Algorithmic Management for Community Health Worker in Sub-Saharan Africa: Curse or Blessing?

Algorithmic management can potentially improve healthcare delivery, for example, in community-based healthcare in low-andmiddle-income countries. However, most research neglects the user perspective and focuses on health-related outcomes. Consequently, we know little about the effects of algorithmic management on the user: community health workers. This paper reports on a 12-week pilot study in ComBaCaL, a community-based healthcare project tackling the increasing burden of non-communicable diseases (NCDs). We evaluate the Community Health Toolkit (CHT), a digital tool designed to support CHWs in community-based NCD care. We find that CHT is generally suitable for this purpose and can help CHWs to assume broader responsibilities. However, its design creates a tension between control and autonomy when confronted with reality. This tension could lead to disempowerment and attrition among CHWs. We propose design adaptations for CHT's task scheduling, balancing the socio-technical system to resolve the tension between control and autonomy.