Improving Motivation Among Community Health Workers in Ghana

A deliberate attempt was made to seek input from the unconventional voices usually excluded from health systems planning in this context. All in all, over 110 people were involved in the research, design, testing and build phases, with 60 community health nurses, 12 nurse supervisors, 18 pregnant women and nursing mothers, as well as more than 20 public health, program management and design thinking stakeholders from partner organisations. The nurses ventured away from the project's initial label of them as 'beneficiaries' and beyond the team's label of them as 'end-users' - instead, they became 'designers' by leveraging what they know and applying it to change their existing situation into a more preferred one

Six modules were developed on a smart phone application called “CHN on the Go”: 1. Learning Center - Global health distance-learning education 2. Point-of-Care - Decision-support tools to provide care and counseling 3. Peer Connect - A peer-to-peer communications platform 4. Planner - A calendar tool to help nurses plan and record the various activities they perform 5. Staying Well: A personal wellness tool to address stress and provide inspirational material. 6. Achievements - A tracking tool to set targets related to their day-to-day work The end result was a useful and usable suite of mobile applications built upon an iterative cycle of learnings from taking a design thinking approach

It was not just about involving the end-users it was also about bringing the health system leaders, project planners, technologists, public health experts and others together. Combining this group with frontline nurses and supervisors brought those affected into the design process to co-discover, co-create and co-produce solutions with a systems approach. It is therefore not only about delivering programs to better fit the needs of the beneficiaries, bringing people along, to define their own problems and design their own solutions, this is what ensures ownership and long term sustainability.

Allocating the time and space to characterize the user perspective increases the weight placed on that by key decision makers during critical milestones. Taking a 'human-centred' approach ensured a rich and nuanced understanding of the nurses and supervisors context. For the project team, this meant grounding their decisions in the words, values, experiences and ideas of the end-users themselves - throughout the project. However unintentional, prior projects delivering m-health solutions in the region have had limited beneficiary participation in defining needs or solutions early enough to influence the decisions affecting them. This project shifted the focus to be outward looking rather than inward looking

Complications during and immediately following delivery, and premature births are the predominant causes of early childhood mortality and maternal deaths in Ghana. With mobile network coverage continually expanding and costs for airtime and devices steadily decreasing, mobile devices are viewed as playing an increasingly important role as a support tool in the health system, particularly at the frontline level. Through the use of the mobile modules, the nurses have reported the following benefits: - Gaining knowledge and confidence - Increased efficiency, transparency and accountability - Improved supervisory, client and peer-to-peer relationships This has contributed to a stronger health system.