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.

⬤ Introduction

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)

Primary health care is the level of the system that is closer to the users, and it does that through Health Centers, Community Agents and actions in communities and schools.
There is a misunderstanding that the word “primary” means the importance of the level.
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.

Primary health care is the level of the system that is closer to the users, and it does that through Health Centers, Community Agents and actions in communities and schools.
A worldwide problem in health care: how can we integrate the health system of our country? A proposal is Polyarchical Networks, where Primary Health Care is the first point of contact of the patient with the health system.
⬤ 01. Challenge

Design a solution for communication within Primary Health Care teams

Family Health Teams are responsible for the health of a particular population, having as their main actress for the field work the figure of the Community Health Agent. They use tools of general use to supply the lack of professional communication resources.

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.

The workflow of Community Healthcare Agents is full of paper forms with endless questions.
⬤ 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.

Inside a Primary Health Care center in Brazil.
A collection of quotes and observations from the interviews with health workers (pink) and patients (green).
Key Findings
Since there are no official tools, they invent their own, such as this notebook with patient data labeled with codes.

1. Lack of professional communication tools

To meet de demand for work communication, these professionals use tools such as WhatsApp to exchange information about patients and schedule. Calls are made when there is an urgency.
Everyday, the physician makes a written-copy of the official patients list for the day before handing it in to the recepcionist.

2. Information is not accessible

The lack of resources and tools make information storage a problem. In one of the health centers the patients data is inside an archive that is at the physician’s room – it means that whenever other professionals need these infos, they will need to interrupt any medical appointment happening. Another example is for the patients list: everyday a transcript is made in a piece of paper.
During a workshop with the healthcare professionals, they exchanged information about routine and common problems. Miscommunication in spontaneous demands was a critical point.

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.

Community Health Workers visit the houses of people in communities in Brazil. They are responsible for updating the health status of hundreds of people to the municipality. Physicians and nurses cannot come into the community without being accompanied by a CHW.

“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 […]”

Kahssay H, Taylor M, Berman P (1998). Community health workers: the way forward. Geneva, World Health Organization

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

Promote communication

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)

Their data is pre-paid and mainly needed because of WhatsApp and Facebook. There is no hope about having the municipality paying for it.

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.


Visit Management

  • 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)
Technologies used: PHP, Telegram

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.

Features: Visit Management:
  • 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.
Registration in the Government Database = Planting Seeds:
  • 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;
Make an appointment for a patient (plant):
  • 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

Tests results

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.

A Community Health Worker trying out a prototype of Quintal

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