mCHW Project pioneer community health volunteer Eunice showcasing the mCHW REFER app

Design & Evaluation of Mobile Learning and Supervision for Community Health Workers

With thanks to the University of Oxford for contributing this article which is about the innovative use of technology for health care training in Kenya as part of a joint DFID & ESRC research programme

This mHealth project was designed to advance the training and supervision of community health workers in Kenya and is improving access to primary health care for marginalised communities.

Using a participatory action research approach, the project started working with 20 community health workers and 5 supervisors, and was scaled up to 100 community health workers and their supervisors through peer-to-peer learning in late 2014. Through workshops child health and development were identified as top priorities where improvement was needed. Using the same participatory approach a smartphone app to assess developmental milestones of children under five was co-designed.

The resulting REFER mobile app was used as a decision-making support tool by community health workers supporting the referral of children for specialist care in cases of severe developmental delays and disability.

The app was developed in consultation with pediatricians and developmental experts in Kenya and the UK and is based on conversation-stimulating questions. The caregiver is able to respond to the questions and, where possible, the child is engaged in activities to identify potential delays in the development. At the end of each assessment, depending on its outcome, the community health workers has to decide whether or not to refer the child to the nearest facility. The app generates a report out of the assessment and the referral decision, which is automatically sent to the community health workers’ supervisor for review and feedback.

The findings from this research have have contributed to the evidence base on the effectiveness of mobile-based activities to increase community health workers’ capabilities. The research has also made a significant contribution to the challenges of embedding mobile-based supervision and training within existing local primary health infrastructure.

Two additional tools were trialed during the project alongside the REFER App:

  • The community health workers Whatsapp group was used for mentoring and social support. During a cholera outbreak in Kibera the Whatsapp group also enabled the community health workers to be kept up-to-date on new cases that had been diagnosed and fatalities
  • The ALPHA toolkit was developed as means for community health workers to develop their own smartphone apps without the need for coding skills

Community health workers had not received any training on the development of children under five prior to this work. They received training on the use of technology and smartphones. Together, these three tools have lead to improved data collection, supervision and mentoring, training and skills in the formal health system for community health extension workers (supervisors), for community health workers, and for the Kenyan Ministry of Health. The project has demonstrated how a mobile intervention can be a training tool, a job aid, a data collection tool and a community mobilisation and advocacy tool. It has also:

  • Raised awareness at a ministerial level about developmental milestones, developmental delays and disability
  • Improved the supervision and mentoring skills of community health workers
  • Substantially increased the knowledge of the development of children under five for community health workers and households

Through this innovative project, the University of Oxford, the UCL Institute of Education and Amref Health Africa have significantly improved the quality of referral decision making and monitoring. Research following the initial phase has focused on improving links between caregivers of children with disabilities and specialist care in Kenya (funded through the John Fell Fund) and on building an interdisciplinary network of researchers through the newly-founded Oxford Network of Health Care Training, Social Justice and Technology.

Background to Department for International Development and Economic and Social Research Council joint funding

This programme was set up in 2005 to fund world class social science research that addresses the goal of reducing poverty amongst the poorest countries and people globally. Part of a broader strategic partnership between the Department for International Development and the Economic and Social Research Council, the joint fund aims to fund research which provides a robust conceptual and empirical basis for development with strong potential for impact on policy and practice for poverty reduction.

Further Information

Also published as part of this series: