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Community Health Workers in Sierra Leone

Community Health Workers and mobile technology for improving health

We know from the last step that there are still difficult challenges to tackle in achieving sustainable child and maternal health. In this step, we are going to explore the AIM Health project in Africa which uses medicine and public health supported by mobile devices (MHealth) and Community Health Workers (CHW) to improve health outcomes. It is an interesting case study of how collaboration between organisations can achieve SDG 3.

Around the world, many organisations play different roles to improve health, and align to the agenda laid out by the SDGs.

For example:

  • The World Health Organization (WHO) invests in building health systems, especially in training midwives and in making emergency obstetric care available round the clock. It leads the Partnership for Maternal, Newborn & Child Health, an alliance of more than 700 organisations, in 77 countries, from the sexual, reproductive, maternal, newborn, child, and adolescent health communities.
  • Every Woman, Every Child is a global movement that coordinates governments, multilaterals, the private sector, civil society organisations, and NGOs to work together on child and maternal health. This movement is putting into action the Global Strategy for Women’s, Children’s and Adolescent’s health, 2016–2030.
  • The World Bank has established the Global Financing Facility. This finances country-led efforts to improve the health of women, children, and adolescents.

Health Alliance International (HAI) training for midwives in Timor-Leste. Health Alliance International (HAI) training for midwives in Timor-Leste. © WHO / SEARO /Karen Reidy

As we have seen from previous case studies, collaboration between government agencies, local communities, and NGOs can create the most sustainable outcomes. We can see this when global health researchers, NGOs, development agencies, and governments work together. They are trying to push the boundaries of what we know to ensure that new knowledge results in real benefits, and has a positive impact on real lives.

One example of how different groups can work together to improve child and maternal health is the AIM Health project. This is led by a development NGO called World Vision, with funding from Irish Aid, and the Department for International Development in the UK.

AIM Health: Community Health Workers

AIM Health is a five-year programme implemented by World Vision Ireland in five African countries: Sierra Leone, Mauritania, Uganda, Tanzania, and Kenya. Its goal is to reduce infant and maternal mortality rates by 20%. AIM Health provides local communities with skills to improve and manage their own health services. During the course of this programme, over 2,000 Community Health Workers (CHWs) are being trained to deliver simple health messages, such as the importance of breastfeeding as well as simple nutritional advice, directly to the households in their communities.

There are often insufficient numbers of health workers in the health systems of developing countries, and CHWs help to fill that gap by delivering basic services.

CHWs are men and women who want to make a difference in their local communities. They have volunteered to work in their communities delivering important health messages to the households in their area. While they are not paid, they are recognised by their national Ministries of Health as an important part of the health system.

In the AIM Health Programme, CHWs have been trained to deliver timed and targeted counselling programmes to mothers. Their job is to visit households and engage with mothers and children, 10 times during pregnancy, and the first 2 years of the child’s life. They give information and encourage mothers to engage with the relevant health services.

There have been some signs that this programme is making a difference. For example, in Mutonguni, Kenya, presence of a Skilled Birth Attendant at deliveries increased from 54% in 2011 to 76% in 2014, while in North Rukiga in Uganda, it increased from 30% to 73% during the same period. More women are in a situation where a skilled medical professional is there to assist in the case of complications during birth, contributing to a reduction in maternal and new-born mortality.

Graphic of the presence of a Skilled Birth Attendant at deliveries increasing from 54% in 2011 to 76% in 2014, while in North Rukiga in Uganda, it increased from 30% to 73% during the same period. © World Vision 2017

MHealth: how health projects impact communities

Another piece of the puzzle is how these health projects impact on communities. The Centre for Global Health, at Trinity College Dublin, partnered with the Ministry of Health and Sanitation Sierra Leone, World Vision Ireland, and World Vision UK to improve maternal, newborn, and child health in the Bonthe District, Sierra Leone.

Trinity researchers focused on trying to understand the impact of mobile health (MHealth), or the use of mobile phones to enhance the efficiency of service delivery and improve quality of healthcare. The researchers were interested in exploring the impact of mobile phones on the motivation and performance of some of the CHWs engaged in the World Vision project.

Each CHW took a ten day basic training course and was then expected to serve between 100-500 people. The CHWs were supervised by a local Ministry of Health official who checked in with them monthly and visited them quarterly.

AIM Health used mobile technology to try to enhance the counselling work carried out by the CHWs. The technology used was a mobile phone and a specific software. This was intended to help CHWs with data collection, and reminders of key messages during house visits. The phones also enabled CHWs to access supervision more frequently.

A CHW [Hashiru Jalloh] demonstrating the use of the MoTECH Suite application to a Ministry of Health Official [Sidie Yayah Tunis – Director of ICT in the MoH] and a Ministry of Information and Communication Official [Ambrose Levi – Deputy Director, Policy & Planning] during their field visit to assess the application. December 3-4, 2013; Imperi, Bonthe District A CHW [Hashiru Jalloh] demonstrating the use of the MoTECH Suite application to a Ministry of Health Official [Sidie Yayah Tunis – Director of ICT in the MoH] and a Ministry of Information and Communication Official [Ambrose Levi – Deputy Director, Policy & Planning] during their field visit to assess the application. December 3-4, 2013; Imperi, Bonthe District

To determine the impact of the mHealth technology, researchers compared three different groups of volunteer CHWs working on maternal, newborn, and child health (MNCH), across five chiefdoms in the Bonthe District, Sierra Leone.

  • One group did not receive any mobile phone to support supervision.
  • The second group received a phone
  • The third group received the phone plus an additional software package.

The phones were set up to allow users to make unlimited calls to each other and their supervisors only.

Trinity researchers measured whether CHWs reported systematic changes in perceived supervision, work engagement, job satisfaction, and motivation as a result of this use of MHealth. Self-report questionnaires were used to measure changes.

The researchers found that there were no major differences in perceived supervision and motivation with the introduction of the phones and software. Mobile technology alone in this case was not sufficient to improve motivation of the CHWs.

The researchers’ conclusion was that:

While there is a rush to use mobile technology within health service provision, it will not always bring lasting benefits and in fact its impact depends on many other factors. They highlighted several important factors to consider when a new mobile health project is being planned and implemented.

In the next step we will be asking you to consider these important factors, and evaluate how a similar MHealth project may work in your own country.

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This article is from the free online course:

Achieving Sustainable Development

Trinity College Dublin

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