M health for community health_Luk_5.1.12


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M health for community health_Luk_5.1.12

  1. 1. mHealthNuts and Bolts Rowena Luk May 1, 2012 0
  2. 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. 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. 4. What kind of projects are using mHealth?
  5. 5. All Kinds 4
  6. 6. Designing mHealth Projects 5
  7. 7. Match Existing Workflows Example: Remote Consultation 6
  8. 8. Unsuccessful System 7
  9. 9. Successful System 8
  10. 10. Don’t Automate Broken Systems 9
  11. 11. Design Under the Mango Tree 10 10
  12. 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. 13. What happens after?
  14. 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. 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. 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. 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. 18. Extra Slides 17
  19. 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. 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. 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. 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. 23. Ideal vs. Actual Practice1.Global HQ IDEAL INTERVENTION2.In-country HQ3.Field Managers4.Talking to CHWs ACTUAL INTERVENTION5.Working with CHWs 22
  24. 24. Who’s doing the content?
  25. 25. ≠ 24