What Community Health Workers Want: A Conversation With SEWA Rural
Could you give us an overview of your work as it pertains to maternal health and/or mHealth?
SEWA Rural is a voluntary organization with over three decades of experience of working with Community Health Workers (CHWs). Over last decade, our CHWs have been instrumental in reducing the maternal mortality ratio and neonatal mortality rate by 78% and 38% respectively across our project areas in Gujarat.
Within maternal health, where do you see mHealth as having the highest impact or highest potential for impact?
One of the important uses of mHealth solutions is to improve performance of CHWs. However, programs aimed at improving performance may experience a “burn-out” after initial enthusiasm. Therefore, managing the change in working environment of CHWs (with the introduction of mHealth) is critical to make mHealth acceptable and attractive to them on sustained basis. For that to happen, we need to understand what CHWs want and how their needs can be met using mHealth solutions while we focus on improving their performance.
How can mHealth initiatives geared towards improving maternal health better address the needs of end users?
To facilitate scale up and to improve health outcomes, we make mHealth attractive to end users such as CHWs. The first step would be to listen to them, understand their motivations and experiment with them as equal partners. Our grassroots work with CHWs has taught us that motivations of CHWs include timely payment of performance based incentives, regular replenishment of supplies, recognition for good work, respectful behavior and opportunity to learn and grow. These were some of the requirements that we tried to fulfill while developing and implementing a new mobile phone application called “ImTeCHO” which ultimately aims to increase performance of CHWs.
ImTeCHO has digitized measuring CHW performance, which has helped to pay CHWs using performance-based incentives so that they now receive timely payment. We recognize good performance of a particular CHW by sending weekly “CHW of the week” story to all CHWs through ImTeCHO application; this inspires other lesser-performing CHWs to improve their performance so that she could be next “CHW of the week”. A facilitator calls every CHW once a month to congratulate good performance and motivate lesser performing CHWs in respectful manner.
How has mHealth strengthened the delivery of your maternal health programs and how has this impact been measured?
The measures mentioned above have resulted in high uptake and acceptability of ImTeCHO among CHWs. Community health workers are now more comfortable with dispensing medicines to treat sick women and children because ImTeCHO provides information about the drug customized for the client. This makes the CHW feels more empowered and makes local government health staff replenish their supplies more regularly due to higher demand. Most importantly, we have continued to listen to CHWs and improvise ImTeCHO‘s application and implementation model through iterative cycle and action leaning over last 10 months. We have created a small mHealth laboratory in 45 villages with the CHWs, local government heath staff, and investigators as partners.
On an average, our CHWs have logged in ImTeCHO application 90% of working days and completed 75% of assigned tasks consistently over last 10 months. There has been no attrition among CHWs and none of them have stopped using the mobile phone application. There are numerous reports of previously poorly performing CHWs now making better efforts and doing so enthusiastically.
Do you have an opinion on the role mHealth can play to improve maternal health? What do you see as the biggest advantages of mHealth? The limitations? If you are interested in submitting a blog post for our ongoing guest blog series on mHealth for Maternal Health, please email MHTF Research Assistant Yogeeta Manglani at email@example.com.