Netbooks Empower Community Health Workers to Improve Health in Bangladesh’s Poorest Communities

K4Health Highlights

Sidhartha Deka

Formerly CCP | Program Officer

K4Health's Bangladesh Knowledge Management Initiative (BKMI) has rolled out an eHealth pilot in April in two low-performing districts. The pilot is aiming to normalize the use of digitized resources on netbook computers by community-based fieldworkers for the purpose aiding their client-based counseling and supplementing their own knowledge in three key technical areas: MNCH, family planning, and nutrition. USAID's Monica Bautista and Peggy D'Adamo visited Bangladesh in early April where they observed the launch of the pilot in Chittagong District.  In this recent post on USAID's Impact Blog, they reflect on the value of including fieldworkers in the vision of a Digital Bangladesh

With a population of 150 million, Bangladesh is a bustling country filled with vibrant people. On a recent trip to Dhaka and Chittagong we experienced first-hand the kindness and welcoming spirit of the country. The goal of our trip was to meet with various USAID implementing partners, and several units within theMinistry of Family Health and Welfareto find out more about their behavior change communication work. Developing high quality, evidence-based communication campaigns that promote healthy behaviors is quite a challenge for Bangladesh with their large population, numerous rural communities, and with so many health issues that need to be addressed. These health areas range from improved antenatal and postnatal care, family planning, nutrition, and child health. USAID implementing partners and the Ministry of Family Health and Welfare are now streamlining their health communications work, making sure their messages are in agreement, effective, and accessible to a range of people of all ages and educational backgrounds.

Community health workers in Bangladesh receive training on the new netbooks

Community health workers receive training on the new netbooks.

Photo credit: Bangladesh Knowledge Management Initiative

A key part in this new effort was the launch of a three-month eHealth pilot program, developed by Johns Hopkins University – Center for Communication Programs in partner with Eminence, the Bangladesh Center for Communication Programs, and the Ministry of Health and Family Welfare, with funding from USAID. The pilot will take place in Sylhet and Chittagong where 300 community health workers have received a netbook computer loaded with several eToolkits that contain a digital library of communication materials in maternal and child health, family planning and nutrition, and eight eLearning courses. The eToolkit includes 116 materials and tools which were selected by a team after a detailed assessment and review. The eToolkit will improve the quality and effectiveness of counseling visits that the community health workers have with their clients, while replacing the heavy materials they previously carried from house to house. The eight eLearning courses on the netbooks are meant to supplement the training that community health workers currently receive. Each course also includes an assessment designed to measure changes in the knowledge and skills of community health workers.

Puspa Rani Paramdar, a community health worker

Puspa Rani Paramdar, a community health worker, said she felt empowered with information and knowledge after she received the netbook.

Photo credit: Bangladesh Knowledge Management Initiative

The eHealth pilot is one of the first large steps towards achieving a Digital Bangladesh by 2021. The use of digital resources will help extend the reach of key messages for health, population, and nutrition. In early April, colorful balloons and banners welcomed guests to the launch event for the pilot program in Chittagong. Here we witnessed the ceremonially hand-off of ten netbooks to community health workers before an audience of more than100 guests who were excited and engaged, asking interesting technical questions and offering suggestions for future iterations of the project.

On April 20-21, the first 30 community health workers attended an orientation, learned to use the netbook, and navigate the eToolkit and eLearning courses. Facilitators led an interactive orientation to ensure the community health workers felt comfortable operating the netbooks. There was much enthusiasm for the eHealth pilot program from the field workers during the orientation, who shared they felt empowered, informed, and energized to continue their important work.

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Comments

Were the tools used (the content) in English or in the local language?  Do you have plans to evaluate the impact of this activity? I am asking since here in Cambodia we are considering some pilot activities but the evidence on impact seems weak so far (although this may be due to implementation issues rather than actual potential) in using digital solutions for BCC.  My understanding of the literature is that it has shown more promise for data collection purposes.  Again, I don't want to be negative since it might just be that we get the "systems"and ""messages" right, but I would just like to have the project's thoughts on this.  Regards  I could also be reached via e-mail at caroline@psi.org.kh

 Hi Caroline,  Here are my answers to your questions:  Were the tools used (the content) in English or in the local language?  Yes, the eToolkit and eight eLearning courses were provided in Bangla. If you are interested, here is the online version of the toolkit. It's pretty easy to navigate through since it includes English in the navigation.  http://www.k4health.org/bangladesh-toolkits Do you have plans to evaluate the impact of this activity? Yes, we do have a thorough M&E plan for the pilot project. Before the start of the pilot, we did a pre-assessment of CHWs involved in the pilot and community members where the CHWs operated. We looked at community member's intention to adopt specific behaviors relating to MNCH, nutrition, and FP based on counseling services provided by field worker. We also  evaluated field worker's current counseling practices and operating skills of computers.  The pilot started a few weeks ago and we have implemented a monitoring plan. We have appointed monitoring officers to visit with the CHWs who received the netbook. We are evaluating their usage of the eLearning and eToolkits through tracking indicators (browser history, tracking mechanisms on eLearning platform, and evaluation of performance on quizzes for eLearning courses). The monitoring officers will visit with the field worker every two weeks throughout the three-month pilot.  After the pilot, we will aggregate the data from the tracking of the usage. For example, we will get an understanding what BCC materials the field worker used most from the eToolkit for their counseling during the pilot. We will also be doing a post-assessment evaluating the same behaviors and practices from the pre-assessment.   Some other thoughts on your comments:  We went through a vetting and pretesting process of the BCC materials that were to go into the toolkit with our central-level counterparts in the MOH in Dhaka and also in the field with CHWs. The materials were evaluated for their message content, cultural appropriateness, etc. All BCC materials were collected from the MOH, local NGO counterparts, and donor affiliates. So after collection and the vetting process, we deemed these to be the "gold-standard" of BCC materials existing in Bangladesh. However, I understand this is vetting and collection process is not perfect but it is iterative. We will be updating the toolkit continually with new and updated materials based on their content worthiness. Hope I was able to address all your queries. I would love to hear what you are doing in Cambodia.  Thanks!Sidhartha

Hi,May I know the status of this program, We are considering a project proposed by an Ebola health worker to distribute computers to health workers presently in Sierra Leone. Rob SImpsonRotary Club Of Esperance Bay Australia

Dear Rob: The eHealth pilot in the field ended in late 2013. Results from pilot have shown that health worker knowledge in technical and service delivery areas increased from the use of the electronic toolkits and the eLearning courses. Now, the Government of Bangladesh has adopted the electronic toolkits from the pilot as a part of their own tablet program for public-sector health workers. The toolkits will be placed on 10,000 tablets and distributed to health workers within the next couple of years. The 300 netbook computers that were part of the pilot have been repurposed for use in a USAID and DFID co-funded program called the NGO Health Service Delivery Project (NHSDP). -- Best, Sid