Mobile phones, tablets, and other technical platforms are increasingly being used for health worker training, patient diagnosis, treatment, and referral, and to manage health data in frontline settings around the world. In many geographies, these digital health tools are improving the delivery of quality health care and allowing CHWs to reach larger numbers of patients.
Best practices for when and how to use these tools are still emerging. None of our Exemplar CHW programs had, at the time of research, fully implemented and assessed the performance of digital tools in their CHW programs, though some have begun using digital tools to improve training and service delivery, like the mobile learning management systems in Liberia and Bangladesh.
India provides perhaps the best examples of large-scale implementation of digital tools. Its largest program to utilize technology to support frontline health workers is the Integrated Child Development Services Common Application Software (ICDS-CAS), which is used by more than 600,000 Anganwadi workers in 27 states, covering more than 98.5 million households. Through this program, Anganwadi workers use a mobile phone app to manage data related to the households they serve, including home visit scheduling and child growth monitoring.
Smaller programs in India include the Mobile Academy, which uses an automated telephone response system to provide frontline health workers with remote refresher trainings in five languages. More than 150,000 frontline health workers in 13 states have used these trainings. Also in India is Mobile Kunji, which provides frontline health workers with a deck of illustrated cards on a ring, each card depicting a different health challenge alongside a code that can be used to obtain audio on that topic, via cell phone. Currently, nearly 50,000 frontline health workers in three of the country’s poorest states (Bihar, Odisha and Uttar Pradesh) are using this tool.
Other notable examples outside India include a Democratic Republic of the Congo program in which CHWs, who distribute and install long-lasting insecticide treated bed nets, use smart phones to note GPS coordinates of each home and take a photo of each installed bed net. This documentation improves accountability and accuracy. Living Goods in Uganda and Kenya, and upScale in Mozambique, also demonstrate how digital tools can support CHWs in the delivery of their service packages.
Johns Hopkins University’s report, "Mobile Technology in Support of Frontline Health Workers," provides a valuable overview of how countries are adopting mobile technologies and adapting them to meet their needs. The report also identifies challenges and benefits countries are encountering as they incorporate digital health tools in their programs. The WHO has a number of reports on digital health tools, including: WHO's classification of DH Interventions, WHO's Recommendations on Digital Interventions for Health System Strengthening, and WHO's MAPS Toolkit: mHealth Assessment and Planning for Scale.
Agarwal, Smisha & Rosenblum, Leona & Goldschmidt, Tamara & Colder Carras, Michelle & Goel, Neha & Labrique, Alain. (2016). Mobile Technology in Support of Frontline Health Workers: A comprehensive overview of the landscape, knowledge gaps and future directions.
World Health Organization, United Nations Foundation, UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction & Johns Hopkins University. (2015). The MAPS toolkit: mHealth assessment and planning for scale. World Health Organization.