement.
The SmartHealth™ app and mobile platform allows Living Goods-supported CHWs to:

Diagnose illnesses and ensure quality health care. The SmartHealth™ App offers menu-guided iCCM assessment with biosensors, dosage guidelines, automated treatment and pregnancy follow-up reminders, and household registration to gather demographic data. The workflows built in to the app follow all WHO protocols. These workflows guide CHWs through standard assessment questions and protocols that then produce diagnoses or recommend referrals for acute cases.
Improve performance and monitoring. Every action a CHW enters into the app is synced to cloud-based performance dashboards that show supervisors how CHWs are performing in real time. This best-in-class performance management system enables branch supervisors to understand CHW performance to tailor coaching, identify struggling CHWs for additional support, track outliers to spot inconsistencies in data, and eliminate paperwork.
Deliver health education by SMS. After CHWs register a treatment, their client receives free automated treatment adherence reminders. Using mobile data, Living Goods sends weekly text messages to educate customers on vital health behaviors. CHWs also use their smartphones to register every pregnant woman and newborn child in their community. Once enrolled, these new mothers receive automated stage- and age-appropriate SMS messages to promote a healthy pregnancy and safe delivery.

While many CHW networks still rely on paper-based reporting with little insight into real-time performance, Living Goods equips every CHW with a smartphone armed with a mHealth app. The mobile phone and app ensure consistent care, gather valuable data to enable more client-centered care, support CHWs to more effectively triage care of households and communicate with facilities about patient referrals, automate reporting to create efficiencies, and drive performance management of CHWs.
Living Goods is integrated with government systems and health facilities and continues to design the SmartHealth™ app to be more easily adopted and scaled by others. Its long-term goal is to leverage its innovations to create more seamless collaboration between the community and facility level to improve the quality and continuum of care for patients.
Currently all of Living Goods health data is shared with government partners through customized dashboards that show real-time results in their geographic area, enabling it to be counted towards DHIS2 goals. Living Goods is working to establish a seamless integration between the SmartHealth™ platform and DHIS2 in Kenya and Uganda so that data is automatically entered into the government system.