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Good Practice:
Kawok: Supporting Community Health Workers in Guatemala
 

Name of institution that executes the initiative:
TulaSalud

Type of institution: Civil Society or Non-Governmental

Other participating institutions:
Dimagi

Category:
mHealth
Telehealth or Telemedicine
Access to Information

What health topics does it address?

Where is the initiative being implemented?

Country or countries: Guatemala

Locality or localities: Alta Verapaz

Is there a target group or beneficiary population?  No

Initiative began in: 2009

Is it still active?  Yes

Description:
Using mobile phones, TulaSalud has been able to improve the flow of information between health professionals based in hospitals and community health workers (CHWs) in remote villages; There are currently 195 CHW using Kawok (CommCare application) serving more than 700 communities and a population of more than 300,000 residents. TulaSalud partners with the Ministry of Health and the Cobán School of Nursing and receives support from the Tula Foundation based in Canada.

Kawok is a suite of applications, maps and reports designed to support community health workers (CHWs) in their daily work in the TulaSalud community health program. The core component of Kawok is a mobile application, based on CommCare by Dimagi, which CHWs use to create and manage clinical cases via their cellular telephones. The mobile application was developed in close collaboration with TulaSalud staff and CHWs in field.

Kawok helps CHWs follow appropriate clinical workflows and includes culturally appropriate images and audio recordings to improve usability and act as an educational tool. Much attention was paid to make the application very simple to use and feedback has been extremely positive. Bona fide epidemiological results are evident from the resulting data, which is automatically and securely synchronized over the internet. At any time, over 2000 pregnancy cases from 700 communities are being monitored, enabling nurses and doctors in local health centers and PECs to respond to what is happening at the community level.

Simple and actionable maps and reports are automatically produced daily using the information entered by CHWs. Customized information is generated for health districts, service providers (PECs) and CHW supervisors. Some reports are aimed to improve the effectiveness and efficiency of case monitoring (e.g. making sure women are receiving timely and appropriate prenatal care and counseling), while others are aimed to improve the effectiveness and efficiency of health worker monitoring (e.g. making sure CHWs are interacting with communities as expected and investigating any potential issues). Work is in progress to define and implement this most effective ways to utilize the Kawok information to further improve clinical outcomes, and we expect additional progress to be made in the coming months.


The Status of Kawok (as of April 2013)

The application is currently being used by 195 CHWs in approximately 700 communities in Alta Verapaz. DASAV would like to expand the system to cover all of Alta Verpaz, which would entail supporting about 1000 CHWs.

Most CHWs who are part of the Kawok program work for and are monitored by the NGOs in the PEC. The CHW visits as part of the mobile health teams, and record clinical information entered by the health teams into Kawok, together with other information the CHW gathers directly. Each CHW working in the Kawok trial is supported by a stipend from TulaSalud.

Since November 2012, TulaSalud has been developing a related application for use by auxiliary nurses in Centros de Convergencias. This application will run on Android devices. This application is fully compliant with new ‘Ficha Unica’ forms that the Ministry of Health has developed over the past six months as part of their strategy to standardize clinical information across the country. The application is about 80% complete and field testing will start in about a month, with 14 nurses in San Cristobal. All of the same dashboards, maps, reports work with the new application. Kawok can be integrated with legacy systems, such as CensoNet (used by service providers) and SIGSA (used nationally), and with modern systems including cloud-based applications. TulaSalud is just at the start of what is possible with Kawok. The Kawok/CommCare platform was designed and implemented to support any type of point-of-care health application and deliver the information needed at all levels of care. For example, TulaSalud will use Kawok to develop a Malaria specific application as part of the current project and roll these extensions into other Kawok applications in the future.

For more information, visit http://tula.org/tulasalud/technology/

Additional Resources:

Close and Personal TulaSalud mHealth Work Guatemala

Lessons learned from 5 years of experience in rural Guatemala

Links to photo albums on Picasa, Flickr or similar sites:
http://goo.gl/YfpVb

Initiative website:
www.tulasalud.org

Main Contact:

Main Contact: Ray Brunsting, CTO
Organization: TulaSalud
 

Additional Contacts:

Name and Title: Isabel Lobos, GM
Organization: TulaSalud
 

Name and Title: Diego Rios, Field Manager
Organization: Dimagi
 

For more information on this experience, please do not hesitate to contact us.

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