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Published: August 24, 2023

Digitizing Kenya’s community health workforce

For decades, community health workers (CHWs) like Mary Odhiambo have kept track of their clients using a paper register. “I used to bring my book from house to house, about 8 to 10 in one day,” Mary says. “I wrote down information about children’s immunization records and pregnant women’s antenatal care visits, but the books would get so heavy, and sometimes caused errors.” But now Mary has access to a new digital platform, which guides her through household visits, prompts her when to refer clients for services like immunization and antenatal care, and allows her to enter client data into her phone. “It has made my job so much easier,” Mary says.

In the future, every CHW in Kenya will share Mary’s experience. The electronic Community Health Information System (eCHIS), a new digital platform owned by the national government, was developed to digitize Kenya’s community health workforce and advance Universal Health Coverage. Using the eCHIS platform, CHWs can manage caseloads from their phones, and information can be aggregated at the local, county, and national levels to be used for decisionmaking. Lwala was a key partner in developing eCHIS at the national level, and we are also supporting its rollout in Migori County.

“eCHIS aims to eliminate the need for community health workers to carry heavy paper records from house to house. It also brings to an end a paper-based system that was prone to errors and data quality issues. With eCHIS, data can be aggregated and used for timely decision-making–this can help the government identify health trends, respond to outbreaks, and allocate resources appropriately.”

- Dr. Adrian Ochieng, Lwala’s Product Manager 

Ending fragmentation in community health data

For years, community health partners in Kenya have tried to solve this challenge by equipping CHWs with various mobile solutions. While many of these digital tools have made the work of CHWs easier, it also created fragmentation–different mobile solutions were deployed across counties, and in some cases, within counties. This made it impossible to aggregate data at county, regional, or national levels, limiting the ability of the government to track community health outcomes and plan for service delivery. To end this fragmentation, a group of partners including Living Goods, Medic, and Lwala supported the government in developing eCHIS, which incorporates best practices from the mobile health space. It will be used across the country–meaning that all CHWs will report into the same system, allowing national and local governments to make data-informed decisions.

The process of developing eCHIS began in 2021, when the government and partners agreed to work toward a common community health data system. The National eCHIS Technical Working Group was established, and together, we created a roadmap for system development and conceptualized the digital modules that would train CHWs and their supervisors. Lwala provided input based on Lwala Mobile, a customization of Dimagi’s CommCare platform, used by the CHWs we support in Migori.

A central tenet of this work was designing a system with all of the end-users in mind–we wanted to make it as easy as possible for CHWs to use eCHIS throughout household visits and to enter data. We also knew CHWs’ supervisors needed to be able to view the data, work with CHWs to improve data quality where needed, and create summaries at the end of the month. Finally, government stakeholders–from Subcounty Health Management Teams up to the national Ministry of Health–needed to be able to consume aggregated data for decision-making, policy development, and budgeting.

After multiple rounds of input and iteration, as well as a pilot in Kisumu, national rollout of eCHIS began at the end of 2022. Lwala supported the government in developing a plan for deploying the initial 25,000 mobile devices to 7 counties, conducting a training of trainers at the national level, and setting up a “service desk” to provide technical support to counties.

Digitizing CHWs in Migori County

As eCHIS was being finalized nationally, Lwala supported Migori County to develop a rollout plan, including strategies for training CHWs and supervisors, as well as partner coordination. We began rolling out eCHIS in Awendo, Suna West, and Nyatike Subcounties, where we have trained 1,191 CHWs to date. Throughout this process, our digital systems experts at Lwala are documenting what we learn.

Human-centered design is the most sustainable

We spent time assessing the workflow of CHWs, identifying potential pain points, and understanding what infrastructure was required. We knew that poor connectivity is often unavoidable, so we changed the network settings of the mobile devices to optimize performance. We also upskilled county information and communications technology staff to handle basic troubleshooting and user management. These actions led to a system that was user-friendly, but also technically feasible.

Digital tools must be adaptable

Government priorities and health needs shift. For this reason, eCHIS was designed with the ability to add new prompts or indicators. For example, we plan to integrate prompts for drug distribution for neglected tropical diseases, which were previously not included, while equipping CHWs with additional commodities.

Government-led training and mentorship is key to adoption

Initially, we worked to address hesitation among some CHWs in transitioning from a paper-based to an electronic system. Mentorship and support are key, so we increased our emphasis on training for CHW supervisors. It’s also critical for local government to lead training, to ensure that CHWs appreciate eCHIS as a government-owned platform that will be used in the long term.

These lessons will be used in Migori and beyond as the government works to scale eCHIS. Over the next 12 months, we will equip CHWs in the remaining 5 subcounties with digital tools, advancing Migori County’s goal of digitizing the full community health workforce.

“[eCHIS] is reliable, and relevant, capable of meeting current and future needs. We started with the people, not the technology … so they have what's necessary to move and progress the community health agenda forward.” 

- Simon Mbae, Medic East Africa Program Lead

A bold vision for CHWs in Kenya

The national rollout of eCHIS is part of a much larger vision for professionalizing CHWs in Kenya–meaning they are paid, trained, supervised, and equipped with digital tools and commodities. Earlier this year, the President and county governors agreed to a cost-sharing arrangement where the national government will provide conditional grants to counties to pay CHWs, in addition to the counties’ own resources. Additionally, the government will equip each CHW with a kit of commodities and medicines used for daily services.

To accelerate these goals, Lwala’s role is threefold. First, we will advocate and ensure that these Presidential commitments come to fruition. Second, we will support implementation planning and rollout, especially in counties without existing community health partners. And finally, we recognize that digitization and payment both rely on training, especially on the basic CHW and technical modules–and this hasn’t happened to a large extent across the country. The most effective way to close this gap is through training of trainers, where we establish a pool of qualified trainers for counties to tap into. Together, digitization, payment, and equipment will advance professional CHWs, who can provide better care for their communities.

Agency, health, and wholeness of life.

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