[email protected]

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A telehealth approach that helps community health workers provide basic health services, sexual and reproductive health services, and products to communities in Uganda, Kenya, Tanzania, and Burundi.

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CONTACT

Janharmen Drost
Business Development Manager
Email

CASE STUDY SOURCE

Healthy Entrepreneurs

PROJECT STATUS

Ongoing

IMPLEMENTATION PARTNERS

Healthy Entrepreneurs

FUNDER

Dutch Postcode Lottery
Dutch Ministry of Foreign Affairs

GEOGRAPHIC SCOPE

Uganda Kenya

Target Users

Health Care Provider

Enabling Environment Building Blocks

Workforce

Family Planning Program Classification

Service Delivery, Supply Chain Management

INTRODUCTION

Access to basic health care services, including Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH), is limited in rural, hard-to-reach areas of sub-Saharan Africa. In addition, families face barriers such as walking long distances and other opportunity costs like time and money in accessing these services. During the outbreak of COVID-19 additional barriers in restrictions in movement resulted in limited access to healthcare services.

Healthy Entrepreneurs has a growing network of community health workers (CHWs) in Uganda, Kenya, Tanzania, and Burundi who are trained to become community health entrepreneurs. Each CHW is equipped with a smartphone with health information, screening tools, and a product ordering platform to provide their communities with health-related information and products. In our telehealth solution, ‘[email protected]’, CHWs use their phone to connect to a doctor for screening and advice. 

Our solution provides access to health services at the doorstep of the family’s house, addressing both the barriers in accessing a health facility as well as saving on time and transport costs. In addition, especially during the COVID-19 pandemic, the solution has provided reliable and adequate information about the pandemic in rural areas of Uganda and Kenya.

ABOUT [email protected]

In close collaboration with the Ministry of Health in Uganda, Healthy Entrepreneurs developed a telehealth approach that helps CHWs to continue to provide basic health services, SRH services, and products in their communities. A call center in Kampala, with a team of nurses and doctors, supports a network of approximately 5,500 CHWs operating in 23 districts. These CHWs pay a commitment fee of UGX 70.000 and are trained by Healthy Entrepreneurs on the principles of social entrepreneurship to create a sustainable network of CHWs providing basic health services and products in rural areas.

All CHWs were equipped with a smartphone and met in monthly cluster meetings, received training, discussed patient cases, and were supplied with essential health products, such as malaria tests and treatments, antibiotics, oral rehydration salts (ORS), and modern contraceptives. The telehealth approach ‘[email protected]’ supports CHWs through a toll-free line, with a team of trained nurses and clinical officers. The team offered up-to-date information about COVID-19, triage for identifying suspected cases, and advice about isolation and prevention measures and referrals. Besides identifying and monitoring suspected COVID-19 patients, the team provides consultation on conditions such as maternal health, sexual and reproductive health (SRH), malaria, pneumonia, diarrhea, and COVID-19.

CHWs are empowered to provide the necessary health services because they can always consult a medical expert. As a result, the services improve and the access to services for rural communities drastically improves.

EVALUATION AND RESULTS

Between March 2020 and June May 2021, a total of 30,309 health-related consultations were made through the call center. The call center supported the training of 3,500 CHWs on SRH, infection prevention, and COVID-19 case identification. The data from the call center, interviews, and surveys indicate that the telehealth approach provided a useful strategy for supporting CHWs in rural communities with the provision of basic health services and products.

Since the call center launch, the number of teleconsultations has increased steadily, from 850 per month in April 2020 to over 5200 in June 2021. During the in-depth interviews that were carried out, CHWs who used the call center shared how it supported them: the call center gave them quick and free access to the expertise of a nurse or doctor who could help with triage, remote diagnostics, patient referrals, and answers to questions about health issues and products.

The CHWs pointed out that they often worked in isolation and it was practically impossible to consult with a healthcare professional. The call center provided a useful helpline.”It helps a lot… It still brings the health services nearer to the people who are not close to health centers or hospital” – CHW 7
CHWs said that the call center gave them the feeling that they could receive support if needed and provide better care especially when they were in doubt about a patient. The CHWs also said that the direct line to trained health professionals strengthened their position as CHW in the community.

In the survey, 77.3 percent of the CHWs answered that the call center support improved the quality of their work. Of those who had used the call center, 93.2 percent felt they got the help they needed to treat their patients. CHWs pointed out that, with support from the call center, more patients in remote areas could be served, reducing the need to travel to regular health facilities and saving on travel costs.

LESSONS LEARNED

  • Telehealth is an effective way to support CHWs in their general health management and receive access to general health commodities. Telehealth allows health professionals to treat and consult CHWs in more remote areas, thereby providing quick and easy access to consultations.
  • Keeping the service free of charge is necessary, lowering the barriers for usage in remote and rural areas.
  • Using simple triage makes it possible to support maternal and child health. As a result of this, alignment with local policies, guidelines, and integration in the existing healthcare system is needed. Quick referrals to health facilities or response teams are necessary. Communication lines between districts and response teams are necessary to support the existing response of the Ministry of Health in Uganda.
  • More time and effort are needed to create trust among CHWs and the medical experts at a distance. This can be supported by using ‘promoters’ who already use and trust the service. They can explain to their peers what the system is and how it works. It is important to equip CHWs with a communication infrastructure whereby video calling is possible in the future.
  • Integrating multiple services helps to improve the usage of the center. An integrated response, whereby the option is to ask questions, consult a patient or express the need for health commodities can make the service widely used and available to everyone
  • Using dedicated lines to support health workers is appreciated. It is necessary to have trained health experts answering the calls to add value to the questions and concerns from the CHWs
  • Phone usage and smartphone skills are still very low among the group of CHWs. Therefore, the CHWs called the call center and the call-center agent entered the consultation data to avoid mistakes in data entry.

CONCLUSION

Based on our experience and the evaluation study, it is clear that the ‘[email protected] Distance’ telehealth approach is suitable to provide useful support to CHWs in rural communities in Uganda on a large scale. For example, at the start of the COVID pandemic, the call center helped educate 3,500 CHWs about infection prevention and control practices and how to identify, refer and manage suspected COVID-19 cases. In addition, the call center supported CHWs with diagnosing, referring, and treating patients, adhering to infection prevention and control practices, and communicating product needs. As a result, CHWs felt better informed and less isolated and indicated that the support provided them with better care and better supplies of essential products.

The telehealth approach proved helpful in supporting CHWs in providing continuous basic health services and products in hard-to-reach, rural areas of Uganda, showing that access to basic health services can continue even within the hardships of the COVID-19 pandemic.
Healthy Entrepreneurs will scale further in Uganda from 4,500 CHWs today to 26,000 CHWs in five years, covering 90 percent of rural Uganda and providing access to health services.

REFERENCES

  • Robert A J Borst, Trynke Hoekstra, Denis Muhangi, Isis Jonker, Maarten Olivier Kok. (2019). Reaching rural communities through ‘Healthy Entrepreneurs’: a cross-sectional exploration of community health entrepreneurship’s role in sexual and reproductive health, Health Policy and Planning, Volume 34, Issue 9, Pages 676–683, https://doi.org/10.1093/heapol/czz091

Other Resources

  • Healthy Entrepreneurs (2021).
  • Healthy Entrepreneurs provides health where no one else will go.
  • Website last accessed December 3rd, 2021.
  • Available on: www.healthyentrepreneurs.nl