Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
      • Call for Abstracts
      • The Responsive Feedback Approach
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
METHODOLOGY
Open Access

Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya

Sarah R. Andersson, Sarah Hassanen, Amos M. Momanyi, Danielson K. Onyango, Daniel K. Gatwechi, Mercy N. Lutukai, Karen O. Aura, Alex M. Mungai and Yasmin K. Chandani
Global Health: Science and Practice March 2021, 9(Supplement 1):S151-S167; https://doi.org/10.9745/GHSP-D-20-00378
Sarah R. Andersson
aMurdoch Children's Research Institute, Melbourne, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: srah75@gmail.com
Sarah Hassanen
bHuman-Centered Design Corner, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amos M. Momanyi
cinSupply Health Limited Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Danielson K. Onyango
cinSupply Health Limited Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Daniel K. Gatwechi
dMinistry of Health Republic of Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mercy N. Lutukai
cinSupply Health Limited Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen O. Aura
dMinistry of Health Republic of Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alex M. Mungai
dMinistry of Health Republic of Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yasmin K. Chandani
cinSupply Health Limited Kenya, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    S-Curve for Modern Contraceptive Prevalence Rate in Kenya, by Countya

    a From the 2014 Kenya Demographic and Health Survey.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Human-Centered Design Methodology

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Two Models for Logistics Data Flow from Community Health Volunteers to Supervisors

    Abbreviations: CHV, community health volunteer; USSD, unstructured supplementary service data.

  • FIGURE 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4

    Supply Chain Design Mapping Process Showing Flow of Data and Commodities From National to Community Level, Kenya

    Abbreviations: CHV, community health volunteer; KHIS, Kenya Health Information System.

Tables

  • Figures
    • View popup
    TABLE 1.

    Participants Interviewed for Research on Designing Supply Chain Solution for Community Health, 2 Counties in Kenya

    Samburu Central and East County (N=34), No.Wajir Central and WestCounty (N=27), No.
    County and subcounty health management team members712
    Health care workers including CHVs, CHV supervisors, health facility in-charges, nurses, and family planning coordinators810
    Project partners22
    Community members including WRA, matriarchs, husbands of WRAs, and community and religious leaders175
    • Abbreviations: CHV, community health volunteer; WRA, women of reproductive age.

    • View popup
    TABLE 2.

    Four Key Supply Chain Solutions Designed for Community Health, 2 Counties in Kenya

    Supply Chain SolutionOld SolutionProblems Addressed
    1. Paper-based stock record: redesigned to be highly visual, with circles for tallying, illustrations of the product and disease/conditionPaper-based stock record used in Siaya County, Kenya, that was in English with no illustrations
    • CHVs' low literacy levels

    • CHVs verbally reporting to supervisors

    • CHVs incorrectly recording data

    • Lack of standardized tool used by all communities to report on logistics data

    2. cStock smartphone application: Redesign of the application that includes simplified navigation, context appropriate language, audio prompts, and visual cuesOriginal cStock smartphone application designed for Siaya County, Kenya
    • CHVs' illiteracy and language barriers

    • CHVs' lack of understanding of supply chain terms and concepts

    • CHVs' login challenges/user friendliness

    3. CHV supervisor smartphone application: New cStock application for the CHV supervisors designed to be used to enter data for low literacy CHVs and to validate data plus allow for alternative supply arrangements during migrationInformal processes already in place
    • CHVs' with low tech capacity and low literacy levels had difficulty with data entry and data quality monitoring

    • Supervisors previously reporting on CHVs' behalf but in a nonsystemized way

    4. USSD reporting system: Hybrid USSD and SMS reporting structure to be used by CHVs to report on supply chain data via a feature phone, eventually reiterated to be only USSD reportingSMS only system used in Siaya County, Kenya
    • Some CHVs lacking smart phones

    • CHVs' challenges entering symbols for structured SMS option

    • CHVs' difficulty with case-sensitive SMS structure

    • USSD only option has a time-out feature

    • Abbreviations: CHV, community health volunteer; SMS, short message service; USSD, unstructured supplementary service data.

