When a child comes down with a fever in Zambia, the first medical care they receive is often not from a nurse or doctor, rather from a member of their own community.
Through the Zambia Digital Community Health Project (ZDCHP), an investment from the Bill & Melinda Gates Foundation, PATH has been working alongside the Zambian Ministry of Health (MoH) to create a digital health system that will ensure community health workers (CHWs) have access to the tools and data necessary to deliver high-quality care to their community.
While CHWs support activities across several health programs, they have been especially integral to the fight against malaria, serving as the backbone of the country’s malaria prevention and treatment responses. Despite these significant achievements, the CHW workforce is still under-resourced and lacks access to essential data and tools, resulting in disparities in health outcomes in the communities they serve. With a digital health system, CHWs will be able to diagnose and treat individuals across all health areas and share the data they collect to inform health decision-making at the sub-national and national level more efficiently.
What is a digital health system?
Digital health systems leverage information and communications technologies to improve health care service delivery and health outcomes. They do this by providing essential and accurate data used to inform health decision-making to relevant stakeholders. The goal of many digital health systems is to ultimately provide better care, more efficiently and at a lower cost.
While a number of digital health systems are already used to support decision-making in Zambia, many are siloed by health area, leading to redundancies in data collection and reporting for CHWs and a lack of integration between these various digital health platforms.
To address this inefficiency, the ZDCHP team is working with partners to ensure the digital health system they are building, called the Community Health Information Platform (CHIP), is interoperable—allowing for sharing of data across different digital health systems. The goal of the CHIP is to provide a unified digital system to allow for more streamlined health decision-making.
How was the Community Health Information Platform created?
To better understand what type of digital health system would best fit the end-users, the ZDCHP team consulted over 110 CHWs and relevant stakeholders across eight districts in Zambia. In these consultation sessions, the ZDCHP team leveraged PATH Living Labs’ human-centered design methodology and Collaborative Requirements Design Methodology to define CHWs’ workflows on a day-to-day basis, the challenges they face, and how they envision a digital health system fitting into their workflows.
Workshop participants mapping out their day-to-day workflows. Photo: PATH/John Zgambo
Many CHWs reported challenges related to data collection and reporting. They told the ZDCHP team that they experience frequent stockouts of the paper-based forms used for data collection, limiting their ability to efficiently collect the information they need during service delivery. Coupled with their lack of access to alternative tools for recording service provision, these stockouts contribute to late and incomplete reporting.
One CHW shared, “As a community health worker who feels demotivated by the nonavailability of data capturing tools, I’d like to have readily available and easy-to-use tools so I can capture accurate data quickly and easily.” This CHW envisioned that a digital tool would help improve access to quality health data, which Community Health Officers rely on to make evidence-based decisions on malaria programming. With this better, more timely data, activities and interventions will be better tailored to the specific needs and challenges facing communities impacted by malaria.
The ZDCHP team participated in requirements gathering and refining activities with community health care workers and health facility staff. Photo: PATH/ Daniel Ng’andu
These consultation sessions revealed that the issues affecting CHWs are complex, but that digital tools could be a critical solution to some of the challenges they face every day—and thereby also to making community health services more accessible to those who need them most.
What’s next?
Information gathered through these sessions was incorporated into the current iteration of the CHIP. Next, the platform will undergo an impact evaluation in Ndola, Mpongwe, Kazungula and Katete Districts to determine if the CHIP is able to do what it was designed to do—improve health outcomes at the community level.
ZDCHP’s Director, Mandy Dube, is encouraged by the progress her team has made in developing the CHIP and strengthening the community health platform in Zambia.
The ZDCHP team. Front row (left to right): John Miller, Mandy Dube, Chishala Bwalya, Mercy Mwanza. Back row (left to right): Jacob Siwiti and Daniel Ng’andu. Photo: PATH/Chansa Katongo
She shares, “Investing in CHWs is a worthwhile effort, because without CHWs, there would be a mini collapse of the health system. CHWs often work for many years across several program areas and their commitment earns them a level of respect and trust among the communities they serve.”
She hopes that this tool makes CHWs’ work more efficient, and also can be used to show donors and external stakeholders the value CHWs add not just in the fight to end malaria, but also in improving health outcomes across communities more broadly.
