title: Value of a mobile information system to improve quality of care by community health workers.
abstract: BACKGROUND
  We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC's), where the penetration rate approaches 100%. In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.
  
  
  METHODS
  This paper is a descriptive one, drawing lessons from two Randomised Controlled Trials (RCT's), outlining how a mobile phone information system can be utilized to enhance the quality of health interventions. We organized our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilized by CHWs and a web-based interface utilized by CHW supervisors. Computerized algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs.
  
  
  RESULTS
  CHWs used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing, and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field.
  
  
  CONCLUSIONS
  Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realized health gains for communities is yet to be tested.
authors.affiliation: Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: Global Center for Children and Families, University of California at Los Angeles.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.affiliation: Health Systems Research Unit, Medical Research Council, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.affiliation: Global Center for Children and Families, University of California at Los Angeles.
authors.forename: Dallas
authors.initials: D
authors.lastname: Swendeman
authors.affiliation: Robert Wood Johnson Health and Society Scholars Program, Harvard University ; Center for Global Health, Massachusetts General Hospital.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.affiliation: Health Systems Research Unit, Medical Research Council, South Africa.
authors.forename: Petrida
authors.initials: P
authors.lastname: Ijumba
authors.affiliation: Philani Nutrition and Development Project, South Africa.
authors.forename: Ingrid
authors.initials: I
authors.lastname: le Roux
authors.affiliation: Health Systems Research Unit, Medical Research Council, South Africa ; School of Public Health, University of the Western Cape, South Africa.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Jackie
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Clyral, South Africa.
authors.forename: Andi
authors.initials: A
authors.lastname: Friedman
authors.affiliation: Maromi Health Research, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Colvin
authors.affiliation: Chief of Health, UNICEF, New York.
authors.forename: Mickey
authors.initials: M
authors.lastname: Chopra
keywords: Mobile phones; community health workers; management; scale up; supervision