1. 1
“CommCare Workshop: How to Plan a
CommCare Workshop”
CORE Group Spring Pre-Meeting Workshop
April 22, 2013

2. 2
Drawing from the last four years of implementing
CommCare, this workhop will provide:
§ An overview of Dimagi’s mHealth products and the potential
benefits for equipping CHWs with CommCare
§ Ways to plan for initial implementation and long-term support of
the project (beyond equipping frontline workers with phones)
§ Tools to support your organization in planning its CommCare
implementation
§ Short report-outs from CORE Group members who have
implemented CommCare
§ A discussion about the benefits in implementing an mHealth
solutions like CommCare and associated challenges for your
organizations.
“How to Plan a CommCare Project”

3. 3
In addition to these slides, you will receive following materials to help
you design/implement CommCare
§ Our CommCare beginner’s tutorial: to show you how to design a
CommCare application
§ CommCare Worksheet Manual: to guide you through the process of
designing your application
§ Implementation tools: Our Total Cost of Ownership (TCO) model, case
studies, and guidelines about creating a CommCare project
§ Support resources: including information about our CommCare help
site, access to the CommCare Users Google Group, CommCare Exchange
(our open-source “app store”), and various mHealth list-servs
§ Information about upcoming Proof of Concept opportunities
Materials/Tools You Will Receive

4. 4
Which areas would you like us to emphasize?
1. Dimagi’s CommCare Platform
2. Dimagi’s SMS tool
3. Dimagi’s logistics tracking system
4. CommCare evidence
5. Designing a CommCare application
6. Technical demo of building a CommCare application
7. Process for implementing a CommCare project
8. Tools to implement your CommCare project
9. CommCare Case studies
10. Additional time for breakout groups with other
workshop attendees

5. 5
Dimagi Product Overview

6. 6
§ We are a leader in open
source mobile technology.
Ø This means that our code is
free on the Internet
Ø Anyone can download, use, or
modify our code.
§ We make software solutions
that do not require software
developers to deploy
§ We focus on creating solutions
for resource-limited settings
About Dimagi

7. 7
Cross Sector Support
Dimagi
Products
Health
Logis4cs
Agriculture
Educa4on
and
Training
Water
and
Sanita4on
Financial
Services
for
the
Poor
Emergency
Response
Gender
Equality
&
Women’s
Empowerment
Governance
and
Accountability
Select
Implementers
In
Discussions

8. 8
Who & Where We Are
§ Team of 50+ scientists, public health experts,
physicians, engineers, and field consultants
§ 10+ years of experience with over 100 projects
across numerous sectors
§ We have offices in Cambridge, Massachusetts (HQ),
India, South Africa, and Mozambique
§ We also have field teams in Guatemala, Senegal,
Benin, and Thailand

9. 9
Global Project Locations
Key Stats
§ 31 Active countries
§ 7 Active Sectors
§ 492 Projects to Date
§ 6,050 Users to Date
§ 350,000 Cases to Date
§ 1.6 Million Forms to Date
§ 135 Active Projects
§ 2,027 Active Users
§ 61,213 Active Cases
§ 200,875 Forms last Month

10. 10
DIMAGI SOFTWARE
PRODUCTS

11. 11
Logis&cs
Communica&on
Data
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.
Implementa)on
Services:
technology enablement, design, and support
CommTrackCommConnectCommCare

12. 12
COMMCARE
(DIMAGI’S MOBILE PLATFORM)

13. 13
CommCareMobile
• Community Health Workers
• Research Assistants
• Surveyors, etc.
CommCareHQ
• CHW Supervisors
• Project Managers
• Researchers
• Dimagi Field Managers
CommCare

14. 14
CommCare: DEMO
CommCare Overview: http://tinyurl.com/crscommcare

15. 15
15
Register and find
existing clients
Specialize your
application
Record client
information and share
interactive counseling
messages
Select
Exit
SMS
Reminder
Reena
is
overdue
for
her
follow-­‐up
treatment
please
follow-­‐up
with
her.
Follow-up
with clients
CommCare Mobile

16. 16
Case Management
Track Clients Over Time
- Routinely visit the same clients
- Manage entire case lifecycle offline if
connectivity is unavailable
- All data stored locally on the
workers’ mobile device
Monitor Cases From the Web
- View all registered cases online
- Track how data is changing over time
- Monitor worker productivity

17. 17
CommCare Application Builder
Create Your Own Application
- Online tools to build your own CommCare
application
- Collect information including dates,
multiple choice, images, video, bar code,
and GPS.
- Manage applications remotely
Download From the App Store
- Leverage previously built apps to get
started quickly
- Share your own apps with the
community

