In the realm of global healthcare, Community Health Workers (CHWs) emerge as a crucial part of disease reduction and treatment efforts. CHWs often lack adequate resources, including medical supplies, transportation, and communication tools, which can hinder their ability to provide effective care to community members. Inconsistency in the standard of training programs and evolving health needs in their communities requires continuous capacity building to equip CHWs with the necessary skills and knowledge. While treating patients far and wide, CHWs juggle multiple responsibilities and often face burnout while continuing to provide essential health services and manage their own households and livelihoods.

For CHWs, the current lack, and integration of effective timely mechanisms for supervisors to support their activities and verify their contributions at scale poses a challenge. Support in their daily activities, feedback, and opportunities to provide better patient care are pivotal for these frontline healthcare workers. For countries and implementing partners, challenges in data collection, management, and utilization can hinder program effectiveness and decision-making at various levels of the healthcare system for disease elimination efforts and pandemic preparedness. Rwanda, a country at the forefront of digital health initiatives in Africa, is significantly investing in digital tools for Community Health Workers (CHWs) to effectively tackle these concerns.

To begin a series focusing on frontline health workers, we’d like to introduce Francoise Mukantwari, a dedicated CHW who lives and works in the Nyamagabe district in the valleys of Rwanda. Her typical day involves childhood growth monitoring, providing health education, treating patients for illnesses ranging from malaria to pneumonia and malnutrition, and providing family planning services.

Francoise shared her personal experience using Audere’s HealthPulse Jhpiego app which helped her capture and track malaria testing activities. The app included administration instructions, a process control timer, guided her through capturing a photo of the malaria rapid diagnostic test (RDT) and interpreting the result, and used AI to confirm her interpretation on the backend. The app was available to CHWs during a study supported by Jhpiego’s Catalyst fund, focused on determining the feasibility and effectiveness of introducing a mobile app into the malaria testing workflow for CHWs.

Francoise faces many of the same challenges as other CHWs in Rwanda, including high patient loads, limited resources and a lack of efficient reporting tools. Francoise indicated that using the app enhanced her knowledge of RDT practices and patient follow-ups, supporting her to provide consistent care to the many patients treated. With a high patient load, the app also offered a seamless way to track and save case histories, and provide real-time data for supervisors. She further reflected that the app significantly improved service delivery with its automatic reporting system streamlining documentation, which allowed for easy review of testing activities.

“The application boosted my knowledge. Instructions guided me where to start and where to end. On the side of the client, better services were provided. This app is better in reporting because all you do is automatically saved into the system giving you a chance to see them later.”

According to Francoise, patient perception also shifted positively as the incorporation of digital tools into patient visits instilled confidence and trust in her abilities as a CHW. Francoise shared that patients expressed excitement when she used the app, seeing it as an indication that she was taking their case seriously and that her work as a CHW was supported by the district. As she snapped photos of RDTs, patients recognized her dedication to accurate reporting, and they recognised the app as an enabler to timely feedback from her supervisors, ensuring continuous supportive supervision.

“I remember the first time using this application, I had 4 patients and they were so excited when seeing me taking pictures of the RDT. They asked me why and I responded that the photo will be seen by my supervisor and other staff. From that they said that is good because if I make an error, I will receive immediate feedback.”

Since participating in the study, Francoise believes that equipping CHWs with transformative technology can truly support their daily activities and improve patient care. Incorporating the use of digital tools supports CHWs like Francoise in the care they are able to provide to patients, provides work traceability, and elevates the community’s trust in their abilities. Increasing efficiency in an already challenging environment helps make the days a little more manageable and the job feel more rewarding.

To expand the comprehensiveness of care, Francoise noted her desire for the future integration of additional workflows into the app, including pneumonia, diarrheal illnesses, and growth monitoring. She concluded by sharing, "My desire is to bring this app to every CHW." Her commitment resonates as part of a collective push to upskill health workers and provide them with tools to do their jobs more efficiently and effectively.

Stay tuned for more reflections from healthcare professionals on the impact of digital tools in their communities.

Noella Umulisa

Chief of Party, PMI Impact Malaria at Jhpiego

Eliab Mwiseneza

iCCM Coordinator for PMI Impact Malaria at Jhpiego Rwanda