Improving community health worker performance through automated SMS

Community health workers (CHWs) have been shown to be an effective and powerful intervention for improving community health. Routine visits, for example, can lower maternal and neonatal mortality rates. Despite these benefits, many challenges, including supervision and support, make CHW programs difficult to maintain. An increasing number of mHealth projects are providing CHWs with mobile phones to support their work, which opens up opportunities for real-time supervision of the program. Taking advantage of this potential, we evaluated the impact of SMS reminders to improve the promptness of routine CHW visits, first in a pilot study in Dodoma, Tanzania, followed by two larger studies with 87 CHWs in Dar es Salaam, Tanzania. The first Dar es Salaam study evaluated an escalating reminder system that sent SMS reminders directly to the CHW before notifying the CHW's supervisor after several overdue days. The reminders resulted in an 86% reduction in the average number of days a CHW's clients were overdue (9.7 to 1.4 days), with only a small number of cases ever escalating to the supervisor. However, when the step of escalating to the supervisor was removed in the second study, CHW performance significantly decreased.