18. 18
CommCare Reports
Continuous Performance Improvement
- Support for Project Coordinators in
managing workforce
- Analyze all data submitted to server to
improve worker performance
- Targeted, actionable follow-up activities
for supervisors
- Can utilize Active Data Management for
enhanced reporting

19. 19
CommCare Examples
Pathfinder International (Kenya)
• Currently deploying entire Kenyan Essential
Package for Health
• Focuses on HIV/AIDS, TB, MNCH, malaria
PATH (Navi Mumbai, Maharashtra, India)
• Project from May-August, 2012 for link workers
(LWs) in two health posts.
• Surveyed all eligible women in urban areas,
tracked pregnancies, and educated women about
pregnancy and neonatal health.
• Family planning counseling was the most
frequently used audio prompt and was included in
multiple locations at the request of the LWs.

20. 20
CommCare Examples
Real Medicine Foundation (Madhya
Pradesh, India)
• Child malnutrition identification and
counseling, with referral pathways
URC (Toffo, Benin)
• Application is contributing to the uptake
of family planning services, FP commodity
stock monitoring, and pricing
Catholic Relief Services (Uttar Pradesh,
India)
• Helping 285 ASHAs track pregnancies
• ASHA supervisors monitor ASHAs’
performance through weekly reports

21. 21
COMMCARE EVIDENCE

22. 22
Community Health Worker 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
aPri4on
Quality
-­‐
Short
visits
-­‐
Key
steps
skipped
-­‐
Sensi4ve
issues
avoided
-­‐
Insufficient
training
Experience
-­‐
Job
aids
leT
at
home
-­‐
Low
credibility
-­‐
Messages
not
engaging

23. 23
Technology
PlaUorm
Services
&
Adop4on
Innova4on
&
Research
Smarter Community Services
Measure

24. 24
CommCare Evidence Base
Evidence
Level
#
Published
CommCare
#Unpublished
CommCare
#
Published
Alterna)ve
#
Published
Related
Total
Conceptual
4
1
5
Implementa4on
narra4ves
5
1
6
Qualita4ve
CHW
interviews
2
2
1
5
CHW
Process
improvements
3
2
3
8
Client
KAP
2
2
Total
14
6
2
4
26
§ Review of 26 papers showing improvements in Access,
Quality, Experience, and Accountability of Care.
§ Available at: http://tinyurl.com/CommCareEvidence

25. 25
CommCare: Evidence
Partner
Experiment
Result
ACCESS
Univ.
of
Washington
Randomized
controlled
study
on
87
CHWs
• Increase
4meliness
of
visits
by
86%.
Harvard
Univ.
Blinded
comparison
on
1198
visits
• Task
shiTing
to
counselors
to
triage
HIV
pa4ents
with
86.5%
sensi4vity
and
48.3%
specificity.
QUALITY
Univ.
of
Washington
Pre/post
study
on
24
pa4ent
visits
• Improves
adherence
to
protocols
by
~20%
Harvard
Univ.
Pre/post
study
on
1221
pa4ent
visits
• Improves
adherence
to
protocols
by
~18%.
• 1-­‐4%
improvement
in
classifica4on
accuracy,
compared
to
expert
clinician
(not
sta4s4cally
significant).
IntraHealth
Pre/post
study
on
30
CHWs
• CHW
knowledge
of
danger
signs
increased
b/w
48%
to
70%
EXPERIENCE
Dimagi
Qualita4ve
mul4-­‐country
inves4ga4on
• Improves
ability
to
effec4vely
engage
their
clients.
Berkeley
Controlled
study
• Improves
CHW
performance,
confidence,
and
client
engagement
Univ.
of
Pennsylvania
Qualita4ve
user
experience
research
• Provide
credibility
to
the
message
of
CHWs
• Allow
CHWs
to
work
around
cultural
and
social
barriers
Nanyang
Tech.
Univ.
Cross-­‐sec4onal
study,
in-­‐depth
interviews,
small
group
interviews
• Nurses
reported
greater
reten4on
of
messages
among
CHWs.
• Messages
delivered
via
the
cell-­‐phone
added
authen4city.
MicrosoT
Research
India
Formal
evalua4on
of
10
CHW
deployment
• 90%
CHWs
self-­‐report
improved
social
respect
in
community
from
using
CommCare.
ACCOUNTABILITY
MicrosoT
Research
India
Formal
evalua4on
of
10
CHW
deployment
• Reduced
4me
to
get
data
to
program
coordinator
by
98%.
• Improved
data
completeness
from
67%
to
84%.
Univ.
of
Washington
10-­‐fold
cross
valida4on
with
known
falsified
and
known
true
data
• Outlier
detec4on
algorithms
shown
to
detect
false
data
set
produced
in
Tanzania
with
80%
sensi4vity
of
90%.