    • View popup
    TABLE 3.

    Usability Testing Scenarios for Original Supply Chain Tools and 4 New or Redesigned Supply Chain Solutions for Community Health, 2 Counties in Kenya

    Supply Chain SolutionsUsability Testing Scenarios
    Original ToolsNew or Redesigned Solutions
    Paper-based stock recordPrinted original form used in Siaya County, provided CHVs with mock data and asked to fill out the form with minimal instructionsPrinted Excel prototypes of redesigned form, provided CHVs with mock data and asked them to fill out the form with minimal instructions
    cStock smartphone applicationUploaded original cStock application onto researcher's phone. Provided CHVs with mock data and asked them to complete form with minimal instructionsDeveloped and uploaded clickable prototypes onto researcher's phone.
    Provided CHVs with mock data and asked them to complete form with minimal instructions
    CHV supervisor smartphone applicationNot applicableDeveloped and uploaded clickable prototypes onto researcher's phone. Provided CHV supervisors with mock data and asked them to complete form with minimal instructions
    USSD reporting systemProvided CHVs with mock data and job aids for SMS and asked them to follow instructions to send SMSProvided CHVs with paper prototypes for USSD and then moved to phone to enter an example SMS
    • Abbreviations: CHV, community health volunteer; SMS, short message service; USSD, unstructured supplementary service data.

    • View popup
    TABLE 4.

    Human-Centered Design Insights Generated From Research on Community Health Volunteer Use of Supply Chain Tools, 2 Counties in Kenya

