Sustainable communication for family health teams – connecting Community Health Workers for greater care.
About the client
Quintal is my BA Thesis from 2016, where I worked for 4 months in research, concept development, prototyping, coding and testing. For this project, I learned how to work with NodeJS and MongoDB from scratch to make a functional prototype.
Quintal is a web-based platform to promote communication between Primary Health Care Workers. Each person has a yard (quintal) with their plants (patients).
To make these plants grow beautiful they need each other’s help: they will only blossom after being watered by another health worker.
The collaboration aspect in the platform makes sure the workers are in daily contact with each other’s patients, so they can assess quickly the situation and help those in need.
Primary health care saves lives
“Primary health care is the foundation of a comprehensive national health system and that the health system must be organized to support primary health care and make it effective”
(World Health Organization, 1978)
We can distinguish the levels of health care through the need for technological resources. While in the primary level a doctor can treat patients with orientations and advising, on the third level there is a need for machines and high-tech equipment to treat advanced diseases. It means that unavoidably, users of the second and third levels will return to the primary level. Because of that, instead of a fragmented system, specialists propose a network where all the levels talk to each other for a better health service.
From Brazil to India and UK, Primary Health Care is an essential piece of a health system of a country, accounting, in some cases, for over 80% of all interactions between patients and national health systems.
⬤ 01. Challenge
Design a solution for communication within Primary Health Care teams
This project aimed to understand the context in which these workers are inserted and design a technological artifact for them.
During the process I defined the challenge to increase the quality of communication between them and, finally, improving the quality of the health services offered to the public.
⬤ 02. Research
Unveiling the importance of communication
Field research was 3 weeks long, took place in two health centers and two patients homes in the northeast of Brazil. I had the opportunity to visit the patients houses with the Community Health Workers and Doctor and saw how they perform their work.
I interviewed both healthcare professionals and patients to understand more of the context, as well as ran, later, a workshop to deepen the understanding of the communication topic.
Among the people I did research with there were Community Health Workers, Doctors, Nurses and Dentists.
1. Lack of professional communication tools
2. Information is not accessible
3. Spontaneous demands for communication
During the day many demands appear, such as patients that want to be scheduled for the same day, people with doubts and emergencies. For these cases, the key professional in situation needs to be contacted, but that sometimes doesn’t happen due to many reasons: work overload won’t allow communication, forgetfulness, the key professional is busy, etc.
Focusing on Community Health Workers
During the research, the figure of the Community Health Worker stood out as the important link between the Health System and the community. I decided to focus on them because of their importance in the functioning of the system.
“Perhaps the most important developmental or promotional role of the Community Health Worker is to act as a bridge between the community and the formal health services in all aspects of health development… the bridging activities of CHWs may provide opportunities to increase both the effectiveness of curative and preventive services […]”
The Community Health Worker's Routine
1. Fill in Home and Individual Registers
Every house and individual in a family needs to be registered with detailed data.
2. Visitation planning
For each house the agent goes to, she needs to check the health of every individual. This planning is made by themselves, usually written in a notebook.
3. Visiting patients and filling Visitation Form
They visit the patients every cycle. The cycle is shorter if that patient is sick of bedridden. Every visit needs to be registered in a form.
4. Request scheduling of Home Visits and Sample Collection for exams
Visits with physicians and nurses are scheduled to the bedridden patients’. Because of that, their agenda needs to match.
5. Deliver results of examinations / referrals to bedridden patients
After any appointment or exam, they usually deliver the results in person to check the patient’s condition.
6. Entry visitation data and deliver papers
All CHW need to enter visitation data in the E-SUS web system and submit visitation papers to the Secretary of Health of the municipality. It’s the step they dislike the most, so the data and papers accumulate to the last week.
⬤ 03. Problem Definition
How might we leverage communication within Primary Health Care teams in a sustainable and engaging way?
Research unearthed a need for efficient communication within teams. But a solution will not have acceptance unless it is adapted to the users workflow and culture.
⬤ 04. Ideation & Prototyping
Research has shown that ineffective communication is one of the keys for their work. The solution aims to promote work-related communication in a way that is easy to understand and transmit.
Work well on old smartphones
Community Health Workers’ salary range is from low to average. It is common for them to use low-tier phones.
Low data usage (3G)
Concept 1: Gianbot – Chatbot assistant
Gian is a chatbot that helps the team managing schedules and patient records. He facilitates the contact between CHW and physicians/nurses for appointment management and patients list. He’s based on Rede Globo‘s actor Reinaldo Gianecchini, who once played a butler in an advertisement.
- Organization of home visits into schedules (day, week)
- Report at the end of the day (or week) of the houses that remain to be visited and tells the number of houses that have been visited
- “Share” a visited patient with the doctor/nurse to arrange them a visit
Shift and Event Management
- Shows it to everyone and remembers who is scheduled to work at reception on what day and time;
- Remembers events that will take place at the station (meetings, actions, community groups)
Concept 2: Quintal – Collaborative gardens
Every worker has a Quintal (“Yard”), where their plants are their patients. To make and maintain a beautiful quintal, they need each other’s help because watering your own plant is not allowed and you need your friend’s help.
- Each patient/family on the CHW agenda is a seed to be collected.
- By visiting all the patients on your daily or weekly schedule you have enough seeds to make your area of the valley flourish.
- Mark that you have already registered the forms in E-SUS for your flowers to bloom;
- Only the other team members can water your flowers: They need to visit your garden and water your plants so that they continue to grow;
- Send a flower to be taken care of by the doctor (= request a day for an appointment with the doctor)
Technologies used: HTML5, CSS3, NodeJS, MongoDB
The preference for Quintal over the bot was clear when the Community Health Workers highlighted the visuals of the gardens.
While Gianbot’s interface is mainly through text (keywords combination), Quintal would offer much more appealing features.
The emotional aspect here was visible, and that would come to battle the lack of engagement due to bad work conditions in the Primary Health Care context of Brazilian communities.