Community Health Toolkit

Supervisor CHW Performance Monitoring

Your Organization: Medic Mobile

Organization Type: Technical / CHT Contributor

What Other Organizations Would Benefit from This Feature: Any Organization that has a supervisory need or is executing a performance improvement program for CHW/V’s. Current partners that have expressed interest include: LG, Muso, DTree

Describe the Feature: As a supervisor, I would like the ability to easily monitor CHW performance so that I can better support my CHWs to improve the quality of care provided to patients at home

What “Pain Point” Does The Proposed Feature Address: Supervisors currently do not have good visibility into individual CHW performance data. This leads to ineffective CHW oversight and reduces the ability to provide targeted coaching and support to CHW’s.

Proposed Solution: Periodically synchronizing a CHW’s targets to the supervisor’s device will enable them to provide increased CHW’s performance support without needing to access all of the other CHW’s documents.

Do You Have Funding Available to Help: No

Do You Have Resources (Designers, Developers, PMs) Available: Yes all of the above and we are requesting additional CHT member support to better develop and deploy this feature

Links To Supporting Information / Uploads: Draft of initial improvement concepts for review and comment:

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Hi @hhornung and @vchelule welcome to the CHT forum! Do the currently envisioned supervisor feature improvements address your teams most pressing needs? If not, what’s missing?

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Hi @Max,

Thanks for sharing this document. This looks really well thought through and aligns nicely with what we have identified as our MVP requirements. I have some questions and observations.

When the manager wants to view individual CHW performance information, they should go to the CHW profile to view the performance condition card. (slide 5)
This might not be easily doable right now, but if there is only a small number of targets, this could also be displayed in table form, e.g. with CHWs as rows and targets as columns.

We’re still getting a lot of confusion about our percentage bar widgets. (slide 8)
Not strictly related to this discussion, but I would be interested in hearing what users’ difficulties are and what strategies work to resolve those.

I’m not sue I understood the “Target last updated” concept 100%, and I anticipate that some users will have difficulties with this concept, .e.g. because it is not easily visible when supervisor and CHW last synchronized, and it seems currently difficult to display the last sync date of the CHW (which anyway would only be possible up to the supervisor’s last sync date). One suggestion is to display the date supervisor last synchronized and/or a message that you need to sync to get up-to-date data.

One requirement we might have (but not yet 100% sure) is registering a monthly meeting, possibly with attendance tracking (manually checking off attendants), but I think parts of this if not everything would be possible with the current capabilities of the CHT.

Differently from your document, in our current program supervisors would probably not visit CHWs in the field, but the supervisory group would visit once a month to also discuss performance, and supervisors might follow-up with CHWs personally at the supervisor’s office or over the phone.

All in all, I agree with your assessment of the nice-to-haves and the essentials, and think you struck a good compromise between what seems good from the user’s point of view and what’s technically feasible to do.

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Hi @hhornung,
Thanks for the detailed suggestions and comments. We’ll do a review of the current mockups to see how we can best incorporate these items.

A few clarifications/questions:

Are you interested in an aggregate table for a supervisor that looks something like this?

The current confusion occurs due to the differences in information relevancy between CHW and supervisor. We’ve found that CHW’s are not very focused on aggregate completion percentages, while supervisors require percentage information in order to evaluate performance and identify where to focus education/coaching efforts. This distinction in how information is presented to different audiences is one of the improvements we are looking to make in the next round of updates.

This is a great point. Regular syncing of data is one of the core challenges that we face across projects. We may be able to create a rule along the lines of:

  • if target data is x hours out of sync, a message is displayed notifying the supervisor to update; or
  • an automated data consistency check to identify any conflicts between supervisor data and chw reported data. This is obviously more complete and technically complex. We would need to explore for feasibility
  • Any other ideas?

Since supervisor-chw meetings can happen at varying times, locations, using different modes of communication (ie in-person, phone, etc), perhaps improving the language from “supervision visits” to something that reflects any type of performance check-in meeting would be sufficient. Would this better address the need you are referencing?

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Yes, that looks pretty much like what I was thinking.

Ok, I see. So far we have only very simple numeric targets in the CHV app. As we are adding additional targets, this will be something we need to pay attention to.

With my current knowledge from how our users use the app, I would say the first option seems appropriate.

I think even with the original wording I can recognize our requirement is covered, as long as the text on the card can be customized. I just brought it up for clarification, but don’t think we need to.

