Digitizing LHWs Record Keeping

This project aims to understand the prospects of ICT addressable problems, such as to carry heavy registers in the field and to fill one column on multifold pages in registers, of Lady Health Workers (LHWs) and the ways to acclimate them with technology.

The Challenge

Lady Health worker (LHWs) are the frontline workers who are trained to provide basic healthcare services to their community. The outreach of Lady Health workers (LHWs) is nearly 48,000 almost in every part of Punjab. Each LHW serves the population of approximately 1000 people and makes 10-15 households visits every day. They are accountable for maintaining comprehensive records by updating family records, daily dairy, treatment register and family planning register. LHWs act as indispensable team members for the effective delivery of key national intervention such as Polio Eradication Initiative (PEI). Challenge was to understand the daily work routine and tasks of LHWs and the amount of technology usage in their daily life and what are the possibilities of technological interventions to make their work routine easier. In order to understand the daily work routine and tasks of LHWs, the amount of technology usage in their daily life and possibilities of technological interventions to make their work routine easier, three rounds of semi-structured interviews with same cohort 10 LHWs and supervisors of LHWs. Each session was of 4 hours duration with 3 RAs and 5 LHWs per group.

Our Solution

While preparing for the solution we found out that 90% of LHWs have 10th grade education, 30% had over ten years of experience, every one of them had personally owned feature phone and they never used internet browser as well. Moreover, we also found out that they have to carry heavy registers in field and it is very hard for them to fill one column on multifold pages in registers. We proposed a smartphone or tablet based e-register that is easy to carry door to door, easy to enter details and representation of only relevant data in a user friendly way. In our proposed solution we removed all the duplicate entries and hided the data if it is not required at the moment and it had drop down menus as well as real time calculation of data entries. When we discussed this solution with LHWs, their reaction was not so responsive towards e-register because, they said, it is very hard for them to imagine themselves using a software solution rather than paper and they did not seem interested in that. After proposing the solution we decided to take it to the field, for this purpose, initially we brought only mock-ups. We decided to make mock-ups more appealing and real to LHWs in order to invite the LHWs into at least interacts with the mock-ups. We made the mock-ups with colorful sticky notes, dummy phones with foam, separate screens on individual stock paper and basic android application for LHWs to familiarize them with a real application feel. Before having their hands on experience directly on app, first we introduced them with colorful mock-ups and asked them to perform their task and they were able to do it promptly. After the training on the mock-ups it was easy for them to use the mobile phone app. So it was proved that colorful mock-ups was a helpful training tool. Through all the 3 rounds of interviews revealed that existing LHWs in semi-urban areas of Pakistan have limited interaction with technology in their daily life, which leads them to fear the introduction of technology in their work life. LHWs associate sentimental value to paper registers and it is almost impossible for them to imagine lives without these paper registers. Government implemented the app without consulting them or giving them proper training. So according to LHWs, even financial incentives could not encourage them to use the app, given the poor usability of app.