How technology is enabling better healthcare for rural communities

In the remote villages of Nyando Sub-county, Kisumu County, Millicent Atieno starts her day at dawn with determination. As a community health promoter (CHP), her mission is clear: provide essential healthcare services to the people in her community. With a smartphone in hand, she embarks on her rounds, leveraging the power of technology to transform healthcare delivery.

Millicent's daily household visits are no longer marked by the challenges of manual record-keeping and limited medical resources as was the case when she started her job 14 years ago. Instead, she carries a powerful tool: a smart health app in her phone that has revolutionised how she and thousands of other health workers deliver public healthcare.

Every morning, Millicent’s smartphone buzzes with reminders of her appointments for the day. The device allows her to register new patients, update medical histories and provide real-time information on health trends in her community. With a few taps, Millicent can access vital information about maternal health, immunisation schedules and treatment protocols.

"Before, everything was on paper. We used to carry many record books in our backpacks. Sometimes we would get rained on and the books would soak with water. It was easy to lose track of patient data and needs," says Millicent. "Now, I can see everything on my phone. It helps me remember patient needs and follow up with them properly. It’s accurate and always available." Her work involves monitoring the health status of 169 households within her community.

As the sun sets, Millicent returns home, tired but fulfilled. She spends the evening compiling her reports, which are automatically synced to a central database via the cloud. This seamless integration allows Living Goods, the non-profit organisation she works with, to maintain an up-to-date overview of the health status in various communities, facilitating timely interventions.

For years, community health promoters like Millicent have been the backbone of primary healthcare in underserved regions in Kenya, Uganda and Burkina Faso, where the organisation operates. Their work is indispensable, yet they often face significant challenges—limited resources, inadequate training, and the daunting task of covering vast, remote areas. 

However, in 2022, Living Goods Kenya was selected for the Amazon Web Services (AWS) Diagnostic Development Initiative, a global programme focused on accelerating research and innovation to advance the collective understanding and detection of infectious diseases. This transcended further into their current work.

Kenya was selected for this pilot because its Ministry of Health identified the enhancement of community-based disease surveillance as a key objective in its National Community Health Digitization Strategy 2020-2025.  Living Goods was selected to implement this strategy, aiming to digitise and support all 95,000 CHPs across the country by 2025. 

The initiative is focused on reducing disparities in healthcare access and outcomes, particularly for vulnerable populations. This means ensuring that CHPs like Millicent can reach even the most remote and marginalised individuals with the care they need.

CHPs undergo comprehensive education not only in basic healthcare practices but also in specialised areas such as maternal and child health, infectious disease management, nutrition and family planning. This training is designed to be both practical and context-specific, ensuring that CHWs are equipped to handle the unique challenges of their communities.

For Millicent, the training has been transformative. "Previously, I knew how to take care of common illnesses, but I didn't have the confidence or the knowledge to handle more complex cases. Now, I can identify signs of serious conditions early, provide advice on prevention, and even offer regular support.”

CHPs are also taught how to engage with their communities effectively, building trust and encouraging health-seeking behaviour. This is particularly important in regions where traditional beliefs and mistrust of formal healthcare systems can be barriers to accessing care. By building strong relationships within the community, CHWs like Millicent can overcome these barriers and ensure that more people receive the care they need.

For Millicent, this has been a game-changer. "With my mobile device, I can quickly look up information if I am unsure about a diagnosis or treatment. I can also keep track of the families I visit and make sure they get the follow-up care they need," she explains. "It makes my work so much easier and more efficient."

A critical area of focus has been maternal and child health. In many parts of Africa, maternal and child mortality rates remain unacceptably high, often due to a lack of access to timely and appropriate care. But CHPs have been empowered to provide antenatal care, support during childbirth and postnatal care.

Slava Odhiambo, a supervisor at Living Goods supporting Nyando Sub-county, has witnessed the impact of this approach first-hand. "We have seen a significant reduction in maternal and child mortality in the areas where we operate. The CHPs are able to identify high-risk pregnancies early and ensure that mothers receive the care they need, whether it's through home visits or referrals to health facilities."

In Vihiga County, for instance, many families have experienced significant improvements in their health and well-being, thanks to the enhanced capabilities of community health promoters.

Take, for example, the story of Janet Ambani, a mother of two who lives in a remote village in Ebusakami. “I feared for the worst when my one-year old son developed a high fever,” Janet recalls.  Thanks to the timely visit of a community health worker and the guidance provided by the technology, the child was diagnosed with malaria and treated promptly. “This saved my son’s life. The intervention was timely.”

In another instance, a targeted intervention based on predictive analytics led to a significant reduction in diarrhoea cases in Isiolo County in mid-2020. By identifying contaminated water sources and educating residents on proper hygiene practices, health workers were able to prevent a potential outbreak, notes Mr Odhiambo.

The initiative has also made a difference in the management of common illnesses. CHPs are trained to recognise the symptoms of diseases like malaria, respiratory infections like pneumonia and to provide appropriate treatment or referrals. This is crucial for early detection and intervention and in improving outcomes for those affected.

At the heart of this community healthcare work is a commitment to government-led, community-driven healthcare. This means not only providing services but also working with governments and communities to take charge of their own health and systems. 

The tech system, which was activated in 2020, enables health workers to receive instant updates and alerts about new health threats or changes in medical protocols. This immediacy is crucial in regions where timely interventions can mean the difference between life and death. 

“The partnership between the county and the organisation was anchored on an MOU signed by both parties to work on a 70:30 ratio on implementation of the activities,” Maureen Opiyo, Kisumu Community Health Coordinator, told Healthy Nation.

 “Access to quality primary health care services is brought closer to the people and using preventive health to reduce disease burden and prevent severity of a disease.”

Mr Odhiambo, who oversees the work of 497 other health volunteers, says of these, 493 have been onboarded on the digital platform. "With technology, we have seen a dramatic improvement in our ability to manage health information and respond to health issues promptly.”

"Technology has made our work easier and more effective," Millicent shares. "We can now spend more time with patients and less time on paperwork. This means we can help more people every day."

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