Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Aug 9:14:69.
doi: 10.1186/1472-6947-14-69.

Comparing a paper based monitoring and evaluation system to a mHealth system to support the national community health worker programme, South Africa: an evaluation

Sunisha Neupane  1 , Willem Odendaal, Irwin Friedman, Waasila Jassat, Helen Schneider, Tanya Doherty
Affiliations
Comparative Study

Comparing a paper based monitoring and evaluation system to a mHealth system to support the national community health worker programme, South Africa: an evaluation

Sunisha Neupane et al. BMC Med Inform Decis Mak. .

Abstract

Background: In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs.

Methods: One sub-district in the North West province was identified for the evaluation. One outreach team comprising ten CHWs maintained both the paper forms and mHealth system to record household data on community-based services. A comparative analysis was done to calculate the correspondence between the paper and phone records. A focus group discussion was conducted with the CHWs. Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems.

Results: Compared to the mHealth system where data accuracy was assured, 40% of the CHWs showed a consistently high level (>90% correspondence) of data transfer accuracy on paper. Overall, there was an improvement over time, and by the fifth month, all CHWs achieved a correspondence of 90% or above between phone and paper data. The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators. Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones.

Conclusions: The evaluation emphasizes the need for regular supervision for both systems and rigorous and ongoing assessments of data quality for the paper system. Formalization of a mHealth M&E system for PHC outreach teams delivering community based services could offer greater accuracy of M&E and enhance supervision systems for CHWs.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Data transfer accuracy. Data transfer accuracy between weekly and monthly paper forms using the ‘Follow up visits’ indicator. *indicates statistical significance (p < 0.05).
Figure 2
Figure 2
Absolute discrepancies on paper forms with standard error of mean. Discrepancies (average of ten CHWs) between weekly and monthly paper forms on five types of visits- Pregnancy (P), Post natal (PN), Treatment Adherence (TA), Under 5 and Home based care (U5).
Figure 3
Figure 3
Correspondence between paper and phone data. Data correspondence between the paper and the phone system using the ‘Follow up visits’ indicator. *indicates statistical significance (p < 0.05).
Figure 4
Figure 4
Clinical referrals and back referrals. Proportion of the referrals addressed and captured on the phone and the paper system. Referrals addressed on the paper system exceeds 100% due to accumulation of previous months` referrals, which were brought into the clinics in the successive month.
See this image and copyright information in PMC

References

    1. Ingram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community health workers and community advocacy: addressing health disparities. J Commun Health. 2008;33(6):417–424. doi: 10.1007/s10900-008-9111-y. - DOI - PubMed
    1. van Ginneken N, Lewin S, Berridge V. The emergence of community health worker programmes in the late apartheid era in South Africa: a historical analysis. Soc Sci Med. 2010;71(6):1110–1118. doi: 10.1016/j.socscimed.2010.06.009. - DOI - PMC - PubMed
    1. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;3:CD004015. - PMC - PubMed
    1. Braun R, Catalani C, Wimbush J, Israelski D. Community health workers and mobile technology: a systematic review of the literature. PloS One. 2013;8(6):e65772. doi: 10.1371/journal.pone.0065772. - DOI - PMC - PubMed
    1. Glenton C, Colvin C, Carlsen B, Swartz A, Lewin S, Noyes J, Rashidian A. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2013. p. CD010414. - PMC - PubMed

Publication types