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Social Business: A New Perspective on Healthcare Delivery

SARAH HODSDON, DIMAGI PROGRAM ANALYST

MAY 1, 2014

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“We deliver open and innovative technology to help underserved communities around the world”

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A leader in open source mobile technology This means that our code is free on the Internet Anyone can download, use, or modify our code

We focus on creating solutions for frontline workers in resource-limited settings

We make software solutions that do not require software developers to deploy

170+ active projects in 40 countries

Work across multiple sectors, including health, agriculture, microfinance, etc.

Partners: Foundations, governments, NGOs, and grassroots organizations

Team of 80+ with scientists, public health experts, physicians, engineers and field consultants

Dimagi

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Principles

Care about impact, team satisfaction, profit … in that order

Invest profit smartly for impact and team satisfaction

Be the leading high-value technology provider for frontline programs

Be open, transparent, and collaborative

Demand efficiency and utilize a product-oriented approach

Generate internal and external evidence of impact

Scale only as fast as we can maintain our culture

If we have to choose, we choose empathy over scale

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Healthcare access is limited in most parts of the world.

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Improve last mile logistics

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Current data systems cannot support the workforce

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“Extending the reach of the public health system through a well-trained and

supported community health workforce is a crucial step in meeting the MDGs, strengthening health systems, and

increasing quality health care.”

One Million Community Health Worker Campaign Technical Task Force Report

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mHealth for Community Health Workers

Health records

Patient ID & tracking Supply tracking

Monitoring & Evaluation

Checklists & Protocols

Education & TrainingData Collection

Counselling Messages

Surveillance?

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Frontline Workers

Health

Logistics

Agriculture

Education and TrainingGender Equality &

Women’s EmpowermentFinancial Services for the PoorWater & Sanitation

Humanitarian Response

Governance and Accountability

In emerging markets, frontline workers support development across sectors

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LogisticsCommunicationData and Workflow

Dimagi Products – Powered by CommCare

• Data collection and case management

solution

• Java feature phones or Android

smartphones & tablets

• Secure and scalable

• 2-way SMS-based applications

• Any SMS-enabled mobile device.

• SMS point of service logistics

management systems

• Manage inventory and logistics for

remote sites.

Implementation Services: technology enablement, design, and support

CommTrackCommConnectCommCare

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What Can You Do With CommCare?Step 1: Build or customize a mobile app

Step 2: Download the app onto a phone

Step 3: View real-time data in online reports

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Community Health Challenges

Accountability- Monitoring reports delayed

- Only aggregate data delivered- Data quality low

Access- Many eligible

beneficiaries not enrolled- Missed visits and

referrals - Inefficiency

- High CHW attrition

Quality- Short visits

- Key steps skipped- Sensitive issues avoided

- Insufficient training

Experience- Job aids left at home

- Low credibility- Messages not engaging

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CommCare Solution

Accountability+ Use real time monitoring of daily activity of each CHW

+ Dimagi’s Active Data Management improves workforce performance and efficiency

+ Increase the credibility and confidence of communities in health services

Access+ Increase timeliness + Increase enrollment+ Increase retention+ Increase access to services for rural and

indigenous communities

Quality+ Checklists improve

performance

+ Decision support increase adherence to

protocols

+ Video, audio convey sensitive topics in authoritative voice

Experience+ Audio, images, and video are easy to carry

on phone+ Phone adds credibility

+ Audio and video engage clients more than paper

materials

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The result? Stronger healthcare workersData collection Counseling

Workflow supportTraining reinforcement

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Design Under the Mango Tree

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Good Design Takeaways

Requires being with users (in the field)

Watching prototypes in use

Creating a relationship to get honest feedback

Design does not just apply to technology

When design is done right, technology is often the easy part

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1/1/2005 1/1/2006 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1/2011 1/1/2012 1/1/2013

# of Cumulati

ve Beneficiaries trackedRe

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)Dimagi Revenue and # of Cases Tracked

Revenue* Cases (Approx. Beneficiaries)

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Rapidly Scaling

Business model Open source code

Low hosting fees for our cloud-based server Start-up & support service packages

Web enabled application building tools, CommCare Exchange (an App Store to support diffusion), Offer “Proof of concept” packages to help organizations get started with mServices

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Difficulty in Donor-driven Sector

Many Large NGOs are heavily driven by Large donors 3 to 5 year plans, many deliverables determined up front

Once a grant is awarded: There is not a strong incentive to adapt and admit your original approach was

not correct:• Do what you said you were going to do• Spend what you said you were going to spend

Therefore Duplication of innovation Lack of collaboration Lack of adjustment to realities on the ground Lack of innovation after the plan is in place

Image Credit http://bluebuddies.com/Smurfs_Color_Smurfs_Pictures.htm

But, not unique to Donor Sector

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What are the learnings for impact measurement & action?

Ideal: Collect Data to Measure Impact – CommCare is primarily a Management

Information System (MIS) Do something with the data to improve service delivery on the ground (reminders

for visits, performance benchmarking, targeted real time feedback)

Challenges: As a technology service provider, you are an enabler / amplifier of existing

programs, and dependent on things outside of our control (and even outside our clients)

Baselines are tough to find

Learnings: Don’t Automate Broken Systems A versatile, open source product can help achieve scale and sustainability. (It’s OK

to start small.)

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Broader Lessons Learned

A single solution for both high-performers and low-performers is complex:We warn our partners that our solutions won’t work for every

user

Constraints support innovation: Simplifying our interface for low literate users in Afghanistan

and adding audio became one of our most popular features

Co-design is not just about technology and/or products

It’s okay, (if not better sometimes) to say no

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Pregnant women that have access to

CommCare are 20% more likely to access antenatal care & 22% more

likely to have skilled deliveries.

With CommCare, health workers

completed 20% more of protocols and increased their

knowledge of health danger signs by

22%.

CommCare improves health

workers’ credibility, as well as client and

family members’ engagement.

CommCare reduced the average time it took to submit data

to a program coordinator from 45 days to 8 hours.

Access Quality Experience Accountability

[Afghanistan, 2013] [India, 2012]

[Tanzania, 2008] [multiple studies] [India, 2012]

Measuring Impact

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Other Ways to Measure Impact: Research

85% More timely Visits Randomized Controlled Trial

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 2012, to

appear

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Examples of Dimagi Projects

Maternal Health: Pathfinder is deploying CommCare to 2,400 health workers in Haiti to register, track, and treat pregnant women.

Child Health: Terre Des Hommes is rolling out eIMCI application to 400 health clinics in Burkina Faso to strengthen referral systems.

Nutrition: World Vision has deployed a maternal health CommCare application in nine countries to screen children for nutrition status and related illness, plus immunization status.

Logistics/Supply Chain: John Snow International is tracking medical supplies in 8,600 facilities in Tanzania, Malawi, and Ghana with CommTrack.

Family Planning: University Research Coalition is using CommCare in Benin to promote family planning and track FP commodities and pricing.