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Thanks @hhornung for the clarifications. They are very helpful

Hi @vchelule, @ykeita, @dlassala, welcome to the CHT feature request forum! Looking forward to your review and insights on these envisioned supervisor feature improvements

Please excuse my google french translation / veuillez excuser ma traduction en google français :slightly_smiling_face:

Bienvenue sur le forum de demande de fonctionnalités CHT! J’attends votre avis et vos idées sur ces améliorations envisagées des fonctionnalités de supervision

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To this point:

This seems like a common challenge to me too, and it would be great to organize a learning project or study focused on optimizing analytics widgets for health workers with relatively low data literacy. Many of the projects I’m familiar with focus on counts because they’re simplest, and often I’ve seen more complex widgets used when supervisors or other roles with more data literacy are involved. One thing we have done is emphasize the use of color, so for example if you set a percentage target, the bar is red until the target is met and green once it has been met.

In 2017 some folks we know at Cornell Tech and Dimagi did a participatory design study focused on analytics for CHWs, and a key part of it was that the analytics were designed to be presented to the CHW on their own phones will relatively little ongoing explanation/support from supervisors. They also most end up focusing on counts, but in Figure 3 (second image from left) you can see one interesting visual to convey percentage:

To my knowledge nobody has done that kind of visualization in a CHT app, but it might be worth exploring at some point if this seems like a priority to the community.

DeRenzi, B., Dell, N., Wacksman, J., Lee, S., & Lesh, N. (2017, May). Supporting community health workers in India through voice-and web-based feedback. In Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems (pp. 2770-2781). ACM. http://dx.doi.org/10.1145/3025453.3025514

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@Max thanks for the welcome.
Organisation: Living Goods
Type: CHT contributor and CH implementer
The linked document covers most of the items that we want to see being able to be configured for a supervisor user. Another key piece to this would be the context in which this works - more specifically in regards to hierarchy. We are increasingly seeing the need to support peer supervision which is basically, CHWs who are more skilled are mentoring and supporting other CHWs. To achieve this i would imagine we need a flexible hierarchy feature which i have seen is already on the works as part of v 3.7.0 . The other feature would be a way to incorporate incentives (cash and non cash giveaways to CHWs based on performance) so that as a CHW, based on my perfomance i’m able to know how much i have earned.

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Hi @vchelule,
Thanks for the feedback.

Yes, we are very excited for the upcoming release of the flexible hierarchy feature. It’s been a long-time coming and one of the most often requested improvements. Interested to receive feedback on the use case for peer supervisor support that you referenced.

Can you link to any examples of digital payments or rewards platforms/plugins that you like? As you know, we are also big advocates of fair wages for CHW’s. Integrating payments or rewards functionality into the app could definitely be worth exploring further.

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I wonder @vchelule @Max if there’s a way that an incentives workflow could be supported with the core framework’s existing features. One of the key workflow design questions is whether these rewards can be fully automated based on pre-defined rules, or whether the idea would be to have a human supervisor or manager review a health workers data, and then at the end of the month calculate and award a defined stipend/incentive. Full automation would be a little more complex, but my understanding is that Living Goods currently supports the second approach–is that correct?

If so, one can imagine configuring a supervisor app in which there is a form called something like monthly incentive. Based on the supervisor’s review of a health worker’s performance for that month, they would submit that form for a given health worker, and there would be fields for the total payment amount, the phone number that the health worker has registered with a mobile money service (I think this field could be configured to automatically pre-populate with contextual info from the contact profile), and perhaps notes about what the incentive was awarded for (e.g. 200 shillings for meeting ANC targets, 400 shillings for meeting ICCM targets, and 2,500 shillings base stipend). The targets tab is more often used to show a health worker tallies of data from forms that they have submitted, but if the form is submitted by a supervisor about a CHW, I think you could still have a count of total incentives show up in the targets tab.

If the implementation were using version 3.5 or above of the core framework, they could configure the outbound push feature to trigger a REST request to Safaricom’s M-Pesa API or another mobile money provider or a value added service provider.

What do you think @vchelule, would this kind of workflow potentially meet your needs? If you end up experimenting with a prototype like this, I’d love to see you post about it!

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I really like that idea @isaacholeman, could we also in the mean time think about maybe displaying the amount earned- and we can assign an amount to a certain form etc. Like this…

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Hi @joyanne, this looks like a good incremental solution for testing. Thanks for sharing! Perhaps one of the CHT partners has a compensation program that we could learn more about to identify if/how a tech solution like this would integrate.

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Hi @Max, excited to see this feature being moved forward! Overall I agree with the user stories we have prioritized to start with - its a really great set of essentials.

I have a few minor questions and suggestions.

