Community Health Toolkit

Deploying Digital Tools for CHWs During Covid-19

Hi everyone,

I would like to start a thread around the deployment of digital tools for the COVID-19 response. At D-tree, we are working closely with the Zanzibar government to plan for national deployment of a community event-based surveillance system to support over 2,000 CHWs using a mix of feature phones and smartphones. There is a lot of great information here about the technology being developed and we are working closely with the Medic team and others to adapt the CHT EBS workflows for the Zanzibar context.

One area that has not been discussed as much is the deployment and ongoing implementation of these systems. To give some context to our program, we are in the process of scaling up a national CHW program with the government which we expect to be fully rolled out by early 2021 using CHT running on smartphones. As of now, we have trained 370 CHWs on the system and they are equipped with smartphones. We will integrate the EBS workflow into the current CHT app for these users. There are about 1,700 additional CHWs from a different program (which is being transitioned to the national program) who do not yet have smartphones but have been delivering community health services for several years. They will be trained to use the SMS features through CHT to conduct surveillance.

As with everyone, we have a very rapid timeline and will be trying to use a cascade model of training to train nearly 2,000 CHWs on both systems over a period of approximately 4-6 weeks. This is significantly more aggressive than any training schedule we’ve had and are currently thinking through how to do this effectively. We would love to hear from other implementers working through similar challenges to share experiences, best practices, failures and resources. We will add more to this thread as we develop more processes and share lessons learned as we implement this system.

I can provide some details on what we are thinking about right now, and would love to hear what others have done or are planning to do.

Cascade training for EBS tools
We are planning a training of trainers approach, where we would orient district health management teams on the tools (every district is either fully using smartphones or not at all, so we can train on only one of the workflows for each district). They would then train CHW supervisors who would in turn train the CHWs they supervise. We have never had so many levels in which we were not involved in oversight of the training, so have some questions about this.

  • Have others done similar trainings? If so, what types of training materials have you used (in general and specifically for the EBS workflows)? What lessons have you learned?

  • How do you put in quality control measures to a cascade approach to ensure CHWs have the skills they need to effectively use the tools?

  • We are thinking through both proactive and reactive means of communication with CHWs. We have a toll-free hotline set up which CHWs can call at any time. We are also thinking through whether our team and MOH partners should be calling CHWs to see how they are doing, but are aware of limitations at scale. What types of communication channels have others found to be most effective with this type of rapid scale-up?

Implementation of EBS system
We have been implementing digital health systems for many years and know that deploying tools is only the beginning of a functional system. The human processes, quick follow-up and decision making that needs to come from the data generated through the system is often the hardest part of the process. In Zanzibar, while there are IDSR systems, they have not been fully functional in the past. We’d love to hear from other groups who are implementing surveillance systems for COVID to learn about the processes you’ve gone through to support strong processes and follow-ups from investigation teams and decision making groups at the district and national level.

  • How much support have you provided these teams to get the system functioning?

  • How can we do this effectively while limiting in-person contact, given that it is very difficult to work remotely with colleagues at the district level?

  • Are there any best practices or lessons learned we should be thinking about as we roll out this system? We have strong buy-in from the government, but what can we do now to set this up so it can be utilized immediately and effectively?

Remote learning resources
We are also looking into distance/remote learning resources about COVID-19 more generally in order to provide more in-depth information to CHWs. We are speaking with the Community Health Academy and others to determine if there is a platform that can provide offline, factual and easy-to-interpret information about the virus.

  • Have other groups found particularly useful remote learning content around COVID-19?

  • Have other groups introduced this with CHWs? What has been the experience? What should we be considering as we are assessing platforms given the urgency and need for offline, simple content?

I know this is a lot, so feel free to focus on smaller chunks. Any experiences others have would be very helpful to share. Thanks in advance for this opportunity to learn from each other as we move past the technology development and into the implementation of these systems to support the response.

Best
Erica

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Hi @elayer! It’s great to see your post on the forum and I was really struck by your comment:

The human processes, quick follow-up and decision making that needs to come from the data generated through the system is often the hardest part of the process.

These are questions that I think about in my day to day role at Medic Mobile, as our Impact Manager, and, in the context of COVID, they become even more important.

Ensuring quick follow-up and decision-making that is enabled by strong data systems and corresponding visualizations to aid interpretation is something we are actively thinking about as an element of our response to COVID.

For the CHT’s Event-Based Surveillance reference application, we are working with members of Medic’s Research & Learning team to explore the role geospatial data and mapping can play in visualizing reported COVID signals, verification, and investigation. This type of tool would enable data-driven decision-making at different scales of the health system, as well as help inform planning processes as clusters begin to emerge.

We are also thinking about the types of metrics that make sense to capture as part of routine monitoring for COVID use cases. For EBS, we are thinking about some of the following:

  • number of CHWs trained for EBS
  • number of of COVID signals reported (by CHW and location)
  • % of reported signals that were verified by CHW supervisor
  • % of verified signals that were investigated at the sub-county level
  • time taken from signal notification to verification by supervisor
  • time taken from signal verification to event investigation

The challenge, as you point out in your post above, is how to work remotely with our partners using these tools for reporting on the frontlines and those who are making decisions based on these data - at a moment when timely decision-making is critical to combating the spread of COVID.

As we continue to develop our monitoring resources for our reference apps, I look forward to sharing updates with you and our other partners on the CHT forum and discussing, together, how best build capacity for the human processes required to fight COVID now.

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Hey @elayer ! Thank you for reaching out and the good description on what you are seeking to achieve. My daily work as a deployment manager at Medic Mobile involves exploring delivery processes for the different partners that we have while also sharing information with others on what works best of course expecting to learn more from others across the digital space. Your sentiment on the human process for EBS is something I faced at the beginning of deploying such a tool and with COVID response on the table,I must agree with you that the implementation approach should be one that derives the real time action needed while activating an immediate response. Providing access to metrics to the supervisors has helped us manage part of this,by way of creating visibility on signal reporting and their verification status. Additionally we strongly advocate through the partner on the need to have scheduled check-ins to review progress per area of implementation where a walk through on the metrics dashboards is done.This has created a sense of ownership among the various levels of governments.I have also seen Whats app groups with daily interaction being used to explore any challenges and discussing on possible solutions to help improve response time.I would be happy to learn from other partners on what has worked for them.
Regards
Philip

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Hi @elayer, thanks for your post! Regarding remote training, we are also thinking about how we can achieve this efficiently and in a way that is scalable to work for CHWs and Supervisors amongst other roles.

We are exploring SMS onboarding flows via RapidPro and IVR to address illiterate CHWs for SMS-based workflows. We’re also thinking about how to provide extra human support when needed – I really like the idea of the hotline you’ve set up!

We’re also looking at addressing the remote onboarding of CHWs onto the CHT. A few initial ideas around this are to make the onboarding tour configurable and to potentially support tutorials with practice tasks however we are still investigating how to best communicate the use of CHT features.

I’ll post updates in the thread as they happen! Please do share any insights that you continue to discover. :boom:

Best,
Nicole

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cc @elayer for visibility

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