26. 26
CommCare Benefits Frontline Workers
Accountability
+
CommCareHQ
provides
real
4me
monitoring
of
daily
ac4vity
of
each
CHW
+
Dimagi’s
Ac4ve
Data
Management
improves
workforce
performance
+
Increase
Efficiency
Access
+
Increases
4meliness
of
care
due
to
appointment
reminders
+
Increases
client
enrollment
+
Increases
reten4on
through
case
management
+
Increases
rate
of
referrals
Quality
+
Checklists
improve
performance
+
Decision
support
increases
adherence
to
protocols
+
Video,
audio
conveys
sensi4ve
topics
in
authorita4ve
voice
Experience
+
Audio,
images,
and
video
are
easy
to
carry
on
phone
+
Phone
gives
CHW
greater
credibility
+
Audio
and
video
engage
clients
more
than
paper
materials

27. 27
Improved Access
Ø 85% More timely Visits
Ø 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

28. 28
Improved Quality
Ø 20% Improvement to Protocol Adherence in a Randomized Controlled Trial
Ø Intrahealth Preliminary Result in India: ASHAs had increased their
knowledge retention of at least 3-5 key danger signs from 48% at baseline
to 70%
Ø Improvement in IMCI protocol adherence
B. DeRenzi, N. Lesh, T. Parikh, C. Sims, W. Maokla, M. Chemba, Y. Hamisi, and others, “E-imci: improving pediatric health care in low-income
countries,” CHI 2008, pp. 753–762.
Inves)ga)on
Current
prac)ce
adherence
e-­‐IMCI
adherence p-­‐value
Vomi4ng 66.7%
(n=24) 86%
(n=28) -­‐
Chest
indrawing 75%
(n=20) 94%
(n=18) -­‐
Blood
in
stool 71%
(n=7) 100%
(n=3) -­‐
Measles
in
the
last
3
months
56%
(n=9) 95%
(n=21) <
0.05
Tender
ear 0%
(n=1) 100%
(n=5) -­‐
All 61%
(n=299) 85%
(n=359) <
0.01

29. 29
Improved Experience
Qualitative Assessment
Ø Phones/CommCare add credibility to CHWs
Ø Multimedia helps engage clients and their families
Ø Audio helps CHWs recall key counseling messages
Ø Audio facilitates discussion on sensitive topics
Treatman, D., Lesh, N, Strengthening Community Health Systems with Localized Multimedia, M4D’12 to appear.
Chittamuru, D. and Bhavsar, M. (2012). CommCare: Evaluation of a Mobile Application for Maternal Health in Rural India. IAMCR Durban: Communication Policy and
Technology: Critical Perspectives on Digital Inclusion and Policy. Durban, South Africa.

30. 30
Improved Accountability
Detec)ng
Surprising
Answers
§ Analyze
distribu4ons
of
answers
by
a
CHW.
§ Example
Ques4on:
Did
you
give
any
referral
in
this
household?
Overall:
93%
No,
7%
Yes
CHW
#3:
62%
No,
38%
Yes
§ Detects
systema4c
errors
§ Supports
quality
control
Detec)ng
Fake
Forms
(Work by Ben Birnbaum et. al. ‘2012)

31. 31
COMMCONNECT
(DIMAGI’S SMS TOOL)

32. 32
What is CommConnect?
Use Cases
§ Large scale surveys or behaviour change communication (BCC)
§ Drug adherence programs and simple patient tracking (wider reach)
§ Reminder integration with existing CommCare projects (ex. BCC
communication to cases, reminders of clinic visits)
• Larger-scale communication system
(SMS, SMS Reminders, IVR, etc.)
• Stand-alone (ex. surveys) or tied
into CommCare cases (cases can
drive reminders)

33. 33
CommConnect Features
§ Robust survey and reminder builder
§ Outgoing surveys and reminders based on rules
Ø Rules can be date/time based or based on state of a
particular beneficiary (e.g., text all women due this month)
§ SMSes can be sent to beneficiaries or to the person who
registered the beneficiary (e.g. a community health
worker)
§ Incoming data collection support through SMS
§ Fully integrated with CommCare and CommCareHQ

34. 34
How It Works
§ Interactive communication (SMS Survey or IVR) are made
on CommCareHQ
Ø Can use the same form in CommCare and through SMS
§ Reminders/surveys are designed through CommCareHQ

