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mHealth Nuts and Bolts

Rowena LukMay 1, 2012

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Background of Dimagi Founded in 2002 at Harvard and MIT Media Lab, with offices

in Boston, USA; New Delhi, India; and Cape Town, SA

Leadership in Open-Source development and the field of mobile technology with a solid track record of building lasting partnerships

Collaborative Model: Core team of Dimagi experts collaborates with >50 institutional and individual partners

Experience with US and Global healthcare delivery best practices spanning 25+ countries

Highly qualified team of 30+ with physicians, scientists, public health experts, engineers and management consultants

Broad experience with over 100 ICT projects across numerous sectors and technology approaches

CommCare is the most widely used mobile tool for health workers in low resource settings that we are aware of

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Operational Experience (25 Countries)

Country SMS CommCare CommTrack SummaryAfghanistan X X Safe Pregnancy, RapidSMS project

Benin X Safe Pregnancy

Bangladesh X X CommCare, Strategic Consulting

Ethiopia SmartCare

Ghana X X Supply Chain Logistics

India X X Data Survey, Strategic Consulting, CommCare

Indonesia X Health SMS

Iraq X Democracy Survey

Japan Hospital IT Integration

Jordan X Democracy Survey

Kenya X SMS Clinical Trial, HMIS Strategy

Malawi X X X Supply Chain Logistics

Mexico X CommCare Epilepsy Protocol

Mozambique X ODK Household Survey, CommCare

Nigeria X SMS Bednet Tracking

Nicaragua X CommCare for Engaging Fathers

Philippines X SMS Vaccine Clinical Trial, Cold Chain Logistics

Senegal X SMS Social messaging

South Africa HIV Decision Support

Tanzania X X X CommCare Safe Pregnancy, TB, HIV, SMS Logistics

Thailand X SMS Vaccine Clinical Trial, Cold Chain Logistics

Uganda X X SMS Clinical Trial, IVR Clinical Trial, Supply Chain Logistics

United States X X SMS Adherence, Care Coordination, CommCare HIV

Zambia X SmartCare, SMS Lab Reporting, Touchscreen EMR

Zimbabwe X Democracy Content + IVR

What kind of projects are using mHealth?

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All Kinds

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Designing mHealth Projects

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Match Existing WorkflowsExample: Remote Consultation

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Unsuccessful System

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Successful System

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Don’t Automate Broken Systems

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Design Under the Mango Tree

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Design Under the Mango TreeSample CommCare Implementation Plan

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Stage Task Actors Time Frame (25 Weeks) Duration

(wk) Due by: 0 2 4 6 8 10 12 14 16 18 20 22 24

Weeks 1 - 7

Des

ign

&

Pre

para

tion

1.Identify project coordinator PM 3 Wk 3

2.Design application content & translation (in Excel) HE, PM, Dimagi FE 4 Wk 4

3.Identify project site with necessary connectivity PM, PC 1 Wk 4

4.Design plan for power accessibility PM, PC, Dimagi FE 2 Wk 4

5.Procure phones and SIM cards PM, PC 4 Wk 5

6.Identify refinement group of CHWs PC 1 Wk 5

7.Obtain images and video content PM, Dimagi FE 3 Wk 7

8.Dimagi field engineer arrives at project site - - Wk 6

9.Review messages with CHWs Dimagi FE, PC 2 days Wk 6

10.Record audio content HE, PC, Dimagi FE 1 Wk 7

11.Build application prototype Dimagi FE 3 days Wk 7

Weeks 8 - 13

Ref

inem

ent

&

Iter

atio

n

12.Train project coordinator in CommCare use Dimagi FE 3 days Wk 8

13.Train refinement group of CHWs PC, Dimagi FE 2 days Wk 8

14.CHW house observations and feedback sessions PC, Dimagi FE 4 Wk 12

15.Summarize feedback and finalize application PC, Dimagi FE 3 days Wk 12

16.Gather training materials PC, Dimagi FE 1 Wk 13

17.Design phone management contracts PC, Dimagi FE 1 Wk 13

Weeks 14 - 25

Tra

inin

g &

P

ilot

18.Launch pilot – training starts - - Wk 14

19.Train full cohort of CHWs PC, Dimagi FE 4 Wk 17

20.Monitor through CommCareHQ and ADM PM, PC, Dimagi FE 8 Wk 25

21.Project coordinator follows up with CHWs PC 8 Wk 25

What happens after?

