Realising the value of information collected by community health workers

Abstract

The delivery of health services through health facilities such as hospitals and clinics has been found to be inadequate in developing countries. This is due to limited access to facilities by members in communities, especially in the rural context. To address this, community health workers (CHWs) have been utilised in the South African health system to provide basic health services in communities such as home visits, health education, maternal and child health support, communicable disease control, referrals, record-keeping, and collection of data. Various eHealth solutions, in particular mobile technologies, have been developed and deployed to support CHW in their tasks. Since CHWs often are the first line of contact of patients with the health system, they are the first to register individuals, assess their health status and refer them to health facilities if medical attention is required. The data collected by CHWs is currently stored in separate proprietary data stores. There is an opportunity to utilise the information collected by CHWs in the wider health system through interoperability and applicable standards. This will enable the health system to use the registration information captured by CHWs to reduce the need for re-registration on other systems when individuals present themselves at health facilities, enable clinical practitioners to view assessment results from home visits and most importantly, track if a patient referred to a health facility, adhered to the referral. Through referral tracking it will be possible to identify individuals who did not comply with referrals and schedule follow-up home visits. It is particularly important to follow up in cases of maternal and child health as well as suspected communicable or non-communicable diseases. There are proprietary health information systems that have the ability to access both assessment information captured in communities as well as clinical information recorded in health facilities. The benefit, however, is limited to users of that specific system only and no referral tracking is possible between different systems. This paper describes an approach to enable heterogeneous CHW applications and patient management systems to interoperate in a broader, national eHealth system through compliance to defined eHealth standards and a shared foundational eHealth interoperability framework in order to realise the described advantages. This allows any compliant patient management system to use the registration information captured in the field and access health assessment results irrespective of which application was used by the CHW, as long as the application is compliant. In addition, referrals and adherence of referrals can be tracked between CHWs and the various levels of healthcare facilities independent on which information system is used. This enables an improved level on continuity of care to patients in communities across the various levels of healthcare and increase the impact of community health workers in the field.