    Relevance to DesignIllustrative Quotes
    Behavioral Insights
    Nomadic migration has dramatically declined due to the need for education, health, and demarcation of land.Migration was less of an issue than originally assumed and some simple design considerations were required for resupplying CHVs during migration.“People move in search of pastures and water. They move within the sub-county and rarely outside.” —County Health Management Team member, Wajir
    “Communities here no longer migrate, land is being partitioned and allocated to the community.” —CHV, Samburu
    In some communities, only men move with their animals, leaving their women and children behind.As women and children were left behind, CHVs will also remain.“I usually migrate and leave my wives in this home. When I migrate I take 1 wife …, I usually take the wife that doesn't have any young children. I haven't migrated for 5 years.” —Husband of women of reproductive age, Samburu
    Members from the community do visit nearby centers to trade and get basic supplies.In many situations, CHVs within these nomadic communities will have access to health facilities to collect supplies even if migrating.
    Mobile phones are the main mode of communication between the people that move and the ones that are left behind.The use of mobile phones is increasingly common and important for these communities.
    Supply Chain Insights
    Health facilities, which will be or are responsible for resupplying CHVs, have stock-outs and overstocks.Stock imbalances at facilities will result in stock imbalances with CHVs.“Sometimes they make a blind order when they are in town.” —Subcounty Pharmacist, Samburu
    Health facility staff do not routinely use data (demand data) to calculate supply requirements.Health facilities need to have access and include CHV data in calculating their requests.
    Insufficient county level budget allocations result in an undersupply of commodities to facilities.A current lack of data visibility does not support transparency and accountability.“There is too little allocation of funds to commodities, and this is demoralizing to health care workers” —Subcounty health management team member, Samburu
    Family planning products are supplied to the counties from the national medical stores even though demand is low, resulting in overstocking and expiries.When counties do not request commodities, it can result in national level programs pushing out commodities.“The uptake of FP is not high. We do not have supply chain issues for FP. We are generally overstocked rather than understocked” —Subcounty health management team member, Wajir
    Information System Insights
    Lack of standardized supply chain reporting forms has resulted in ad hoc processes.Standardized recording and reporting of supply chain data is critical for making data available to higher levels.“I record commodities like condoms in a notebook, but other reports I do are MOH 513, 514, and MOH 100.” —CHV, Samburu
    Service-related forms were in place but poorly used due to their complexity and unavailability.Reporting forms must be suitable for low literacy CHVs to ensure complete and timely reporting.“Some of the CHVs know how to read and write. The ones that don't know how come to me, and I do it for them (reporting) like their end of month report.” —CHV supervisor, Wajir
    Some county and subcounty level but very few facility-level staff have skills to visualize and analyze data.Facility staff need to be trained to use the data reported by CHVs to inform resupply and ensure CHVs get the commodities they need.
    Human Resource Insights
    CHVs have inadequate supervision due to lack of logistical support for supervisors to travel.The use of mobile phones is one way to overcome some of the challenges associated with providing one-on-one supervision.“I do supervision based on priority or challenges like availability of motorcycle or fuel. It's only my own initiative. I just support myself.” —CHV supervisor, Samburu
    Lack of support throughout the system demotivates CHVs, leading to high attrition.If CHVs are demotivated, it is essential to design a solution that makes their job easy and more rewarding. Also, take into consideration that if attrition is high, supply chain tools must be simple so new staff can be easily trained.“We started with 20 CHVs but only 2 of them are active.” —CHV, Wajir
    Service Delivery Infrastructure Insights
    Mobile clinics are designed to be located at strategic points such as the watering points; however, they are not operational or fully utilized due to inadequate funding and support.Mobile clinics are being strengthened and could possibly resupply CHVs in the future.“The nomadic clinics go to static settlements where there are no dispensaries. If they were designed differently, they would reach the nomads.” —Subcounty health management team member, Wajir
    Meetings are held regularly and with high turnout throughout the system in one county but not the other.Monthly meetings should be strengthened as part of the supply chain strategy to improve communication, data use, and local problem solving.“During the monthly CHV meeting we plan and schedule all activities of the month since it is a challenge to send SMS in between.” —CHV supervisor, Samburu
    Connectivity Insights
    Lack of connectivity and lack of power to charge phones hinders CHVs' communication among themselves and with their supervisor.The design must consider that CHVs will likely not have their phones charged and have network at all times. Therefore, use of phones should be limited as much as possible to one report per month.“Most [CHVs] have feature phones because of the battery life. Some use solar powered charges. They send 1 rep to town to charge all the phones.” —Partner, Wajir
    Few CHVs had smartphones issued by partners, but struggled to use them for anything other than voice communication with family and friends.Smartphone availability is increasing but capacity among CHVs to use them is still low. cStock should be designed for the future of smartphones.“There is no connectivity here in the hospital, not even Safaricom or Telkom. If you want Telkom you go for about 500 meters to access it, for Safaricom you have to go to that hill (about 1 KM).” — Health facility in-charge, Samburu
    “Although CHVs have smartphones we usually (and they prefer too) sending SMSs”—Health facility staff, Samburu
    • Abbreviations: CHV, community health volunteer; MOH, ministry of health; SMS, short message service.

    • View popup
    TABLE 5.

    Results of Usability Testing of 4 Prototype Supply Chain Solutions for Community Health, 2 Counties in Kenya

    Supply Chain SolutionPositive ResultsNegative ResultsChanges Made in Final Iteration
    Paper-based stock record (Paper prototypes)
    1. Most pictures worked well in assisting the CHV to identify the commodity and the symptoms it treats

    2. The circles used in counting the commodities helped those who could not write numbers

    3. When supply chain terms were explained in Swahili, it increased understanding of the action that CHVs needed to do in reporting

    4. If there was a color picture of the actual commodity, this helped CHVs to identify it

    1. Some CHVs had challenges identifying some icons (e.g., family planning method and the avoiding pregnancy icon)

    2. CHVs found it difficult to find where to enter their names

    3. CHVs were familiar with reporting data horizontally (rows) rather than vertically (columns)

    4. Users generally ignored the “units” column and counted based on what they were used to

    5. Some users found the shading of circles difficult, making it difficult to total and some recorded by using tally lines through each circle