35. 35
Coverage
§ Outgoing
Ø Close to worldwide, but some messages may come from an
international number
§ Incoming
Ø India
Ø United States
Ø Tanzania
Ø Malawi
Ø Nigeria
§ Future: Setup an Android phone as a gateway in a
country

36. 36
Possible CommConnect Usages
§ Targeted and Group Messaging
§ SMS Mailing Lists
§ Charts
§ Maps
§ Appointment reminders
§ Scheduled events
§ Referral follow-ups
§ Adherence measurement algorithms
§ Session-based interactive protocols
36

37. 37
COMMTRACK
(LOGISTICS MANAGEMENT)

38. 38
What is CommTrack?
For health workers in low-resource settings who store and
manage commodities, CommTrack is a logistics system-
strengthening tool that provides reliable, real-time, and
actionable information to improve logistics management
in low-resource settings.

39. 39
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
Ø Stockout notification, reporting and routine data collection
Ø Forecasting/planning
Ø 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

40. 40
CommTrack v1 (ILSGateway in Tanzania)

41. 41
With CommTrack, you can…
§ Submit stock reports via SMS or CommCare
Ø You can also revert mistaken reports
§ Send SMS/email alerts and reminders
§ Track stock levels, stockouts, receipts, disbursements,
etc.
§ Access web reports with stock levels, stockouts,
reporting rates, and also auto-calculate monthly
consumption
§ Use configuration tools to specify products, facilities,
and locations and open APIS to expose data for other
logistics systems

42. 42
There are two faces to CommTrack
Standalone Mobile Logistics Hub
§ For national deployments
§ Example end users:
Ø Pharmacists at facilities
Ø Warehouse managers
Add-On to CommCareHQ (under development)*
§ Part of an integrated mobile job aid for health workers
§ Example end users:
Ø CHWs who also manage commmodities
Ø Village-level entrepreneurs
Ø Mobile salesforce
* Note that CommTrack is currently built on RapidSMS,
but will soon be integrated into CommCareHQ.

43. 43
CommCare Pricing Packages

44. 44
CommConnect Pricing
§ Outgoing Messages: $250/month
§ Both Incoming and Outgoing Messages: $500/month
§ Plus $0.01 and cost of any SMS sent or received
Prices include access to CommCareHQ functionality including the
mobile phones, application builder, API access, data exports and
standardized reports.

45. 45
CommTrack Pricing
§ CommTrack Plus (same as CommCare)
§ CommTrack Full (same as CommCare)
§ Plus ~1 cent per-SMS fee (same as CommConnect)
§ Plus 0.75 USD per-CommCare user fee (same as
CommCare)
§ Software is not yet mature enough for a free/self-
service layer although we want to provide that soon
§ CommTrack technical functionality could be provided as
part of a CommCare PLUS or FULL contract today - but
not FREE (yet)

46. 46
CommCare: Implementation

47. 47
Agenda
Application Development2
Implementation3
Getting Started1

48. 48
GETTING STARTED

49. 49
Addressing 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
aPri4on
Quality
-­‐
Short
visits
-­‐
Key
steps
skipped
-­‐
Sensi4ve
issues
avoided
-­‐
Insufficient
training
Experience
-­‐
Jobaids
leT
at
home
-­‐
Low
credibility
-­‐
Messages
not
engaging

50. 50
The Players: Partner Organization
§ Mobile User: User who will be entering data in
CommCare on the phone
§ Technical Officer (TO): Managing the phones, working
out any technical issues.
§ Trainer- leads the training along with the Dimagi team
§ Project Coordinator (PC): Will manage and supervise
users on the CommCare HQ website
§ M&E Officer: Will use data from CommCareHQ
§ Project Manager (PM): Oversees project

51. 51
Dimagi’s Field Presence
Field Manager (FM):
§ Working with partner to design the application
§ Building the application
§ Training mobile users to use application
§ Training project staff to use CCHQ tools
§ Training project staff for technical troubleshooting
§ Remote support for deployment

52. 52
Design Under the Mango Tree
52
User-focused Design
- Rapid content prototyping
- Mature technology platform

53. 53
The Process
§ Decide what we the program will do
Ø What is the goal?
Ø Who are the users?
§ Iteratively design the app
§ Develop/build the app
§ Pilot/test the app with users
§ Make changes
§ Build capacity of local team to sustain, expand
§ Train all users and staff

