Making healthcare more resilient through digitisation

This blog post was written by Clara Kakai, Living Goods Communications Manager -Kenya.

COVIDAction awardee Living Goods is working to digitise healthcare by providing almost 3,000 community health workers (CHWs) in Kenya with digital solutions for vital data gathering and health delivery support to the last mile. In the wake of the COVID pandemic, Living Goods has worked to quickly adapt these tools to aid safer in-person and remote service delivery and is partnering with the Ministry of Health in Kenya and other stakeholders to provide more resilient healthcare for all by achieving digitization at scale.

When Agripina Adema went into isolation after testing positive for COVID during a routine health worker test in 2020, she knew that she could no longer visit her clients’ homes as she had always done. But having volunteered as a CHW in Kakamega County, Kenya for the past 12 years, Agripina also knew that the more than 100 families she served needed her even more amid the COVID-19 pandemic. Thankfully, she had the tools to ensure she was not going to abandon them.

A CHW in Kenya enters data into her smart phone using a guided assessment on the Smart Health app to diagnose a sick child. Photo by Christian Bobst.

“I had no symptoms and other than the anxiety and discomfort of restricted movement and having to stay apart from my family, the one thing that kept me going was that I could still be there for my clients,” says the 43-year-old mother of four. “It was comforting to know that even in isolation, all I needed was my smartphone to continue saving lives,” she beams.

Like Agripina, CHWs in Kenya are under more pressure due to COVID-19 as families increasingly turn to them for health care. Despite their volunteer status and the reality that most of them have no access to digital tools, they serve as vital links to healthcare for many communities and are the solution to easing crowded and overstretched medical facilities.

Agripina is among nearly 3,000 government CHWs in Kenya who are supported by Living Goods and equipped with essential medicines, training, supportive supervision and a smartphone loaded with an m-Health application. The digital technology enables them to provide standardized care including ante and post-natal care for pregnant women, and diagnoses and treatments for sick children under age five. With the emergence of COVID, Living Goods modified the Smart Health app in the CHWs phones to ensure that CHWs could safely continue working in this new context remotely or with adjusted in-person protocols.

A CHW conducts a breath count test using the Smart Health app to assess a sick child for pneumonia.

Equipped with these enhanced digital tools and backed by strong supervision, provision of free essential medicines and a motivating CHW compensation structure, individuals like Agripina have made a huge difference in their communities. In 2020, Living Goods-supported government CHWs in East Africa — majority of whom are women — served a population of more than 8.5 million people and saved an estimated 17,000 to 19,000 lives, nearly doubling 2019 results.

After 21 days of isolation, Kenyan CHW Agripina Adema was happy to get a clean bill of health which finally allowed her to mingle with family members and resume physical contact with her clients. She now combines remote services and in-person visits that she says have improved her effectiveness and motivation.

Scaling digitisation of community-based healthcare

Beyond implementing the government-approved telehealth and low-touch COVID protocols on the Smart Health application and supporting almost 3,000 digitally enabled CHWs, Living Goods is on a mission to help extend digitization to the estimated 100,000 CHWs in Kenya. As Kenya’s Ministry of Health (MOH) spearheads efforts to digitize healthcare nationally, Living Goods has joined government partners in aligning with this goal to support the establishment of an integrated and robust electronic community health information system (eCHIS).

In this collaborative effort, Living Goods is lending its expertise in implementing digital tools for community health and is currently upgrading its Smart Health application to meet required standards for national scale. Rachel Wanjiru, Community Health Digitization Programme Manager, at Living Goods explains, “My role is to lead the various work streams within Living Goods to support the Ministry of Health in implementing the national community health digitization agenda. We are providing technical support on adoption, testing and scaling of digital solutions for community health and helping MOH think through how to utilize generated data for performance management”.

eCHIS is timely. With a largely manual CHW workforce in Kenya, a fragmented digital landscape characterized by more than 28 piecemeal digital solutions for community health, and no centralised or coordinated way to work, the emergence of the COVID pandemic provided an increased sense of urgency in leveraging digital technology for data to track disease trends and provide real time surveillance at community level.

“In March 2020, I was in a Ministry of Health meeting where we were discussing digital solution strategies to improve data management for response teams in the wake of the global COVID pandemic,” says Wanjiru. “When the first COVID case was confirmed in Kenya, reality set in,” she continues. “The news created fresh impetus for prioritization of ICT and health informatics and for government action to automate health data collection”.

A CHW learns how to use the Smart Health app during a training in Kenya’s Kisumu County

Subsequently, Kenya’s MOH launched a strategy early this year to create a uniform, national digitized solution for community health whose implementation focused on design of a functional eCHIS prototype that aligns to the government’s requirements for testing and progressive nationwide scale-up. With the support from FCDO’s- Resilient Health System funding, Living Goods has supported the MOH in conducting engagements with stakeholders that have culminated in a co-designed eCHIS blueprint. After an in-depth review of existing community health digital solutions to gauge their level of alignment to the eCHIS blueprint the MOH-led multidisciplinary team selected the Smart Health app as the reference tool for implementing the eCHIS testing and pilot phase. Living Goods is now working with MOH and partners to develop an eCHIS training curriculum for CHWs and enhance the app to be pilot and integration ready.

Living Goods has an eye on the bigger picture of strengthening community health services management across the African continent through supporting implementation and advocating for broad adoption of an integrated approach that supports digitally enabled, supervised, equipped and compensated community health workforces, and is currently providing technical and programmatic advisory services in implementing scalable digital healthcare solutions in additional countries — Uganda and Burkina Faso.

“We look forward to realizing nationwide scaling of eCHIS in Kenya and sharing lessons from our implementation to inform adoption of similar approaches in Uganda and Burkina Faso, muses Wanjiru. “In the future, we would definitely want to contribute to the revolution of digitization in the public health sector across Africa and beyond,” says Wanjiru.

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