Knowledge first webinar
A summary of Avert and OPHID’s webinar, looking at how digital can support community health workers’ work
Avert and OPHID’s joint webinar ‘Knowledge first’ discussed the benefits of digital tools to support the knowledge and confidence of community health workers and peer educators, as well as the challenges of ensuring access and rolling out digital tools in low-resource settings.
The webinar focused on lessons learned from Avert and OPHID’s collaboration to co-create, adopt and roll out Avert’s digital job aide Boost among OPHID’s community health cadres in Zimbabwe.
Welcoming an international panel from Zimbabwe, Kenya, the US and the UK, webinar host Dr. Lennie Bazira, Policy Director of the Community Health Impact Coalition (CHIC), highlighted the progress being made towards salaried, skilled, supervised, and supplied community health workers (CHWs). However, she cautioned that there is still lots of work to do – only 34 out of 91 countries analysed by CHIC had pro-CHW policies in place and “46 low middle income countries (LMICs) couldn't even find any data or policies that mention community health workers”.
Kicking off the discussion, Dr Lennie asked Doreen Achieng Bazara Awino, Director for Health Systems Strengthening at Lwala Community Alliance in Kenya, what she felt some of the premises for successful community health interventions were. Doreen highlighted how “for us to achieve UHC [universal health coverage], it's very critical to engage or involve the community health workers”. As well as being salaried and supervised they need to be resourced with proper tools she said. “We need easy to use tools that support the work and give [CHWs] knowledge so that they can really work with a lot of confidence.”
Dr Tinashe Chinyanga, Executive Director of OPHID, followed up by describing some of the ways OPHID supports the knowledge, skills and confidence of its CHWs. OPHID is a national organisation working to support the Ministry of Health with implementation of public health programmes since 2001.
Dr Tinashe explained how OPHID had been looking at more cost-effective ways of making sure that CHWs are confident, mandated, and trained to provide quality service within their communities. This kick-started a collaboration with Avert in 2019 on the Boost app, with over 450 of OPHID’s community health workers now trained on the app.
“It's really a job aide,” he said, “which has been designed by the community health workers themselves to enhance their continuous learning and decision making when they are in the field, and it increases their legitimacy and efficiency in delivering these services. It's a tool that goes beyond programme specific needs… And it's also a tool that can be used to engage the clients.”
Dr Chinyanga spoke about plans to continue to work with Avert and new funders to scale Boost into other areas of Zimbabwe working with new local partners.
When the Boost application came in, it was a life saver for us...We now feel that we know more. We have been boosted in our knowledge, in our understanding of health areas.
Ellen Nhambura, one of OPHID’s Community Outreach Agent Coordinators based in Chitugweza gave a personal perspective on how Boost had changed and benefitted her work. “When the Boost application came in, it was a life saver for us,” she said. “Why do I say so? Because when you're out there in the community you need to communicate, to deliver correct information to the client… Boost has helped to incorporate youth – they had been feeling left out.” Ellen went on to share that she is aware that her and her fellow CHWs “now have the information correct as the Ministry of Health expects of [us]. We need to deliver correct information.”
“With Boost it's fun, it's light, it's engaging,” she continued. “We now feel that we know more. We have been boosted in our knowledge, in our understanding of health areas.” Asked about the single greatest change from Boost, Ellen said “now it's just your phone in your pocket and you are easy to go and distribute the knowledge.”
OPHID’s Boost Project Manager Privillage Charashika was asked about the challenges of rolling out Boost. She said potential issues had been avoided through a co-design process with community health workers and a cascading process of sensitisation meetings from the community level up to the national level. Layering Boost on top of their existing TASQC USAID-funded programme had enabled them to use existing structures and “because of this existing structure we managed to roll out Boost projects easily”. Phone were already provided by the programme and reporting and supervising structures were already in place.
Avert’s Director of Programmes Simon Moore provided some background to the original development of Boost back in 2019 saying that while there were lots of other tools around focused more on M+E, “we kept hearing that the knowledge components were missing or not really developed in a way that was relevant and accessible to community health workers.” Boost’s co-creation process aimed to change that, resulting in a free tool available on the web and as an Android native app, but one that can also be adapted and enhanced for specific partners and programmes. “The feedback we've had from individuals and organisations who've used Boost so far is really encouraging.”
The feedback we've had from individuals and organisations who've used Boost so far is really encouraging
Asked about future plans for Boost, Simon set out two scale routes: through take-up by individual self-motivated CHWs (with over 65,000 users already in Africa) and through organisational adoption. “We're really keen to hear from any organisations who feel Boost can support their community health worker and peer-educated cadres,” he said, “and from funding agencies who can see how investment in Boost can support efficiencies and reduce duplication across the sector.”
Bringing the session to a close, host Dr Lennie asked Doreen about strategies for sustainability of digital health interventions in LMICs. Highlighting open-source approaches, coordination with government strategies, and examination of wider costs savings on training and administration, she also stressed the need to “ensur[e] CHWs have the right tools to use for their situation”.
She also sent out a plea not to underestimate CHWs and assume they can’t take on new tools. “No, come on, give it a chance!” she said. “We’ve proved that once we take them through and empower them, they are able to use some of these things… We just need to think carefully. Look at the community going to use this, have appropriate tools that they are able to use. Make it simple, don't make it so complicated. And [then] we have the outcomes that we are looking for.”
Bringing the meeting to a close, Dr Lennie gave a message to Ellen as a representative of the voice of thousands of CHWs. “Thank you and all the other community health workers for the amazing work that you do tirelessly to serve your clients and to save lives.”
Photo credit: Hilton Matyatya