The 7th annual Global Digital Health Forum (GDHF), which took place in December of 2020 was aimed at sharing how Global Health stakeholders are making digital health work for everyone, including and especially frontline health workers. One of PSI’s strategic priorities for Digital Health is to power remote stewardship and support of frontline health workers using their mobile phones.
As mobile phone penetration and connectivity improves across low to medium income countries (LMICs), this creates an increasing pathway to drive support to frontline health workers in a scalable and cost-effective manner. To this end, PSI convened a panel of implementing agencies to share their experiences on remote support of frontline health workers during the GDHF.
The panel consisted of PS Kenya, Viamo, Living Goods and Amref Health Africa, all major players supporting public and private sector health workers using digital solutions. The session captured the panel’s experiences on the approaches their organizations have taken to drive remote engagement, the effectiveness of these approaches, and their potential for sustainability.
Below are the key take-aways from the session, providing useful insights to stakeholders involved in frontline health worker support.
Leverage digital engagement approaches that are already familiar to, and comfortable for, the target audience
Health workers, as with the general population in LMICs, tend to be on different parts of their journey to digital access and literacy. Device ownership varies greatly in every context (basic handset, feature phone, smartphone), as does the health workers’ ability and behavior to interact with their mobile phone. It is important to drive digital engagement taking into account both the devices the health workers have and what they are already comfortable doing with the devices on a day-to-day basis. This has been demonstrated by the success PS Kenya shared on driving Ministry of Health approved training using WhatsApp – given the health providers’ familiarity and comfort using the platform on a day-to-day basis for communication purposes. This has also been demonstrated by Viamo’s success in using Interactive Voice Response to train Community Health Workers (CHWs) given their ownership of basic handsets and lower level of digital literacy. Remote engagement interventions should ideally prioritize approaches that resonate with users based on their day-to-day interaction with their mobile phones.
A user-first rather than technology-first approach should be taken both in design and deployment of remote engagement interventions
It is important to put the end user at the center of design and implementation of remote engagement, rather than the technology. The panelists highlighted continual user insight/experience gathering as a critical key to successful implementation of remote engagement interventions. Some of the key learnings from users highlighted by the panel include:
- Embedding capabilities that support self-paced engagement, particularly given that frontline health workers tend to be busy, hence their available window of engagement may vary across a given day. This is the case with private sector health providers supported by PS Kenya
- Integrating human engagement avenues within the digital solution. Living Goods highlighted that the CHWs did not want to entirely lose the physical touch they formerly had in the conventional classroom-based training, hence they integrated remote peer-to-peer mentorship within their approach
- Simplicity is key, given digital literacy concerns. The manner to which the remote engagement solution is designed should minimize the need for continuous training and support. The closer to ‘plug and play’, the better.
Remote engagement interventions should ideally host continuous user feedback mechanisms to understand and address user pain points through adaptive implementation.
Remote engagement has proven cost effective, which is critical given the size of the health workforce (public and private) in any context
The panelists unanimously noted that remote digital engagement has greatly reduced the cost and time of providing stewardship and support to frontline health workers, relative to in-person engagement. The immediate cost deviation is on operational items, such as transport facilitation and reimbursement for attendance of training, or site visits. Amref estimated that the cost of digital training has been a quarter of the cost of in-person training. PS Kenya’s most recent Ministry of Health certified remote training of 1,000 private sector providers cost approximately $65 per provider, yet delivering the same training in person would have cost $300 per person. If PS Kenya were to train a further 1,000 providers it would reduce the cost to $17 per person driven by economies of scale. Remote engagement can potentially provide a pathway to cost effective, scaled support of frontline health workers, though it should not be viewed as a one-size-fits-all opportunity for all needs of frontline health workers.
Partnerships are key to ensure success and sustainability of remote engagement interventions
To ensure success of remote engagement interventions, various stakeholders should ideally be engaged to bring in their skills and influence. By partnering with Ministries of Health, Amref has been able to build resilient systems as well as expand reach to health workers. PS Kenya has partnered with the Ministry of Health to ensure that remote capacity building courses are certified and contribute to Continuing Professional Development (CPD) points tethered to licensing of private sector providers. This has been demonstrated to be a significant motivating factor with regards to provider engagement. Living Goods and Viamo have forged partnerships with Mobile Network Providers to reduce (and in some cases eliminate) the transactional cost of remote engagement with the target audience. An example of this is Living Goods’ collaboration with the main mobile network provider in Kenya to whitelist the training website for free access. Partnerships are key to building resilient remote engagement