Invisible Work in Two Frontline Health Contexts

Abstract

Frontline health workers provide essential services for their communities, but much of their work remains invisible—undervalued and underappreciated. Examining this invisible work ensures new technologies do not amplify or reinforce inequitable power structures, especially as governments and organizations push to digitize health work processes. We build on a burgeoning conversation by studying how invisible work manifests and how this invisibility can be challenged in two contexts of frontline health: home health aides in New York City, USA and Accredited Social Health Activists (ASHAs) in Uttar Pradesh, India. We highlight three shared manifestations of invisible work: (1) work done outside of the workers’ boundaries (2) work done to gain and share knowledge and (3) work done to manage relationships. These common categories are experienced differently in the two contexts, raising nuances to consider when designing technology for frontline health workers. We discuss these nuances and other tensions through concrete examples of how workers can escalate feedback and conflicts, quantify implicit expertise about patients, or build more awareness of their situation. Our paper guides the creation of technologies that take into account a more comprehensive understanding of the frontline health workers’ processes and highlight more of their contributions.