Building capacity of community health workers remotely

Rehana Khatun, 34, has been delivering health education and primary health services for more than 12 years, to her community in Dhaka’s Mugda area. She is one of 4,500 BRAC’s shasthya kormis – community health workers – who reach out to as many as 20,000 people in their respective communities.

Shasthya kormis are an integral tier of the world’s largest non-governmental pool of community health workers. Armed with basic training, an Android tablet and primary non-communicable disease screening devices, they make regular visits to households and link them to institutional care through government hospitals in their locality.

Read more: COVID-19: Update from Asif Saleh (16 May 2020)

As COVID-19 tightens its grip on Bangladesh, resulting in limited access to facility-based healthcare, people need Rehana’s support now more than ever. “Rumours are on the rise,” she notes. She has been actively raising risk awareness among her community.

Rehana is having to adapt to new protocols frequently, in order to minimise the spread of COVID-19. She is quickly learning new information and methods to provide support. However, as lockdown continues across Bangladesh, Rehana can no longer rely on in-person sessions in group settings as she once had.

To ensure learning continues during the pandemic for thousands of shasthya kormis like Rehana, BRAC Health, Nutrition, and Population Programme has been developing Dishari, an internally funded distant learning platform to remotely train shasthya kormis on:

● Raising risk awareness and addressing misinformation regarding COVID-19 in the community
● Emphasising on preventive measures
● Safe practices for engaging with patients amid COVID-19 outbreak
● Continuity of care for non-COVID-19 related health needs (ie, maternal and child health)

The lightweight, android-based app has been designed with a simple interface in Bangla, and requires minimal typing. The courses consist of images and short videos, while exams consist of multiple choice questions.

One component integrated in the system assesses the knowledge level of each individual shasthya kormi and guides them accordingly. Another component, a supervisor dashboard, receives aggregated data on users’ learning performances, and pushes out important messages.

Dishari’s pilot

The first version of the app was piloted in two locations: Dhaka, covering a pool of shasthya kormis in an urban setting, and Khulna, covering a rural setting.

In-office training was conducted in the branch offices, with attendees and trainers maintaining strict social distancing and safety protocols. The area managers presided over the training sessions and installed the app into each of the participants’ tablets.

The participants became acquainted with the app with the help of the area manager, who walked them through a course, after which the class completed an exam on that particular topic together. They revisited the process of solving problems in the app, and then completed another set of courses and exams on their own.

After the in-office training session, the users gave feedback on the initial version of the application. Shasthya kormis were instructed to complete another round of training from home, which came with a deadline enforced within the app. Dishari is available in the Google Play store.

Read more: Manoshi: Ensuring maternal care in a pandemic

The pilot yielded promising results among participating shasthya kormis. A high percentage of knowledge retention was shown among the participants. Rehana also participated in this pilot, and this is what she had to say:

“Having a deeper understanding of COVID-19 and learning what to do during this time is helping me feel like I am making an impact. I am glad that I can be of help to people without leaving my home and putting others at risk.”

Training through Dishari can be easily customised with new content. Lessons learned from the application deployment will also help decide whether Dishari would also be a good fit for other health cadres.

BRAC’s health programme is now looking to scale the use of this tool among its entire pool of shasthya kormis, who reach nearly 110 million people across Bangladesh.

Monzur Morshed Patwary is Senior Manager at BRAC. Luba Khalili is Deputy Manager, BRAC Communications.