Louis Anato is a Service Designer at Medic, based in Dakar, Senegal. He shares his experience working with the Ministère de la Santé et de l’Hygiène Publique in Togo to design SanteComTogo, a national community health information system.
People are at the core of Medic’s work.
Whether it’s designing and building an open-source product, researching innovations, deploying tools for scale, building our team closest to the users and communities we serve, or supporting our partners and our team to thrive.
That’s where our human-centered design process comes in.
What is human-centered design?
Human-centered design (HCD) is a collaborative practice that places the user and their context at the heart of the design process.
At Medic, it means listening to community health workers (CHWs) delivering care in their communities, and translating their experiences into technology that goes the extra mile for last-mile health delivery. Through a continuous process of discovery, ideation, prototyping, testing, and iteration, we anchor our work in real users’ needs, experiences and motivations.
The first stage of designing a health service is always special.
This begins with observing CHWs as they carry out their day-to-day activities to understand their needs, both expressed and unspoken. Immersing ourselves in their environment is extremely important to help us understand the context.
From that moment on, CHWs are involved in each step of the design, providing feedback and insights until the final stage when they are invited to test the service.
Community healthcare in Togo
Over the last few years, the Government of Togo has been rolling out a strategy to strengthen the national health system, with a focus on Information and Communication Technologies (ICT).
The government is focused on community care, and it’s against this backdrop that we found ourselves designing a system to support existing efforts to upskill and professionalize community health workers – known as agents de santé communautaires (ASCs) and community relays (RCom).
In September 2023, the Ministère de la Santé et de l’Hygiène Publique Togo (MoH) selected Medic to design SanteComTogo, a national electronic Community Health Information System (eCHIS) with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Meeting health needs in Togo
Every country’s context is different. In Togo, we considered the specific customs and traditions of the population as well as the awareness, commitment, and expectations of all involved – the ASCs (including RCom), MOH, and even the public.
We also accounted for the specific needs of women and children. According to World Centric and Integrate Health, 368 women die in the country for every 100,000 live births, while nearly one in 10 children will not make it to their fifth birthday. This is often caused by diseases that are easily treatable by ASCs, such as malaria, diarrhea, and pneumonia.
Maternal health is critical in Togo, and it is vital that every woman, in even the most remote areas, has access to the services she needs.
Digitizing community-based care
Before SanteComTogo, health service delivery and other care protocols were carried out manually. Inventory of medicines and health kits were counted and written on sheets of paper before being sent to the health facility for aggregation – often by physically walking to the facility.
This manual and paper-based accounting understandably led to inaccuracies, misunderstandings, and frequent and sudden stockouts.
SanteComTogo digitized and automated inventory tracking, allowing CHW managers to track health commodities in near real-time, prevent shortages, and ensure that medication is ready at the facility for ASCs when they go to re-stock.
We also realized that the ASCs had different levels of health worker training and tenure, meaning that the detection and treatment of certain illnesses left a margin of error.
SanteComTogo is designed with evidence-based, decision-making aids and care guides, including workflows to help health workers quickly detect and treat certain diseases and reduce error rates. The app will also include in-app training modules to deliver refresher training to ASCs.
Making sure no one is left behind
A major challenge in many last-mile health settings is knowing the exact number of patients in each village. This is critical during disease outbreaks when public health organizations need to quickly notify everyone at risk of infection to stop the spread.
SanteComTogo makes it easy to register every member of the household and therefore track population and health trends in each village. This will be invaluable if and when the next epidemic arrives.
A second challenge identified by ASCs was monitoring pregnant women. ASCs did not have automated tools to support reminders or monitoring charts – leaving only handwritten notes and their memory to guide them.
Now, SanteComTogo helps ASCs to keep track of patients more systematically, with automation to remind them of any necessary follow-ups, and proactively identify and intervene on health concerns that could threaten the life of the mother and child.
While an app alone cannot save lives, it can enable more accurate, timely, and equitable care delivery. No one should have to die bringing life into the world. Every child should have access to the immunizations they need. SanteComTogo helps ensure already marginalized community members do not fall through the cracks.
Human-centered design: the gold standard
The human-centered design process takes time, empathy, and many iterations. It must consider the effect of culture, political and economic environments, gender, technology, infrastructure, connectivity, access to healthcare, and other factors that may impact individual users’ access to, and use of, the technology.
However, when I saw ASCs download and use an app that they helped create, I couldn’t imagine using any other approach.
While SanteComTogo is only a few months old, ASCs have already told us how important the app is to them. The Ministry of Health launched the program in one region in March 2024, supporting 1,328 ASCs. As the app scales nationally, the goal is to provide a single program for community-based interventions, with rich and reliable data to manage community health and help advance universal health coverage.
As the design project wrapped up, we felt such a sense of accomplishment and a desire to do even more for these health workers. They give so much to their work and are not nearly talked about enough on the global stage.
Community health workers know what they need. So why wouldn’t we ask?