54. 54
Standard Implementation Plans
Duration Phase 1 Phase 2 Phase 3
Design & Preparation # weeks
§ Identify key Program Team members 2
§ Specify requirements & features, and Build
application prototype
4
§ Procure Equipment & design plan for logistics 3
Refinement & Iteration
§ Train project coordinator, supervisors, & pilot CHW
groups
2
§ Gather, summarize, & iterate feedback 3
§ Software Development Sprint 4
§ Finalize application & training materials 2
Training & Deployment
§ Project deployment – training starts 1
§ 1st Training cohort of CHWs & distribute phones/
SIM
3
§ 2nd Training cohort 3
§ 3rd Training cohort 3
§ 4th Training cohort 3
§ Data Collection & Analysis -
Monitor
through
CommCareHQ
and
ADM

55. 55
APPLICATION DEVELOPMENT

56. 56
Mobile Application Development
§ 1- Identify the goals to be achieved by the mobile
application
Ø Data collection
Ø Workflow support
Ø Content delivery
§ 2- Design the system around the skills, knowledge and
challenges of CHWs
Ø Education
Ø Performance
§ 3- Build and revise the application based on observations
and feedback from the field
Ø Usability, Content, Multimedia, Impact

57. 57
1- What do you want your application to do?
Data collection?
Counseling?
Training reinforcement?
Workflow support?

58. 58
1- Know Your Program: Data Usage
How does the organization want to analyze
data?
•
Think
about
the
variable
names/keywords
when
designing
the
applica4on
•
Make
sure
they
understand
the
difference
between
case
exports
and
form
exports
•
Set-­‐up
or
show
them
how
to
set
up
saved
reports
Who will be monitoring the data?
•
Can
you
do
things
that
are
easier
for
field
staff
downloading
the
data?
•
Do
we
need
to
make
APIs
available
to
partners?
•
Do
they
need
indicator
reports
(custom,
NOT
free)
What indicators are being monitored?
•
Are
they
collec4ng
these
in
the
applica4on?

59. 59
1- Know Your Program: Groups
What are the denominations important for the
program?
•
Care
coordina4on
(ASHA,
AWW,
ANM
teams)
•
Supervisors
(cluster
groups)
•
Government
(PHCs,
blocks,
districts)
•
Program
Managers?
•
Trainers
(training
groups)
•
Researchers?
Who is involved in monitoring and supervision?
What does the partner want?
What is easiest for the field team?
How will the data be analyzed?

60. 60
1- Worksheet

61. 61
2- Know Your Mobile User: Case List
• How does a CHW plan home
visits?
• How does a CHW prioritize
cases?
• What information is absolutely
critical for identifying cases?
• What kinds of acronyms can be
used? Symbols?
• How can we leverage the sort/
filter feature? Is it too
complicated?

62. 62
2- Know Your Mobile User: Case Detail View
• Which data points will
help distinguish cases
that look identical on
case list?
• Which critical data does
CHW need access to
offline?
• Should we use the call
feature from detail
screen?
A Review Form can be an alternative for low literate users with multimedia prompt.

63. 63
2- Know Your Mobile Users: Language
Input
ALKA
अलका

64. 64
3- Build App: CommCareHQ.org

65. 65
3- Exchange: An Open Source App Store for
CommCare (www.commcarehq.org/exchange)

66. 66
IMPLEMENTATION

67. 67
M-Health Training for an Entire
Organization!
Train field supervisors
Train technical staff
Train the trainers
Train the pilot CHWs
Train all CHWs

68. 68
Adoption and Scale-Up
Mobile
Web/HQ
Applica)on
Troubleshoo)ng
Monitoring
Data
Analysis
Maintenance
CHW
ü
Supervisors
ü
ü
ü
Trainers
ü
Op4onal
Technical
Support
ü
ü
ü/Op4onal
Managers
ü
ü
ü
Data
Staff
ü
ü
Organizational training needs for CommCare

69. 69
Experiences from Training Programs
§ Roll out initial training program at a slower pace, with ample time
allocated for follow-up soon after training, especially for groups with
lower literacy
Content
Training
Mobile
Training
n
Days Day
1 Day
2
A.
B.
C. Week
1
Week
2
Week
n
Day
1 Day
2 Day
n
In field follow-up Refresher training

70. 70
How to get started/resources (will send out after
workshop)
§ General CommCare Support
Ø CommCare Help Site (“The wiki”)
Ø CommCare Users Google Group
§ Getting Started
Ø CommCare Exchange
Ø Worksheet
§ Helpful listservs
Ø ICT4CHW
Ø M-Health working group

