Mobile health (mHealth) technologies can help community health workers (CHWs) improve their performance through data-driven management. mHealth systems collect data on CHW activities and client outcomes that supervisors can use for supportive supervision, feedback, and incentives to motivate high performance. Successful mHealth requires organizational changes, technical support, training, and scaling capabilities to fully utilize data and sustain results over time. A maturity model outlines five stages programs progress through to maximize mHealth's impact from initial demonstrations to integrated, long-term solutions.

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mHealth and CHW Performance Improvement
Neal Lesh, Chief Strategy Officer
CORE Group Fall 2014 Global Health Practitioner Conference

2. 1
CommCare in use by a CHW

3. 2
mHealth Data Cycle
mHealth for
Service
Delivery
Data-Driven
Management
Supportive
Supervision
Better Data

4. 3
Types of Data-Driven Management
Performance Data
● Metadata about CHW visits
● Can re-use across project
types
Programmatic Data
● Project-specific data
● Informs programmatic
decisions vs. direct
feedback to CHWs
Programmatic Data CHW Performance Data
How many pregnant women in an
area give birth in a facility?
How frequently is a CHW meeting
with a particular client?
What portion of pregnancies result in
live births, still births, or maternal
deaths?
How long does a CHW spend on a
counseling session?
What percentage of pregnant women
receive 2 tetanus shots
How many clients is a particular
CHW meeting caring for right now?

5. 4
Performance Feedback (examples)
 Worker Activity Report for field supervisors
 Visit reminders / supervisor alerts
 Relative ranking feedback
 Social recognition
 Pay for performance

6. 5
Worker Activity Report

7. 6
Reminders w/ Escalation (Brian DeRenzi et. al)

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Self Tracking
CHWs shown their performance relative to others:
Results: None overall, but 38% increase in performance of top
third of intrinsically motivated CHWs.

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Seems so simple...

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Successful mHealth Requires:
● A lot more than technology
● Organizational change and capacity
and thus a fair bit of time...

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Maturity Model - Stages
Stage 1
Demonstration
Stage 2
Iteration
Stage 3
Value
Creation
Stage 4
Scale-up
Stage 5
Sustain /
Improve
Example
Proof of concept
tool for using
phones to deliver
protocols
Stabilized and
field-tested tool
Validated tool for
delivering value
to frontline
workers
Packaged
repeatable tool to
scale up
Ongoing stable use
and value extension
of platform
infrastructure at scale
Demonstration
National
Programme

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Maturity Model – Capabilities
Stage 1 - Demonstration Stage 5 - Sustain and Improve
Program Design
New content, small number
of use cases
Multiple use cases supported by
the technology platform
Data Driven
Management
Data collected but not used
to improve workforce
Increasing levels of automation
for data-driven management.
Data used to improve program
design.
Technical Support
Limited technical capacity
among program staff
Technical resources fully
capable of managing program
independent of external support
Training and
Implementation
Training and implementation
policies not yet modified for
mHealth
Training and implementation
practices institutionalized and
improvements rolled out
iteratively
Scale
Designing and
demonstrating with small
number of users
Fully deployed to target
userbase
Sustainability
Focus within single
organization with single
source of funding
Core solution in national strategy
receiving core programmatic
funding

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Project Maturity Assessment

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Thank you!
Contact: Neal Lesh (nlesh@dimagi.com)
Additional Videos:
CommCare Overview Video: http://youtu.be/ZpfvISKxylE
CommCare Demo Video with multi-lingual support from India: http://youtu.be/30Ftk6STM3U
Recorded Webex of CommCare Presentation given to NetHope: http://bit.ly/tiLaYy
Additional Resources:
http://groups.google.com/group/ict4chw
http://www.commcarehq.org
http://www.dimagi.com

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