Presentation on the role of WhatsApp in linking community health nurses for improved performance in Ghana made at the 2017 American Evaluation Association conference.

1. Soumya Alva
Sophia Magalona
JSI Research & Training Institute
November 10, 2017
American Evaluation Association , Washington DC
The Role of WhatsApp in linking
Community Health Nurses for
Improved Performance in Ghana

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A freeware and cross-platform instant
messaging service for smartphones
Fast, simple, secure messaging and calling
for free*, available on phones all over the
world
More than 1 billion people in over 180
countries use WhatsApp to stay in touch with
friends and family, anytime and anywhere
WhatsApp

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Usage ofWhatsApp as a communication method among health facility staff at
a plastic and reconstructive surgery section (India: 2013)
Examination of the potential ofWhatsApp to facilitate communication in an
emergency surgery setting (UK: 2015)
WhatsApp as a communication tool among medical residents on awareness of
patient-related information (India: 2015)
Undergraduate nurses reflections onWhatsApp use in improving primary
health care education (South Africa: 2015)
Use of WhatsApp for supervision and professional development among
CHWs in Kenya (Kenya: 2016)
Understanding reasons for use of WhatsApp among CHWs in Malawi, the
benefits and constraints (Malawi: 2017)
WhatsApp in Global Health

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Community Health Nurses (CHNs)
• Frontline health workers of the Ghana Health Service
• Work in rural, underserved areas
• Face many challenges
• Affects their motivation and morale
• Affects retention and quality of care
CARE COMMUNITY HUB (CCH):
• An innovative solution to address barriers in health worker job
satisfaction and motivation through the use of ICT via a smartphone
application (CHN on the Go).
Designed using a Human Centered Design approach
Implemented by Grameen Foundation under the Innovations for
MNCH Initiative (Gates Foundation/Concern Worldwide).
Research and evaluation by JSI
Our Use of WhatsApp in Ghana

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Care Community Hub (CCH)
To improve connectivity and career development
among CHNs, increase their linkage and interactions
with a professional network and supervisors, and
provide clinical refreshers
Project details:
• 5 districts
• 50 health centers
• More than 300
CHNs and their
supervisors
• June 2014-May
2016

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CCH Phone and CHN on the Go App

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Learning
Center
Health
knowledge
Point of Care
Health
knowledge,
relationships
Planner
Targets, Work
scheduling
Achievement
Center
Targets,
relationships
Staying Well
Keeping well,
relationships
AnAdaptationoftheTheoryofChange
Driver (Direct outcomes (Modules & Intermediate outcomes) Direct outcomes ) Driver
Change Pathways
WHATSAPP
Communication &
Connectedness
Supervisor App
Monitoring & Supervision
FINAL OUTCOMES:
Better CHN performance
Better quality of care
Improved maternal & child health
ASSUMPTION: Health
workers feel unmotivated
and frustrated in their
jobs
SYSTEM LEVEL CHANGES: Supervision, education/learning

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Groups formed
• 12 official groups formed at Sub-district and District
Levels in Nov 2014
Original intent
• Keep nurses connected to each other for support
and motivation
Other informal groups &
Individual conversations with
supervisors, peers,
family and friends
District No. of
members
South Dayi 74
South Tongu 123
Ada East 33
Ada West 24
Ningo
Prampram
83
Total 337
WhatsApp Groups Formed

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Analysis
• Content of Chat Transcripts
• Questions on WhatsApp use in KIIs with CHNs and
Supervisors
• Focus on extent and nature of use of WhatsApp, and
benefits
WhatsApp Groups: Analysis

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Improved communication of official messages
across the district
• Communication from the national level. Example:
Salaries and allowances
• District level communication
• Information on meetings
• Information on report submissions deadlines, with incentives
to encourage completing the reports
• General health info – announcement of outbreaks
• Announcements of trainings and other district activities
• Info on CCH app – announcements to download the
app, complete courses etc.
WhatsApp Groups: Type of Info Shared

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Sharing of Professional & Personal Info
Communication with supervisors
• Request advice on difficult cases
• Report issues and resolve ahead of supervisory visits
• Coordination
Communication with other CHNs
• Coordinate activities within the district and sub-district
Communication with family and friends
• Sharing of jokes, stories, recipes, religious messages
Communication with Grameen project staff
• Updating mobile app, troubleshooting

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Communication and Connectedness
• WhatsApp has facilitated communication between
CHNs and people they work with as well as family and
friends.
• They feel connected, because it’s easier to ask questions
from their supervisors and peers and to disseminate
information via their CCH phones.
“The app has changed the
frequency of communication.
Like with WhatsApp, when we
want to channel any information
to the CHNs in this sub-district,
you just use the WhatsApp. Or
even if you don’t want to call,
you just use the app.” -CHN,
Ada East/West
“It has made our district smaller.” –
District Director, Ningo Prampram
“It has satisfied a need we didn’t know
we had.” – District Director, South
Dayi.
You communicate more with your
staff or the staff that are working under
you as compared to the past.” -
Supervisor, South Tongu

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Change in Professional and Personal Life
“An example is that there is this
nurse at Sogakope who referred
a client to our facility and she
called to inform me to take care
of them for her. So then they
came, I took care of them, and I
WhatsApped to tell her the
progress of the client.” CHN,
South Dayi
“I use it to communicate with my
family. I explain some of the things if
they ask me for help. Sometimes I
also use it to chat with them [through
WhatsApp].” –CHN, South Dayi
“Even if you are bored at the
house and you read your
WhatsApp, there may be a post
that says have a lovely day and
at least it brings you up a little.”
–CHN, Ada East/West

14. Thank you!