Collaboration with local health services in Kenya led to the development of a mobile app supporting child development assessments, and the training of 100 community health workers – embedding mobile-based practices, improving local healthcare and reducing poverty.


  • The research led to the development of the REFER app – a mobile resource for reference material, guidance and support for child development diagnostics and referrals.
  • Community health workers (CHWs) received training on child development and the use of technology and smartphones. The training was ultimately extended to 100 CHWs and their supervisors.
  • These tools have led to improved data collection, supervision and mentoring, training and skills for CHWs.
  • The increase in the quality of referral decision-making and monitoring improved local healthcare services.
  • The research increased health workers' and families’ knowledge of the development of children under five.
  • It embedded mobile-based supervision and training into existing local primary health services – with potential for other medical applications.
  • The project also trialled two other tools: a WhatsApp social media group for CHWs, and the ALPHA Toolkit enabling CHWs to develop new smartphone apps.

"The mCHW project has built the capacity of community health volunteers working in tier one of health service delivery using smart phone technology – demonstrating that technology can be used at community level to contribute towards lasting health change." (Dr Alice Lakati, Amref Health Africa)

About the research

Marginalised and poor communities in Kenya generally have low levels of healthcare, with a lack of health facilities and staff. The mobile health project mCHW, co-funded by DFID and the ESRC, supported an innovative collaboration between the University of Oxford, Amref Health Africa and UCL. It was designed to improve the training and supervision of CHWs in the marginalised communities of Makueni County and the Kibera informal settlement using mobile technology – in turn providing better access to healthcare and potentially reducing poverty.

The research project initially included 20 community health workers and five supervisors, later extended to 100 health workers and their supervisors. Local workshops showed that child health and development were top priorities for improvement. CHWs had previously not received any training on the assessment of the development of children under five.

In collaboration with paediatricians and developmental experts in Kenya and the UK, the REFER mobile app was developed to assess development milestones for children under five. The app is based on questions designed to stimulate conversations with carers and engage children in activities to identify potential delays in their development. It helps health workers decide whether the child needs referral for specialist care in severe cases. The REFER app automatically generates reports of assessments and referral decisions and sends them to the health worker's supervisor for review and feedback.

Following the training, a systematic developmental assessment of children under five was carried out in the participating communities, identifying several children with delayed development and disabilities. The research helped to embed mobile-based supervision and training within local primary healthcare.