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Sustainability

Custom•many codebases

•new code

Platform•many codebases

•shared code

Product•1 codebase

•many installations

Turnkey Product• 1

codebase

• 1 installation

GenericCustom

Low EffortHigh Effort

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CommCare/HQMobile Solution for Health Workers

Shared server costs

Shared maintenance effort

Everyone benefits from new features

Shared usability testing and refinement

Rich tools for users to customize software

Rich community of implementers

Turnkey Product•1 codebase•1 installation

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Shared Tools Lead to Shared DataShared Data Lead to Shared Lessons Learned

False Positive: 10%

True Positive: 75%

CHW Performance Over Time

Active Data Management

B. DeRenzi, L. Findlater, G. Borriello, J. Jackson, J. Payne, B. Birnbaum, T. Parikh, N. Lesh, “Improving Community Health Worker Performance Through Automated SMS”, ICTD 2011, to appear

B. BirnBaum, B. DeRenzi, A. D. Flaxman, N. Lesh, , Automated Quality Control for Mobile Data Collection, ACM Computing for Development 2012

Automated Quality Control

SMS to Reinforce Supervision

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Thank You!

Recap All kinds of groups are using mHealth. Field test early & often

Match existing workflowsDon’t automate broken systemsiterate, iterate, iterate

Know the tradeoffs between custom and generic tools

Contact: rluk@dimagi.com

Additional Resources:

http://www.commcarehq.org

http://www.dimagi.com

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Extra Slides

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CommCare: Mobile Solution for Extension Workers

CHWs use CommCare during each home visit and to register each client.

CHWs get SMS reminders for visits and encouragement to register every eligible client (improving access to care)

CHWs use electronic checklists, decision support, and educational training materials (improving quality of care)

12 April 2012

CHWs use audio clips, pictures, and videos to enhance credibility and discuss sensitive topics (improving the experience of care)

CHW programs extensively leverage data on CommCareHQ to improve supervision and monitoring of their programs (improving data-driven management)

See online video demo

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CommCare Product Overview

Global Client List, Visit Schedules, Authoring tools, Reports, Data Export, Secure backup.

Registration forms,Client records,Checklists & protocols,Multimedia

CommCare Mobile Clients (CHWs phones)

CommCareHQ (cloud-based server)

Data Sent to HQ:Registrations, Client dataVisits: who, when, duration

Data Sent From HQ:Reminders,

EncouragementForm updates

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CommTrack: SMS Logistics Platform

SMS data collection of stock information from any point in the logisitcs chain, from the service delivery point, facility, district, or block level

Stockout notification, reporting and routine data collection

Forecasting/planning

Order fulfillment Web based reports aggregate and display data for more relevant and accurate decision making

Currently in use in Tanzania, Ghana, Malawi, and Uganda. The Ministry of Health in both Tanzania and Uganda are in the process of deploying this technology on a national scale.

12 April 2012

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CommConnect: Configurable SMS Platform

Enables rapid deployment of configurable SMS projects Timed reminders for medication adherence, research studies, workflow

monitoring Broadcast messaging for notifications and broad reach communications Structured SMS data collection for surveys or polling with custom

reporting output Built on 3rd generation of

Dimagi SMS platform from experience with dozens of SMS deployments, research trials and custom workflow solutions

CommConnect is deploying SMS in 14 countries with AIDS Clinical Trial Group as the flagship client

Can support daily medication reminders, a simple SMS poll on user satisfaction, or broadcast out a meeting reminder to a group. 12 April 2012

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Ideal vs. Actual Practice

1.Global HQ

2.In-country HQ

3.Field Managers

4.Talking to CHWs

5.Working with

CHWs

IDEAL INTERVENTION

ACTUAL INTERVENTION

Who’s doing the content?

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