Implementation of a mobile health application used by community health workers in Ekurhuleni Health District
1
Public Health Medicine, University of the Witwatersrand, Johannesburg, South Africa
2
Public Health Unit, Ekurhuleni Health District, Germiston, South Africa
3
NHI Directorate, National Department of Health, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
The integration of digital technology into healthcare, which began in the early 2000s, has transformed healthcare service delivery and management. In South Africa, the Ekurhuleni Health District was selected in 2017 as a pilot site for the CommCare mobile health application, designed to support Community Health Workers (CHWs) and Outreach Team Leaders (OTLs) in ward-based primary healthcare outreach teams. Despite the potential of mobile health (mHealth) tools, challenges in adoption, scale-up, and sustainability remain. This study aimed to assess the the experiences of end-users and key stakeholders in the use and implementation of CommCare over a five-year period. A mixed-methods cross-sectional descriptive study was conducted in the Ekurhuleni Health District. Data collection included semi-structured interviews with seven key informants and an online self-administered questionnaire distributed to 1,197 CHWs and OTLs. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis using Atlas.ti. Of 1,197 end-users invited, 464 (39%) participated. Among respondents, 83% reported that CommCare met their expectations, 85% expressed overall satisfaction, and 95% recommended its adoption in other districts. However, 35% experienced challenges including poor connectivity, difficulties with data management, and device malfunctions. Training posed logistical challenges, particularly in securing suitable venues, and CHWs’ varied educational backgrounds required adaptive approaches such as peer pairing. Asset management was a recurrent concern, with frequent device losses leading to the enforcement of accountability measures. Key informants emphasized the effectiveness of the cascade training model and highlighted the need for dedicated technical teams, improved ICT infrastructure, multi-stakeholder engagement, and long-term planning. The implementation of CommCare in Ekurhuleni was largely successful, with high end-user satisfaction. Key findings underscore the importance of robust planning, investment in ICT infrastructure, and sustained technical support to ensure scalability and sustainability. Lessons from this evaluation provide valuable insights for future digital health initiatives in South Africa and beyond.
The integration of digital technology into healthcare, which began in the early 2000s, has transformed healthcare service delivery and management. In South Africa, the Ekurhuleni Health District was selected in 2017 as a pilot site for the CommCare mobile health application, designed to support Community Health Workers (CHWs) and Outreach Team Leaders (OTLs) in ward-based primary healthcare outreach teams. Despite the potential of mobile health (mHealth) tools, challenges in adoption, scale-up, and sustainability remain. This study aimed to assess the the experiences of end-users and key stakeholders in the use and implementation of CommCare over a five-year period. A mixed-methods cross-sectional descriptive study was conducted in the Ekurhuleni Health District. Data collection included semi-structured interviews with seven key informants and an online self-administered questionnaire distributed to 1,197 CHWs and OTLs. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis using Atlas.ti. Of 1,197 end-users invited, 464 (39%) participated. Among respondents, 83% reported that CommCare met their expectations, 85% expressed overall satisfaction, and 95% recommended its adoption in other districts. However, 35% experienced challenges including poor connectivity, difficulties with data management, and device malfunctions. Training posed logistical challenges, particularly in securing suitable venues, and CHWs’ varied educational backgrounds required adaptive approaches such as peer pairing. Asset management was a recurrent concern, with frequent device losses leading to the enforcement of accountability measures. Key informants emphasized the effectiveness of the cascade training model and highlighted the need for dedicated technical teams, improved ICT infrastructure, multi-stakeholder engagement, and long-term planning. The implementation of CommCare in Ekurhuleni was largely successful, with high end-user satisfaction. Key findings underscore the importance of robust planning, investment in ICT infrastructure, and sustained technical support to ensure scalability and sustainability. Lessons from this evaluation provide valuable insights for future digital health initiatives in South Africa and beyond.
| eISSN: | 2654-1459 |
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