Including the Voice of Care Recipients in Community Health Feedback Loops in Rural Kenya

Community health programs in low-resource settings (like rural Kenya) aim to provide essential health services to vulnerable populations. However, to date, there has been limited research that explores the design of mechanisms that enable care recipients to provide feedback regarding their satisfaction with the services they receive. Such feedback has the potential to increase the motivation of community health workers (CHWs), enhance training procedures, detect fraudulent behavior, and inform key performance indicators for health programs. Our paper explores the design and deployment of a USSD-based system that allows anyone who possesses a basic mobile phone to provide feedback regarding the health services and quality of care they received from a CHW or during a hospital visit. Our system was designed through iterative fieldwork in rural Kenya that engaged with multiple stakeholder groups, including care recipients, CHWs, and high-level decision makers. After designing and testing the system, we deployed it for seven weeks in Siaya, Kenya, collecting both quantitative system usage data and qualitative data from six focus groups with 42 participants. Findings from our deployment show that 168 care recipients engaged with the system, submitting 495 reports via USSD. We discuss the broader factors impacting deployment, including the feasibility of USSD, actionability of feedback, scalability, and sustainability. Taken together, our findings suggest that USSD is a promising approach for enabling care recipients to submit feedback in a way that balances privacy, equity, and sustainability.