Electronic medical records are, in a lot of ways, I think the aspect of technology that is going to revolutionize the way we deliver care. And it’s not just that we will be able to collect information, it’s that everyone involved in the healthcare enterprise will be able to use that information more effectively.– Risa Lavizzo-Mourey
Although there are not enough doctors to meet all patient care needs in Kenya, there is an army of committed community health volunteers who have worked for decades to fill the gap—providing critical preventative care and referrals at the community level. While their work is lifesaving, they have long faced significant challenges, including reliance on paper-based tools and records that can easily be lost, destroyed, or misplaced.
To ensure a more integrated and comprehensive approach to delivering quality primary health care at the community level, in 2021 Kenya launched a new digitization strategy and Community Health Strategy that promised to equip all 95,000 CHWs in the country with an integrated digital tool that would enable quality patient assessments, data collection, disease surveillance and more, and help advance Universal Health Coverage. This Electronic Community Health Information System (eCHIS)is a standardized system developed to improve community health in Kenya.
Kenya’s Ministry of Health completed piloting the new eCHIS in Kisumu County in mid-2022 in partnership with the county government and Living Goods, which developed an mHealth app for community health workers and supervisors upon which the eCHIS is based. A comprehensive system that extends throughout the health system, eCHIS ensures a consistent quality of care at the patient level and also supports effective reporting, referrals, supply chain, and performance management of CHWs. Jael Atieno, a CHW in Kabodho west in Nyakach sub-county, says the tool has been transformative “I have been a CHW for 20 years. The introduction of eCHIS has made our work easier. The app guides and reminds me of what to do. So, I cannot forget anything. For example, I cannot forget to do a follow-up visit to a client,” she says, as the app sends the regular automated reminders that tell her what to focus on next.
Health data collection, collation, and sharing along the information chain is digitized through eCHIS. Manual processes have been done away with and access to information by all users is in near real-time. This makes it easier to monitor health indicators in the communities across government departments and swiftly intervene where necessary.
eCHIS has also proved to be effective in commodity management. Beatrice Otieno, a Living Goods supervisor coach supporting the Nyakach sub-county community health team, says that “the pharmacist is able to check consumption rates on the dashboard and does not need to wait for physical papers to be brought to verify what was disbursed against what is remaining.” The system has improved restocking time for medicine and curtailed the wastage of expired commodities. However, there is still room for improvement, in terms of the timeliness of the commodity supply.
Health data collection is a vital part of the eCHIS. This data is used to monitor health indicators and inform interventions. Therefore, data credibility is important throughout the entire process of collection, collating, and storing it. How has eCHIS improved this? Neighter Achola, a CHW in Koru, Muhoroni sub-county with 20 years’ experience compares eCHIS with the manual system. “One of our roles as CHWs is to feed the health system with data. Under the manual system, sometimes we could cook data and reports. But under eCHIS, it is impossible to do so.” The different digital modules under eCHIS have installed preset parameters that make it difficult to fake data. In addition, verification is done at all stages of collection and collation. For example, the supervisor verifies that the data collected by the CHW is authentic before forwarding the same to the sub-county focal person, who in turn also verifies the same. Since the process is digitized, there is minimal time used in the verification and authentication process.
One of the challenges experienced during the eCHIS pilot phase is the unreliable and unavailable mobile data network in some areas of the county. CHWs need a good and strong mobile data network on their phones to sync the data they have collected so that it is visible on the dashboard’s back end. Kennedy Akani, a Living Goods Supervisor Coach in Muhoroni sub-county, says they have coached the CHWs and CHEWs to ensure that they move to specific areas where connectivity is strong and do the syncing from there.
So far, the pilot phase has gone smoothly. The CHWs have embraced the system and are reporting through it. The authenticity of data and supervision of CHWs has improved. Challenges such as connectivity and commodity supply hiccups have been noted and it can only be hoped that this will inform the national rollout of the system.
Thomas Owino, a Community Health Extension Worker (CHEW) in Muhoroni, adds that the tool has also improved his work as a supervisor. “There is no way a CHW can sit under a tree and cook data. It has made remote supervision more effective. I can see what a CHW is doing in the field in nearly real time. The data speaks.”
Living Goods, KE Communication Office