71. 71
CommCare: Impact and Tools

72. 72
TOTAL COST OF OWNERSHIP

73. 73
CommCare: Example India TCO model
§ Surveyed CommCare partners in India to identify complete costs for an
organization to deploy CommCare
§ Produced (total cost of ownership) TCO tool to help organizations estimate
total costs, explore permutations, and plan budgets – Excel Model
Available.
Category
Key
Elements
Annual
(USD)
Avg.
Training
Costs
2
days
ini4al,
1
day
annual
recurring
($9
per
day)
$11
CHWs
Op
Costs
Data
Transfer,
SMS,
Charging/Electricity
$9
Field
Staff
Op
Costs
1
per
500
CHWs
($6,600
per
year)
+
Site
transport
costs
+
Data/Air4me
$19
Project
Managers
Op
Costs
1
per
500
CHWs,
$4,400
per
year
+
Site
transport
costs
+
Data/Air4me
$13
Office
Op
Costs
Office
Internet
$1
Yearly
Equipment
Costs
(Avg.
over
3
year
life4me)
Mobile
Phones
/
chargers
/
SIM
card
&
registra4on
for
CHWs,
GPRS
Modem
&
Netbook
for
Office
$37
Dimagi
User
Fees
$.75
per
CHW
per
month
(aTer
the
20th
user)
$9
Total
cost
for
each
CHW
per
Year
$99
Total Cost of Ownership (TCO) Model: Average yearly running costs by category for a 3-yr project

74. 74
TCO Model
CHWs,
$9
Project
Managers,
$13
Field
Staff,
$19
Avg.
Yearly
Training
Costs,
$11
Office,
$1
Avg.
Yearly
Capital
/
Equipment,
$37
CommCare
per
CHW
User
Fee,
$9
Annual
Total
CommCare
Cost
per
CHW
(Modeled)

75. 75
RESEARCH

76. 76
Technology
PlaUorm
Services
&
Adop4on
Innova4on
&
Research
Smarter Community Services
Measure

77. 77
Research and Innovation at Dimagi
§ Team: PhDs, field RAs, data analysts,
external research partners
§ Example projects/studies
Ø SMS-based reminders for visits
Ø Performance feedback graphs
Ø Anomalous data detection
Ø Cost effectiveness models
Ø Evaluations of CommCare’s impact on
visit quality, who attends sessions, CHW
knowledge tec.
§ Strong focus on publishing results

78. 78
Active CC Investigations at a Glance
Hypothesis
Experiment
ACCESS
•
CommCare
increased
number
of
family
members
who
par4cipate
during
a
home
visit/counseling
session
•
Comparing
number
of
home
visits
and
self-­‐reported
number
of
family
members
present
during
counseling
sessions
for
ASHAs
using
CommCare
QUALITY
•
CommCare
improves
mo4va4on
of
CHWs
•
Studying
mo4va4on
levels
of
CHWs
in
control
site
vs.
CommCare
interven4on
sites
using
job
sa4sfac4on
survey
•
CommCare
improves
knowledge
of
CHWs
and
reinforces
training
concepts
•
Studying
pre/post
knowledge
assessments
•
CommCare
increases
client
reten4on
of
informa4on
•
Test
knowledge
improvement
amongst
beneficiaries
in
CommCare
interven4on
and
control
sites
EXPERIENCE
•
CommCare
allowed
CHWs
to
discuss
sensi4ve
or
taboo
subjects.
• CommCare
allowed
CHWs
to
work
around
cultural
and
social
barriers
(use
of
mul4media)
•
Studying
paPerns
of
mul4media
usage
in
home
visits
where
CommCare
was
used
ACCOUNT-­‐
ABILITY
•
Regular
feedback
to
CHWs
improves
performance
metrics
•
Studying
2-­‐3
performance
indicators
over
3
months
for
60
CHWs
in
Madhya
Pradesh,
who
received
weekly
performance
feedback
via
Call
Center
* Two Large Evaluations Planned for 2012:
+ Randomized controlled study in Bihar. Partnering with CARE and Mathematica Policy Research to assess the overall health impact of
CommCare as a package intervention in the delivery of maternal and newborn health services in Bihar.
+ Factorial randomized controlled study. Also partnering with the government of Kaushambi in Uttar Pradesh, Catholic Relief Services (CRS),
Harvard Business School, and University of Washington to more deeply probe how CommCare influences CHW behavior and client outcomes.