  • Are we considering additions to targets widget types within the scope of this feature?

  • Being able to generate tasks based on targets, calculations across targets is really exciting! Would we also be able to use targets + forms (thinking monthly meeting forms etc) to inform these tasks? Another way to approach that question would be – would we need to configure a particular performance metric in targets if we needed it to trigger a CHW performance related task?

  • Goals in targets — could we explore how flexible we can be with how the goals can be configured (preconfigured goal that applies to all users of that type will not work for all cases), currently we can only set the value of the goal per widget, that is likely to be a big limitation for many health systems. E.g. number of pregnancies expected in one CHW’s area is different from what’s expected in another CHWs area (same for a health facility’s catchment population) and the numbers change every year.

  • Tables — I see the value of being able to see performance of all CHWs laid out in the same place for comparison and easy access, however, a table format is likely to be challenging to fit and display properly in our app. Throwing in a couple very rough ideas just off the top of my head. Would be great to dig into this user story a bit more if it’s deemed to be within the scope of this particular thread.

    • Targets could have a “CHW view” instead of/in addition to “aggregate targets view?" – this would probably require us having an additional widget kind. Either showing a composite performance metric or listing a few prioritized metrics in a single card.
    • CHW area card could include a performance highlight
  • the point raised by @hhornung re the display of supervisor vs CHW sync status is really important and pertinent to most settings we work in. In addition to displaying a warning for the supervisor to update, we’ll probably also need to have a place to display the last synced time for supervisor in case they are in a place where they are not able to sync but would like to know how recent the information they are seeing is. We will also need to consider how we check and display the targets last updated information in the targets tab where the information is aggregate for all CHWs. In the current mockups we only display this in the individual CHW’s profile. That does not help us know (not easily) how up to date the data is when we are looking at aggregate information across CHWs.

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@vchelule would this be something that’s helpful for your incentive program? We could test how that can integrate into the targets set for pregnancies etc

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Hi @ranju thanks for the feedback. Excellent points that we can integrate into the improvements roadmap. A few follow-up comments/questions:

Yes, please share any concepts that you are/would like to explore.

In this use case, a task for a CHW would be conditional based on time bound performance metrics. Does this align with what you’re thinking?

We’ve had good discussion around improving catchment areas for CHW’s (geographic, household numbers, etc). It seems like this may be a prerequisite to the ability to increase granularity of goal setting. Do you agree? This is a broad topic area and worth exploring in a separate thread.

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@hhornung I think D-Tree has done some work around incentives and making that information available digitally. Your insights could be beneficial here

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Sorry for the long silence. There’s lot’s of great suggestions in this thread.

  • I definitely see a value for displaying the amount earned. We had this in a past program (not using CHT), and had simple tables/reports in both CHV and supervisor apps. Looking at this from the CHV’s point of view, a drawback for them might be it’s difficult to calculate the final sum if there’s a larger number of targets.
  • I also generally like the suggestion to generate tasks based on targets. Our supervisors are supposed to follow-up with low-performing CHVs, so automating this could make things easier for them. On the other hand, the application logic could become complex quickly: while after some months our supervisors might get a feeling with which CHVs they need to follow up more closely, putting all this into hard and fast rules might not be the best option (could be too complex, give a false sense of “security” if tasks not triggered, could trigger tasks to early/too often/unnecessarily, etc.).
  • Goals in targets: we are currently also hitting this limitation. We wanted to define goals based on the number of people/households/kids U5/etc. registered in a CHVs catchment area. While it’s generally possible, a limitation is that we would calculate the target based on people/etc. registered in the last month, to avoid “moving targets”. For example, if we say x% of registered U5 children should be visited, if you register a child, your target changes, which led to CHV frustration in a past program.
  • Tables: We are currently experimenting with this. Depending on screen layout and the amount of data, it might be possible to come up with a design that requires only horizontal or vertical scrolling instead of both. Even if scrolling is required, the information a table conveys could be superior to the information you get navigating “through the hierarchy”.
  • Automated payment of incentives: while really interesting, we probably would not opt to do this at this point since in the past there had been a) too much need for manual adjustment (e.g. people weren’t able to synchronize due to network issues), and b) too much back and forth with a mobile money service provider due to different issues. However, for scalability, automation and distribution of inventive payment approvals, e.g. to supervisors, are interesting points to discuss.
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Thanks for the continued feedback on the supervisor improvements concepts. We are working on pulling together a more complete plan that incorporates requests from this thread as well as from recent field visits. Progress will be posted here. This thread will remain open so feel free to add any additional thoughts or comments.

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