Lwala Community Health Workers conducting household visits in Migori County, Kenya.

Building a real-time decision support tool for community health workers

How Lwala Community Alliance uses data integration to strengthen healthcare in western Kenya.

The following was written by Julia Buzan, a contributor at Open Function, after an interview with Will Edman of Lwala Community Alliance.

Lwala Community Alliance is a community-led innovator proving that when communities lead, change is drastic and lasting. They operate in rural western Kenya, a region where infant and maternal mortality rates are high and HIV rates are almost triple the national average. Lwala partners with communities to source, measure, and share bottom-up innovations to address these challenges. As a Vanderbilt-affiliated organization, Lwala is building an evidence base proving that local solutions are uniquely positioned to transform health systems. Alongside the Ministry of Health, Lwala seeks to influence how 1 million people access healthcare with an end goal to cut maternal and child mortality in the region.

In addition to running a community hospital which provides primary care, maternal and reproductive health services, and HIV care and treatment through nearly 50,000 patients visits each year, Lwala operates an extensive network of Community Health Workers (CHWs). CHWs track, screen, treat and refer every pregnant mother and child under 5. The longitudinal data collected by CHWs supports their provision of healthcare at the household, allowing them to provide care tailored to each family and identify and manage urgent cases as quickly as possible.

Lwala’s Data Systems, and How Open Function Helps

In early 2015, Open Function’s partner organization, Vera Solutions, helped Lwala to implement a Salesforce system that enabled better client tracking and health outcome analysis.

By 2016, Lwala was eager to incorporate a mobile data collection system to reduce the lag time required for data entry from paper forms and make their data more reliable and timely for CHWs. Lwala identified CommCare as the ideal mobile data collection tool for CHWs to monitor their clients and collect longitudinal tracking data in offline environments.

Community Health Workers participate in a training on CommCare’s mobile app.

That said, Lwala didn’t have a way to automatically connect data collected via CommCare to their central Salesforce database for client tracking, data aggregation, and analysis. They also couldn’t automatically update the information displayed on CHWs’ mobile phones to reflect updates to patient data made from within the Salesforce database.

To solve this, Lwala uses Open Function to automatically pass data to and from CommCare and Salesforce. Mother and child health data collected by CHWs in the field via tablet is now automatically reflected in Lwala’s central database where it can be easily analyzed by Lwala M&E and Program staff. Crucial updates made from within the database are now also automatically synced to CHWs’ mobile phones, ensuring they have the most up-to-date information possible.

Why Does Integration Matter?

To better understand why Lwala uses Open Function, and how data integration helps, we sat down with Will Edman, Lwala’s Technology Systems Fellow responsible for setting up and maintaining Lwala’s Open Function integrations.

“We wanted to make sure that our system actively supported the CHW workers as a decision support tool, not just a data collection tool. For example, we wanted them to have real-time data to keep up to date on their protocols, to highlight their biggest priority clients, and to flag who they should be visiting next. We’re able to do this by integrating our systems using Open Function,” said Will. He explained that data integration has enabled decision support in two ways.

“We wanted to make sure that our system actively supported the CHW workers as a decision support tool, not just a data collection tool.”

First, integrating mobile data collection via CommCare with their Salesforce database has enabled Lwala to save valuable staff time and to reduce crucial time lags between data collection, analysis, and action. Previously, Lwala staff would receive paper-based patient data once a month. It would then often take another week to input that data. This meant that acute clinical cases would sometimes be resolved in less time than it would take to flag them. Lwala estimates that between the three main CommCare forms whose data is being automatically passed to Salesforce the platform currently saves staff about 200 hours/quarter of data entry time.

For example, staff might receive a paper form that reported in the last month a malaria case was tested on this date and treated on this date. “That’s useful to know,” Will explained, “but we can’t really intervene in certain cases if we receive information after the fact. With real time data, our team can look at individual key cases as they happen and ensure that referrals are made or that CHWs get the key resources they need.”

Open Function saves staff ~200 hours of data entry time every quarter.

Second, integration has made CHWs’ jobs easier. Adopting any new technology is difficult. As Will noted, transitioning from paper to mobile data collection was particularly a challenge for older CHWs. But by actively tailoring the system to meet needs identified by CHWs, such as flagging the biggest priority patients and providing them with up-to-date information, Lwala has worked hard to ensure that data integration is immediately useful at all levels within the organization. “Adoption of the mobile data tool was hard at first, but this quickened over time as it became something the CHWs really appreciated,” Will explained. “They’ve appreciated that the system makes their jobs easier, and that it opens lines of communication to help us to address issues with patients quickly.”

CommCare and Salesforce automatically sync so that CHWs always have access to up-to-date information.

What’s Next?

As part of its holistic programming, Lwala will further integrate other aspects of its clinical, education, and outreach programs and a related technology system at the Lwala Community hospital. In Will’s words, “One of the reasons we chose to use OpenFn was because we have aspirations to move beyond integrating CommCare and Salesforce to having an even more integrated overall data system.” OpenFn allows Lwala to solve the problems they face today while also enabling the organization to evolve and solve new problems as they arise.

As a leader in the field of global public health, Lwala is working with the Ministry of Health to extend their proven CHW model throughout Migori County, reaching 1,000,000. The integrated data system built for one region can be expanded to track new populations throughout the county.

In the meantime, Lwala’s staff seek to continually set the bar higher for their CHW program data. In Will’s words, “We’re always seeking ways to improve. We’re constantly listening to CHWs to identify and incorporate ways in which we can help them to better assess a case using the system.”