“[I]rregular or inadequate supervision is almost universally cited as a key problem in CHW programmes. Regular supervision has been associated with better project outcomes and more accurate classification and treatment of childhood illness by CHWs.”
INTRODUCTION
IRC Community Health Worker in Somalia.
The International Rescue Committee (IRC) works with a network of about 15,000 community health workers in over 25 countries around the world. In many places, community health workers are the first line of defense against preventable child deaths. Oftentimes, community health workers are volunteers who are trusted in their communities. heir task is to share information and sometimes provide integrated community case management services (iCCM) to diagnose and treat the most common causes of death in children under five: diarrhea, malaria, and pneumonia.
With the advent of COVID-19, community health workers have become even more critical to ensuring continuity of care such as life-saving treatments for children under five . Traveling to clinics can be risky, and providing socially distant care within communities will be key. In addition, during COVID-19 health facilities may be overwhelmed with COVID cases and may want to limit the numbers of community members attending clinics for other services.
The Risks of Inadequate Supervision
Misdiagnosis of iCCM conditions:
May neglect to treat the child for diarrhea.
If CHW are not correctly taking the respiratory rate of a child, they may incorrectly classify a child that has simple cough as having pneumonia
Neglecting to systematically check and ask about general danger signs in children under five:
If a CHW is not systematically checking and asking about general danger signs, they may neglect to refer a child who is severely ill to a health facility
Neglecting IPC measures or adapted iCCM protocols to prevent transmission of COVID:
CHWs may put themselves and/or community members at risk of COVID-19 infection by not following no touch iCCM protocols (if these have been put in place by the MOH) and not following infection, prevention and control measures
CHALLENGES
Front-Loaded Training
When CHWs begin work, they often receive a one-off training which covers a wealth of information and introduces many new skills for assessing and treating common childhood diseases. Follow-up trainings are not common, so skills and knowledge are reinforced only during infrequent visits from CHW supervisors.
Infrequent observations of CHW performance
Community health workers work long distances from health facilities. They often operate for long periods of time without their supervisors observing their work. As a result, they may be unaware of mistakes they are making and these may go unnoticed by their supervisors.
Community health worker efforts aren’t recognized
Although community health workers provide lifesaving care for thousands of children around the world, they are often invisible outside the community, and their unrecognized accomplishments and progress can sap motivation.
WHAT IS DELA?
Dela is an application which enables community health workers to receive virtual supervision and feedback.
The app works offline to enable community health workers to capture video and audio of their consultations with sick children.
That video is sent on to their supervisors, who can then provide feedback and advice based upon what they’ve seen in the video. In particular, supervisors can share instructional videos on how to perform essential skills that they see the community health worker may need to review.
The easy-to-use app is designed to work with limited access to phone service, and with limited digital literacy skills by using voice-over functionality. IRC is cognizant of the fact that there is often a digital gender gap in many of the countries where we work an we will ensure that both females and males are receive digital literacy training and offer more intensive classes for female CHWs as needed.
KNOWLEdge sharing
Dela allows supervisors to observe and assess their CHW’s skills by video, even when they can’t be with CHW in person. They are able to provide each CHW with individual feedback and link them to digital job aids, such as visual guides and videos, to refresh CHW skills.
FREQUENT SUPERVISION
Dela enables more frequent supervisions including direct observation of CHW performance by their supervisors since they are no longer forced to travel long distances and can provide support remotely. This enables supervisors to catch and resolve issues early and improve the quality of services delivered.
Automated RECOGNITION
Dela tracks individual community health worker performance over time, acknowledges progress, and showcases their accomplishments to themselves and their supervisors. This allows their supervisors to focus their attention on areas of improvement and gives CHW positive reinforcement for their work.
impact
Bringing Quality of Care to Children
Ultimately, we believe that the Dela App will improve the quality of care that community health workers can provide to children under five. Supervisors will be able to provide ongoing support and guidance by watching videos of consultations with actual sick children, something that is not always possible during in-person visits due to time-constraints after having to travel long distances. By watching these videos, supervisors can identify areas where community health workers are performing poorly, and help them improve specific skills to provide better care in the future. And by acknowledging progress and showcasing achievements, Dela can help motivate community health workers for their lifesaving work.
how we reach scale
Our goal is to equip CHWs across the globe with this powerful tool. Our scaling strategy is underpinned by three core pillars:
Broadly applicable
To increase adoption rates and ensure sustainability, Dela has been designed specifically for low-literate community health worker populations. Our research and prototyping processes ensure that the solution is desirable and useable by CHWs including those with low literacy and minimal experience using technology. This solution has the potential to support CHW’s and improve the quality of service through remote supervision in a diverse range of contexts where IRC operates, including extremely remote and hard to access locations, disease outbreaks, as well as situations where we see large numbers of people on the move as a result of conflict or natural disaster.
Operationally efficient
The Dela app is designed to be a stand-alone or “add-on” feature to existing technology platforms that support CHWs (e.g., training and/or data collection solutions). By leveraging existing infrastructure and ensuring interoperability, our solution can efficiently be integrated into existing systems. Any CHW with a smartphone will have access to Dela. We’re currently exploring the feasibility and viability of a range of operating models that are either in use or can be used in geographies where the IRC operates. We will then have options for how to reach impact at scale, such as saturation of all CHWs within a country or more opportunistic approaches to reach select cadres of CHW across countries.
Collaborative partnerships
The IRC is well placed to develop partnerships with key stakeholders who are eager to support the scale up of this solution including other implementing organizations, Ministries of Health, and private sector companies.
NEXT STEPS
1
Identify relevant field-based contexts where we will prototype and adapt Dela to meet the needs of CHWs.
2
Create a strong fundraising and partnership strategy that achieves impact at scale and sustainability.
3
Explore innovative operating and business models aimed at galvanizing widespread adoption of Dela where it's needed most.
