High-Impact Growth – Episode Summary

“Improving Health Worker Jobs to Improve Outcomes with CommCare Connect”

Podcast: High-Impact Growth
Host: Dimagi (Co-hosts: Amie Vaccaro, Jonathan Jackson)
Release Date: September 13, 2024

Brief Overview

This episode is dedicated to unpacking CommCare Connect, Dimagi’s ambitious initiative to radically improve the jobs of Community Health Workers (CHWs) as a pathway toward better health outcomes. The roundtable assembles key members of the CommCare Connect team—Mercy Simi, Sarvesh Tiwari, and Divya Sivaramakrishnan—alongside host Jonathan Jackson, to reflect on two years of experimentation, early wins, unexpected challenges, and the transformative potential of giving agency (and compensation) directly to the frontline workforce.

Main Theme & Purpose

• Highlight Dimagi’s big bet: building a scalable, high-impact digital platform for CHWs—CommCare Connect—that empowers workers to upskill, deliver more services, and get paid for their contributions through an opt-in model.
• Explore barriers and opportunities for scaling and systematizing better CHW jobs as a major lever for global health impact.
• Share honest learnings from pilots, partnerships, and the ongoing evolution of funding and organizational models that support direct-to-frontline improvements.

Key Discussion Points & Insights

1. The Problem CommCare Connect Is Trying to Solve

• CHWs are central yet underserved: Despite evidence that CHWs have enormous impact (return on investment up to 11:1), their jobs are often stressful, underpaid, and lack support or scalable supervision. [05:33]

  “Community health workers have been shown ... to have huge potential impact both on health outcomes and huge return on financial returns up to 10 to 1 ... maybe 11 to 1 on the returns.” —Jonathan Jackson [05:33]

• Limited focus on making CHW jobs better: Few industry solutions tackle job quality, skill-building, and agency for CHWs in addition to pay.
• Dimagi’s strategic shift: Post-COVID, Dimagi’s top priority became “improving outcomes by improving jobs.”

2. CommCare Connect’s Four Pillars (“LDVP”)

• Learn: Digital upskilling and certification for new intervention areas.
• Deliver: Flexible, opt-in service delivery by CHWs in their communities.
• Verify: Digital verification of completed work ensures quality and accountability.
• Pay: Direct compensation for services delivered and verified. Target: 90% of funds to frontline workers, only 10% to platform/admin. [07:30]

  “If we can connect Learn, Deliver, Verify and pay at scale, this creates a transformative opportunity for CHWs to opt in to choose the additional work they want to do in their community and get paid a strong livable wage for doing so.” —Jonathan Jackson [08:44]

3. Early Reactions from the Team

• Mercy: Excitement about professionalizing and upskilling CHWs, especially women with limited formal education in Kenya. Skepticism about payment logistics—but positive so far. [13:33]

  “What appealed to me about CommCare Connect... [was that] it allows them to professionalize that stepping in and gets paid for it, and also it helps upskill them... It sets them up for upward mobility within their health system and they don’t have to rely on Ministry of Health to do it for them.” —Mercy Simi [13:33]

• Sarvesh: Excited but cautious; digital learning and verification are tough pain points from prior projects. Especially interested in direct-to-frontline approach, not just organization-mediated work. [16:14]
• Divya: Initially skeptical (“what’s new?”) but saw value in empowering locally led organizations (LLOs), channeling funds to local economies, and innovating around cost, scalability, and impact measurement. [18:25]

4. Traction & Early Evidence: Do CHWs Actually Want More Work for Pay?

• Strong desire to opt in: Pilots in Malawi showed high (84%) uptake of new interventions delivered through CommCare Connect.

  “In one of the pilots... 84% of the frontline workers successfully completed a full learn, deliver, verify pay cycle on their own.” —Sarvesh Tiwari [27:00]

• Peer-to-peer learning: CHWs organically helped each other navigate challenging new tests and skills—evidence of community investment.
• Community demand: Households not targeted by a pilot intervention actively requested CHW visits, indicating community-wide perceived value. [29:58]

5. How the Model Works at Organizational Scale

• Organization engagement: Open RFPs have drawn significant interest from locally led organizations—over 40 letters of interest in Nigeria alone for the child health campaign. [38:28]
• Replication & scalability: Standardized digital onboarding, training, and verification functions allow organizations to cover large numbers of beneficiaries and monitor quality better than resource-heavy, analog processes.