    6. CHVs with low literacy could not identify different columns with supply chain terms

    7. Some CHVs entered their age as opposed to the year which the report is being submitted

    1. Changed icons that were confusing to users

    2. Moved CHV names and their details to the left of the document

    3. Changed Month, to Month of Report and Year of Report to clearly define purpose of cell

    4. Included clear visual distinction between commodities such as a gray bar between commodities and the alternate shading of horizontal rows

    5. Used horizontal rows instead of columns for each commodity

    6. Included colloquial or familiar terms for some commodities (e.g., dewormers for albendazole)

    7. Added Swahili translations in brackets under existing supply chain terminology to aid in the translation of often confusing supply chain terminology

    Redesigned cStock smartphone application (Paper then clickable prototypes)
    1. The audio was the most appreciated feature by the CHVs as it helped identify the commodities

    2. The icons allowed for CHVs to identify commodities based on look rather than text

    3. The CHVs were also able to identify icons that they had previously seen in the paper recording tool

    4. The back and next arrows were understood by some of the CHVs

    5. They were able to scroll down the months when selecting the period for reporting

    1. CHVs found some of the icons confusing because they were not representative of reality

    2. Some CHVs clicked the icons and not the buttons when selecting which reports to send

    3. Most CHVs had difficulty identifying the fields to enter their data

    4. Some users understood the arrows to mean “next,” but other users did not

    1. Changed the receiving and dispensing icons based on user feedback

    2. Added audio for most icons

    3. Changed the icon for audio from a speaker to a person speaking

    4. Changed commodity icons to reflect the commodities' actual look

    5. Changed icons to match the revised paper tool

    6. Included navigation arrows, as well as buttons with “next and back” to allow multiple paths to navigate the app

    CHV supervisor smartphone application (Paper then clickable prototype)
    1. Supervisors appreciated the prototype

    2. The user experience was easy, and they were able to generally follow it with ease

    3. The tech was easy to use, even at various levels of technology literacy

    1. Some supervisors were not able to relate how the dashboard related to the paper-based resupply worksheet

    2. The validation section of the app was confusing due to unclear wording

    3. Most CHVs found the section added for additional CHVs (CHVs that migrate into your area) confusing

    1. Made it clearer that resupply values were the total amounts received from the facility

    2. Changed column heading for the checkboxes in the validation page

    3. Relabeled additional CHV section in dashboard to articulate that those are CHVs who have migrated to the area

    Hybrid USSD and SMS reporting system (Paper prototype)
    1. A large number of the CHVs interviewed had a feature phone as their main phone

    1. This prototype was the most difficult for all CHVs, both literate and low literate

    2. CHVs were not able to switch from USSD to SMS. They entered data on the dial pad and not the SMS

    1. Needed to be redesigned to only USSD and significant tests were done to ascertain its usability in these communities

    • Abbreviations: CHV, community health volunteer; SMS, short message service; USSD, unstructured supplementary service data.

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 9 (Supplement 1)
Global Health: Science and Practice
Vol. 9, No. Supplement 1
March 15, 2021
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya
Sarah R. Andersson, Sarah Hassanen, Amos M. Momanyi, Danielson K. Onyango, Daniel K. Gatwechi, Mercy N. Lutukai, Karen O. Aura, Alex M. Mungai, Yasmin K. Chandani
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S151-S167; DOI: 10.9745/GHSP-D-20-00378

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya
Sarah R. Andersson, Sarah Hassanen, Amos M. Momanyi, Danielson K. Onyango, Daniel K. Gatwechi, Mercy N. Lutukai, Karen O. Aura, Alex M. Mungai, Yasmin K. Chandani
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S151-S167; DOI: 10.9745/GHSP-D-20-00378
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSION
    • Acknowledgments
    • Funding
    • Competing interests
    • Notes
    • REFERENCES
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples
  • Designing for Impact and Institutionalization: Applying Systems Thinking to Sustainable Postpartum Family Planning Approaches for First-Time Mothers in Bangladesh
  • Transitioning to Digital Systems: The Role of World Health Organization’s Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards
Show more METHODOLOGY

Similar Articles

Subjects

  • Cross-Cutting Topics
    • Digital Health
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire