Of all the perils that faced 19th century settlers in the American West, illness was the most feared. In the face of killer diseases such as cholera, smallpox and typhoid, there was little access to health care. Even if a settlement had a doctor, there was a good chance he had few qualifications. As late as 1876, most “doctors” had never even seen a medical school, or at best had spent a few months of required college study to receive a medical degree. Nevertheless, they and their “little black bags” packed with equipment and treatments became a crucial part of settler life. In some cases these health workers traveled 50 to 60 miles a day through all weathers to treat patients and save countless lives.
Fast forward to 2016. There are millions of people around the globe who may never see a doctor in their lifetime. In Tanzania, for example, there are around three physicians per 100,000 people. This is why governments are turning to community health workers. Helena is one such health worker in rural Tanzania who each day visits three homes that have no other access to health care. It takes her three hours to travel between each one.
“Without me,” she said, “they wouldn’t have any other support. Many children I visit are underweight and have poor health. Without my visits a child like that might lose their life.”
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Learning from the past
Compared to those 19th century doctors, Helena has even more limited training. On most days, she makes do with the knowledge and what few materials she has to promote behavior change, offer advice and refer patients to the local clinic.
Helena represents hundreds of thousands of mainly voluntary community health workers doing their best to improve life for children across a range of fragile and low-income countries worldwide. Yet this “army of the willing” are filling the gaps in national health systems around the world and providing much-needed services to families below the poverty line. Sadly, too many ministry of health strategies for expanding community health worker numbers are still missing the modern-day “black bags” that give them a crucial advantage — a mobile phone.
The new ‘black bags’
Mobile phones provide an incredible opportunity to vastly improve the quantity, quality and services community health workers can provide, particularly in countries with very limited resources for health worker training and supervision. More like Mary Poppins’ bottomless carpet bag than a doctor’s bag, a mobile phone provides a health worker with seemingly endless selection of tools. With a mobile phone and the right software, Helena can receive on-going refresher training; she has access to her supervisor; she can access specific protocols to guide her through a series of questions; provide additional information for her and her clients; collect and report valuable information about her clients and the services she renders; and make referrals receiving immediate feedback from the health facility about her clients when they arrive. What’s more, these phones can be used to provide much-needed incentives and payments to these front-line health workers, making sure that they can provide for their families and earn a viable income for themselves, motivating them to learn more and advance in their certifications and skills.
Given the obvious solution that this technology represents, why aren’t more ministries of health including this critical tool as part of their comprehensive community health worker programs?
Not all are convinced of the benefit, seeing phones as an expensive luxury. There is a need to share evidence of the benefits and reduction in overall costs, making sure ministers and donors alike know the real and measurable impacts of these phones.
World Vision is using simple, evidence-based health and nutrition intervention packages combined with mobile phones to deliver critical benefits for women and children during the first 1,000 days of life. Timed and targeted counseling — or ttC — is a proven approach for helping health workers reach pregnant mothers, newborns and young children under the age of two, promoting behavior change and increased access to health care services. Combining ttC with a phone yields even better results and is enabling front-line health workers to collect real-time data on the status of pregnant mothers, newborns and young children.
A logical investment
There is an estimated global shortage of around 7 million doctors, nurses and midwives and the cost to fill that gap is staggering. In contrast, equipping existing community health workers with a mobile phone and software to amplify their impact costs a very modest amount. It’s even cheaper when they already have a mobile phone. The economic and societal arguments are obvious, yet too few are advocating for more investment to properly equip all front-line health workers.
It would have been unthinkable for those itinerant doctors to arrive at American homes without their black bags; don’t the poorest communities of the world deserve these same lifesaving benefits?
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