6. Navigating Funder Dynamics & New Funding Models

• Rethinking traditional funding: CommCare Connect proposes a shift from multi-year, infrastructure-heavy grants to “pay-for-verified-outcome” payments: funders pay only for provable, real work delivered in the field.

  "If we can get to a mode where we're only paying for verified delivery and we've empowered the CHW to opt in, this is like transformatively cheaper because we're cutting out so much current overhead..." —Jonathan Jackson [39:55]

• Sector transformation required: Not all funders immediately buy into job improvement as an end in itself; patience, evidence, and demonstration are needed to encourage broader adoption.
• Alignment with Localization Movement: CommCare Connect’s open platform and direct-to-frontline methods reduce administrative burden (no more deep, inaccessible RFPs), matching global trends toward local empowerment. [45:20]

7. Integrating Complex Interventions

• Beyond simple tasks: The platform supports higher-order interventions (e.g., Early Childhood Development), requiring multiple, timed household visits and nuanced content delivery. Validation via household feedback confirms it’s working, though challenges remain as complexity increases. [47:46]

  "...even with these kind of complex interventions, frontline workers are able to repeatedly go to the same household, they are able to deliver these concepts. And we have verified this also by calling the households..." —Sarvesh Tiwari [49:37]

8. Keeping CHWs at the Center (Opt-In Principle)

• True feedback loops: Unlike top-down programs, CHWs and organizations are only using CommCare Connect if it adds real value, evidenced by actual opt-in and continued usage.

  “The signal that we’ve succeeded in creating something of value to the CHW is going to be that they opted in and are choosing to deliver the service over time because it’s worth their time.” —Jonathan Jackson [50:51]

• Program selection: CommCare Connect focuses on complementing, not duplicating, existing Ministry of Health programs; new interventions are chosen to add value without replacing current CHW roles. [56:18]

9. How Listeners Can Get Involved

• Organizations: If you use CommCare, reach out to participate in pilots or new intervention areas. [58:14]
• Partners and researchers: Opportunities to test the LDVP approach in new geographies and contribute to ongoing research and evidence-building. [59:17]

  “If you're listening and you're a Comcare partner organization ... it would be great to get you on board to test out the intervention areas...” —Mercy Simi [58:14]
  "...if you are a partner that would like to test out the LDVP approach, we would be very keen to talk to you..." —Sarvesh Tiwari [58:38]

Notable Quotes & Moments

• “This is about making community health worker jobs better, as we see that as an essential component to improving health outcomes around the world.” —Amie Vaccaro [00:55]
• “So much of digital health is, well, aspirationally, three years from now this great thing will be true... With CommCare Connect, it's gotta be better right now or you're not gonna use it because you're not being forced to use it. It's gotta be opt in.” —Jonathan Jackson [50:51]
• “The response, not only by our locally led organizations, by the chw, but by the local government and national government has been exciting.” —Jonathan Jackson [44:49]
• “The thing I appreciate most about what I heard today is that this whole concept of ComCare Connect hinges on value creation to each player. It is truly opt in at every level.” —Amie Vaccaro [60:04]

Important Timestamps by Segment

| Timestamp | Segment | |-----------|---------| | 05:33 | Jonathan on the core problem and vision for CommCare Connect | | 08:44 | Explanation of the LDVP framework (Learn, Deliver, Verify, Pay) | | 13:33 | Mercy’s initial reaction and hopes for CHW upskilling and agency | | 18:25 | Divya on why organizational empowerment via platform is novel | | 27:00 | 84% success rate anecdote from Malawi pilot | | 32:43 | Piloting, rapid cohort cycles, and co-design with users in Malawi | | 38:28 | Open RFPs and high demand from organizations in Nigeria | | 39:55 | Funding model shift and outcome-verification philosophy | | 47:46 | Complex interventions: Early Childhood Development example | | 50:51 | Why the opt-in model is a structural guarantee for value | | 56:18 | How new interventions are selected to complement MOH priorities | | 58:14 | Calls to action for partners and researchers |

Conclusion & Tone

The discussion is grounded, hopeful, and transparent. The team is both candid about the challenge of system change (“optimistically cautious”) and enthusiastic about early signals and the growing ecosystem surrounding CommCare Connect. Above all, the tone emphasizes humility, learning, and commitment to frontline worker empowerment—as both moral imperative and pragmatic lever for real impact.

For organizations, partners, or researchers interested in learning more or collaborating on CommCare Connect, email: podcast@dimagi.com.