79. 79
CHW Performance Feedback
§ If CHWs know their relative performance, does that
encourage them to complete more of their visits?
§ Background:
Ø There are a number of studies about relative vs absolute
performance – with variable outcomes
Ø We want to understand how we can provide actionable
feedback to the CHW

80. 80
CHW Performance Feedback: Low Performer

81. 81
CHW Performance Feedback: High Performer

82. 82
PERFORMANCE

83. 83
CHW
CLINIC/
SUPERVISOR
CLIENT
CommCareHQ
SUPERVISOR/DISTRICT/PROVINCE
PROGRAM MANAGERS
SMS
- Alerts
- Activity reports
- Health stats
- Coordination
GPRS
- Form Submission
- Work Management
- Activity reports
Data Collection Supervisor Reports Feedback Quality Improvement
CommCare Data Flow

84. 84
Active Data Management
Continuous Performance Improvement
- Support for Project Coordinators in
managing workforce
- Analyze all data submitted to server to
improve worker performance
- Targeted, actionable follow-up activities
for supervisors
- Weekly and monthly email reports

85. 85
ADM Value Proposition
Today’s Challenges & Pain Points
Too much data:
Large data tables, aggregate data
Difficult data analysis:
Technical and time consuming
Too time consuming:
Limited dedicated resources
Limited visit monitoring :
Too short or informal
Non-actionable data:
Reports often delayed, difficult to act timely
Lack of tracking action:
Action rarely tracked to completion

86. 86
ADM Value Proposition
Today’s Challenges & Pain Points ADM Value Proposition
Too much data:
Large data tables, aggregate data
Focus on concise and simply formatted data
Difficult data analysis:
Technical and time consuming
Focus on simple metrics, provide written statements of
performance analysis
Too time consuming:
Limited dedicated resources
Leverage CommCare platform and work towards building
automated reports
Limited visit monitoring :
Too short or informal
Provides real-time monitoring and benchmarking of CHW
activities
Non-actionable data:
Reports often delayed, difficult to act timely
Provide timely reports with list of clear follow-up actions
by leveraging real-time data collection
Lack of tracking action:
Action rarely tracked to completion
Create a tracking system to track action from
identification to completion.

87. 87
CommCare: Proof of Concept Model + Learning
Collaborative Case Studies

88. 88
PROOF OF CONCEPT (POC)
OVERVIEW

89. 89
89
POC: New Approach to Starting Projects

90. 90
POC #1: USAID Development Innovation Ventures
~1000 CHWs
14 states
16 projects
• Two years of funding- emphasis on
making it easier to start a project
• Planning and sponsoring mobile
technology pilots for 40
organizations in India, which
includes:
• Giving 10 free Nokia/6 free
android phones
• 2 weeks on-site field support
• Ongoing remote support
• Free hosting
• Discounted packages to help
reach scale
• Currently in second round of
launches, lots of lessons learned:
• Plan for scale!
• Improve HQ function in poor
connectivity environments
• Focus on knowledge
management
• Be firm with milestones
Development and Innovation Ventures
(DIV II) grant from USAID to expand and
scale to new programs in health and other
social sectors: Proof of Concept (POC)

91. 91
POC #2: CORE Group Learning Collaborative
§ Supports 12 organizations to create mHealth
applications around maternal and child health in
14 low-income countries
§ Started in April 2012, wrapping up this month
§ Learning Collaborative members receive:
Ø Ten free mobile phones
Ø $500 for airtime
Ø A year of remote,
technical support from Dimagi

92. 92
POC #2: CORE Group Learning Collaborative

93. 93
POC CASE STUDIES

94. 94
Learning Collaborative Project #1
Project Name: Strengthening and
Accessing Livelihood Opportunities
for Household Impact (SALOHI)
mHealth Nutrition Program
Organization: Adventist
Development Relief Agency (ADRA)
Location: Amoron’i Mania region,
Madagascar
Focus Area: Malnutrition for children
under five
Language: Malagasy

95. 95
ADRA’s SALOHI mHealth Nutrition Program
Application Purpose:
§ To improve data quality of Growth Monitoring and
Promotion (GMP)
§ Support health volunteers in providing counseling
messages
Application Details:
§ Tracks children’s monthly nutritional
anthropometric status
§ Calculates weight-for-age Z score
§ Record MUACs
§ Provides appropriate nutritional counseling
messages

