M health for community health_Luk_5.1.12

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  • 1. mHealthNuts and Bolts Rowena Luk May 1, 2012 0
  • 2. 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 1
  • 3. Operational Experience (25 Countries)Country SMS CommCare CommTrack SummaryAfghanistan X X Safe Pregnancy, RapidSMS projectBenin X Safe PregnancyBangladesh X X CommCare, Strategic ConsultingEthiopia SmartCareGhana X X Supply Chain LogisticsIndia X X Data Survey, Strategic Consulting, CommCareIndonesia X Health SMSIraq X Democracy SurveyJapan Hospital IT IntegrationJordan X Democracy SurveyKenya X SMS Clinical Trial, HMIS StrategyMalawi X X X Supply Chain LogisticsMexico X CommCare Epilepsy ProtocolMozambique X ODK Household Survey, CommCareNigeria X SMS Bednet TrackingNicaragua X CommCare for Engaging FathersPhilippines X SMS Vaccine Clinical Trial, Cold Chain LogisticsSenegal X SMS Social messagingSouth Africa HIV Decision SupportTanzania X X X CommCare Safe Pregnancy, TB, HIV, SMS LogisticsThailand X SMS Vaccine Clinical Trial, Cold Chain LogisticsUganda X X SMS Clinical Trial, IVR Clinical Trial, Supply Chain LogisticsUnited States X X SMS Adherence, Care Coordination, CommCare HIVZambia X SmartCare, SMS Lab Reporting, Touchscreen EMRZimbabwe X Democracy Content + IVR 2
  • 4. What kind of projects are using mHealth?
  • 5. All Kinds 4
  • 6. Designing mHealth Projects 5
  • 7. Match Existing Workflows Example: Remote Consultation 6
  • 8. Unsuccessful System 7
  • 9. Successful System 8
  • 10. Don’t Automate Broken Systems 9
  • 11. Design Under the Mango Tree 10 10
  • 12. Design Under the Mango Tree Sample CommCare Implementation Plan TimeFrame( 25 Weeks) DurationStage Task Actors 0 2 4 6 8 10 12 14 16 18 20 22 24 (wk) Dueby: Weeks1 -7 1.Identifyprojectcoordinator PM 3 Wk3 2.Designapplicationcontent&translation(inExcel) HE,PM, DimagiFE 4 Wk4 3.Identifyprojectsitewithnecessaryconnectivity PM,PC 1 Wk4 4.Designplanforpoweraccessibility PM,PC,DimagiFE 2 Wk 4 5.ProcurephonesandSIMcards PM,PC 4 Wk 5 Preparation Design& 6.IdentifyrefinementgroupofCHWs PC 1 Wk 5 7.Obtainimagesandvideo content PM, DimagiFE 3 Wk 7 8.Dimagi field engineerarrivesatprojectsite - - Wk6 9.ReviewmessageswithCHWs DimagiFE , PC 2days Wk6 10.Recordaudiocontent HE, PC,DimagiFE 1 Wk 7 11.Buildapplicationprototype DimagiFE 3days Wk 7 Weeks8 - 13 12.Train projectcoordinator inCommCareuse DimagiFE 3days Wk 8 13.TrainrefinementgroupofCHWs PC,DimagiFE 2days Wk 8 Refinement& 14.CHWhouseobservationsandfeedbacksessions PC,DimagiFE 4 Wk12 Iteration 15.Summarizefeedbackandfinalizeapplication PC,DimagiFE 3days Wk12 16.Gathertrainingmaterials PC,DimagiFE 1 Wk13 17.Designphonemanagementcontracts PC,DimagiFE 1 Wk1 3 Weeks1 4 - 25 18.Launchpilot – training starts - - Wk14Training 19.TrainfullcohortofCHWs PC,DimagiFE 4 Wk1 7 Pilot & 20.MonitorthroughCommCareHQandADM PM,PC,DimagiFE 8 Wk25 21.Projectc oordinatorfollowsupwithCHWs PC 8 Wk25 11 11
  • 13. What happens after?
  • 14. SustainabilityCustom Platform Product Turnkey Product• many codebases • many codebases • 1 codebase • 1 codebase• new code • shared code • many installations • 1 installationCustom GenericHigh Effort Low Effort 13
  • 15. CommCare/HQ Turnkey ProductMobile Solution for Health Workers Shared server costs •1 codebase •1 installation Shared maintenance effort Everyone benefits from new features Shared usability testing and refinement Rich tools for users to customize software Rich community of implementers 14
  • 16. Shared Tools Lead to Shared DataShared Data Lead to Shared Lessons Learned Active Data Management Automated Quality Control SMS to Reinforce Supervision CHW Performance Over Time True Positive: 75% False Positive: 10% B. BirnBaum, B. DeRenzi, A. D. Flaxman, N. Lesh, , B. DeRenzi, L. Findlater, G. Borriello, J. Jackson, J. Payne, B. Birnbaum, T. Automated Quality Control for Mobile Data Collection, ACM Parikh, N. Lesh, “Improving Community Health Worker Performance Through Computing for Development 2012 Automated SMS”, ICTD 2011, to appear 15
  • 17. Thank You!Recap All kinds of groups are using mHealth. Field test early & often Match existing workflows Don’t automate broken systems iterate, iterate, iterate Know the tradeoffs between custom and generic toolsContact: rluk@dimagi.comAdditional Resources:http://www.commcarehq.orghttp://www.dimagi.com 16
  • 18. Extra Slides 17
  • 19. 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)  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 12 April 2012 18
  • 20. CommCare Product Overview CommCareHQ (cloud-based server) Global Client List, Visit Schedules, Authoring tools, Reports, Data Export, Secure backup.Data Sent to HQ: Data Sent From HQ:Registrations, Reminders,Client data EncouragementVisits: who, when, duration Form updates Registration forms, Client records, Checklists & protocols, Multimedia CommCare Mobile Clients (CHWs phones) 19
  • 21. 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 20
  • 22. 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 21
  • 23. Ideal vs. Actual Practice1.Global HQ IDEAL INTERVENTION2.In-country HQ3.Field Managers4.Talking to CHWs ACTUAL INTERVENTION5.Working with CHWs 22
  • 24. Who’s doing the content?
  • 25. ≠ 24