Social Business: A New Perspective on Healthcare Delivery


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Social entrepreneurship is a growing trend, in Massachusetts and around the world. Entrepreneurs who want to build a business AND make a social impact are beginning to spring up around Boston, and some are even registering under new 'benefit corporation' hybrid legal structures. Come listen to three entrepreneurs who are running companies primarily motivated by the greater good. They will talk about what they are doing, why they chose to become ‘social entrepreneurs’ and offer insights for others interested in this growing trend.

Speaker: Sarah Hodsdon, Dimago Program Analyst
Twitter: @Dimagi;
Linkedin: Dimagi, Inc.

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Social Business: A New Perspective on Healthcare Delivery

  1. 1. 0 0 Social Business: A New Perspective on Healthcare Delivery SARAH HODSDON, DIMAGI PROGRAM ANALYST MAY 1, 2014
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  5. 5. 4 “We deliver open and innovative technology to help underserved communities around the world”
  6. 6. 5  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
  7. 7. 6 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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  9. 9. 8 Healthcare access is limited in most parts of the world.
  10. 10. 9 Improve last mile logistics
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  12. 12. 11 Current data systems cannot support the workforce
  13. 13. 12 “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
  14. 14. 13 mHealth for Community Health Workers Health records Patient ID & tracking Supply tracking Monitoring & Evaluation Checklists & Protocols Education & TrainingData Collection Counselling Messages Surveillance ?
  15. 15. 14 Frontline Workers Health Logistics Agriculture Education and Training Gender Equality & Women’s Empowerment Financial Services for the Poor Water & Sanitation Humanitarian Response Governance and Accountability In emerging markets, frontline workers support development across sectors
  16. 16. 15 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
  17. 17. 16 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
  18. 18. 17 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
  19. 19. 18 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
  20. 20. 19 The result? Stronger healthcare workers Data collection Counseling Workflow supportTraining reinforcement
  21. 21. 20 Design Under the Mango Tree 20
  22. 22. 21 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
  23. 23. 22 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 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 #ofCumulativeBeneficiariestracked Revenue($) Dimagi Revenue and # of Cases Tracked Revenue* Cases (Approx.Beneficiaries) 36 25 18 14 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 59
  24. 24. 23 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 But, not unique to Donor Sector
  25. 25. 24 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.)
  26. 26. 25 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
  27. 27. 26 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
  28. 28. 27 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
  29. 29. 28 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.