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Community Health Workers
Home Based Care Providers (HBCPs) play a vital role in serving poor and rural populations suffering from diseases such as HIV as well as providing preventative services such as mosquito nets, oral rehydration solution and family planning. HBCPs are typically in the best position to promote preventive care and convey important health information, and are often the only health workers with sufficient time to get to know the patient and understand their challenges. HBCPs can encourage prompt care seeking behavior, and detect and refer those at risk for tuberculosis, malaria, and other important diseases related to HIV. Finally, HBCPs also have the potential to collect information that is needed at the national level about disease burden and barriers to adopting necessary health practices. HBCPs, however, often receive relatively little medical training, have high turnover, and have limited opportunities to reinforce their knowledge once they begin working in the field. They typically lack effective tools required to maintain the longitudinal records required to provide truly effective care. Furthermore, while living in the communities they serve is the key to the effectiveness of HBCPs, it also makes community health programs extremely difficult to organize and manage.
Together with Pathfinder International, we are developing and testing a phone-based tool, called CommCare, to improve the effectiveness of home-based care provider programs. This approach leverages recent advances in mobile technology that have made it practical to deploy mobile applications in rural settings. Each HBCP will have a phone running CommCare that will assist them to manage household visits and plan their day. CommCare will collect and report data that will help monitor and evaluate community health programs themselves. We envision several levels of functionality eventually (not all of which will be fully developed during this pilot):
- Household visit tracking: The HBCP will record every household visit in CommCare, which will be relayed back to a central server over the cellular network. Even this simple information can help a HBCP ensure they visit each household frequently enough, as well as provide HBCP supervisors with key information about the activity of their HBCPs.
- Household visit support and data collection: CommCare will present a checklist of activities to the HBCP for each visit, as well as collect data, such as information about any births or deaths since the previous visit. The content of the checklist and questions will be easily customizable to meet the needs of each program.
- Followups: Many household visits result in the HBCP advising their clients to do something or go somewhere, such as to go to a clinic for testing or treatment. During a visit, the HBCP will record their recommendations in CommCare. At the next visit, CommCare will prompt the HBCP to follow up, e.g., to see if the person did indeed go to the clinic for testing.
- Record keeping: CommCare will maintain household house records (e.g., number of mosquito nets, presence of pit latrine, etc), as well as information about each member of the household (e.g., age, immunization and weight for children, family planning method for adults, etc).
- Health protocols: CommCare will guide a HBCP step-by-step through relevant health protocols, such as TB and malaria screenings, and refer people to appropriate clinics or testing.
- Day planning: CommCare will help a HBCP plan their day. For example, if a member of a household is referred for a TB test, CommCare can direct the HBCP to follow up on that household after 1 week.
- Data exploration: HBCPs will also be able to use CommCare to explore trends in their activity, and compare data on their clients and activities to those of other HBCPs in the country.
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