96. 96
Getting Started with mHealth
1. Designing the Prototype: describe the data points
Descrip)on
Type
(Number,
Yes/no,
Single-­‐
select,
Mul)-­‐Select,
Date,
Free
text)
When
data
will
be
collected
Full
name
Free
text
Child
registra4on
Date
of
Birth
Number
Child
registra4on
Gender
Single-­‐select
(Male/Female)
Child
registra4on
Current
Weight
Number
(decimal)
Child
registra4on
District/Village
Drop
down
list
Child
registra4on
Name
of
Mother
Free
text
Child
registra4on
Exclusive
breas_eeding
(for
infants
0-­‐6
months(
Yes/No
Monthly
Anthropometrics
Weight
for
age
Number
(kilograms)
Monthly
Anthropometrics
MUAC
(6
months
and
older)
Number
(cen4meters)
Measurements
are
recorded
to
nearest
0.5
mm
Monthly
Anthropometrics
Illness
• Fever
• Diarrhea
Yes/No
Monthly
Anthropometrics
Recovered
from
Illness
Yes/No
Monthly
Anthropometrics
END
OF
REGISTRATION
FORM

97. 97
Question Tree
2. Designed Prototype and Data Outputs
1. Calculations of weight-for-age of
each child by location
2. Number of children 0-59 months
of age who participate in growth
monitoring promotion
3. Number of children who are Sam,
Mam, and normal

98. 98
Counseling Messages
3. Counseling messages: CHV can have complete control
over which messages/audio are displayed or can be
automated depending on conditions.

99. 99
Designing the Counseling Messages
Example 1
1. Text that should appear on the phone: Frequency of
Breastfeeding
2. (Optional) Image that will accompany text: Breastfeed
your baby on demand, at least 10 times day and night, to
produce enough milk and provide your baby enough food
to grow healthy.
3. Image file that can be played by user:
4. When message will be given: 0-6 months of age

100. 100
Designing the Counseling Messages
Example 2
1. Text that should appear on the phone: Nutritional care
of infants and children with moderate acute malnutrition
2. (Optional) Image that will accompany text: (for children
six months or older). In addition to the supplementary
good that the child receives, give 1 additional bowl of
food each day to help your child to recover quickly and
become strong and healthy again. Breastfeed more often
3. Image file that can be played by user:
4. When message will be given: For children in the -2 zone
(yellow zone)

101. 101
Timeline of implementation
April 22 – 30
1. Download the final version of the application on the phone.
2. Insert SIM cards and track which phone is given to each CHV
3. Meet with the CHVs to complete training
4. Distribute the phones to each CHV along with credit for Internet,
money for charging and the phone charger.
5. Train the CHVs on the application including how images/phones be
used in counseling sessions
May-July
1. Conduct field visits with the CHVs during their SPCE session to
observe their use of the phone and answer any questions (visit each
CHV twice).
2. Track reports on CommCare HQ website to ensure that the phones
are being used properly.

102. 102
1st Round of updates to the application
1. There should be a way to "close" the case. This means
that right now the registration form opens a "file" for
the child, and the monthly form updates details about
that child. Most applications have a "close" form that
simply asks why the name is being removed (for
example- because the child is too old, child moved out
of the area, child died, etc.).

103. 103
Timeline of implementation continued
August
1. Distribute evaluations (translated to Malagasy) to each
CHV regarding their involvement in the pilot program.
2. Collect all phones and any extra charging money or
credit.
3. Troubleshoot (i.e. if a CHV has a problem with their
phone who do they tell and how does it get fixed?)
4. Collect feedback on how to improve the tool as well-
what was hard to use/what do the CHVs wish was there

104. 104
Things to consider
§ Audio messages: what is typical is to have a short text
phrase—sometimes just a word or two, and then a longer
audio message.
§ Calculations for Z-Scores: CommCare can handle math well
-- so if you are just using an equation to get the percentile,
that should work very easily. If you are looking up the answer
in a table (e.g. given a child's age and height, where do they
fall on this percentile chart), that is much harder to set up,
but possible.
§ Multimedia: you can upload your multimedia to our cloud
through our website, CommCareHQ. You can grant people
access to download the multimedia files from the
website. From there, you will have to place the multimedia
files on the phone manually.

105. 105
Things to consider cont.
§ Purchasing Phones: purchase phones locally since sometimes
phones are lost/damaged and need to be replaced. Local phones
display in the local language). Nokia C-2 for most deployments, and
the Samsung Galaxy Y or Samsung Galaxy Mini if you're looking to
use Android phones.
§ Word Limits: Welcome to the land of long words! The text would
be displayed on the phone, if it was too long we used shorthand.
§ Common problems in the field: Accidentally deleting things. Could
also be network issues, which is separate from the application
itself. If there is no network, message will be saved on the phone
until network can be found. If they have unsent forms, worker can
try to manually send them or wait until network pops up.
§ What happens to the phones once the program is complete? Do
the CHVs keep them?

106. 106
Learning Collaborative
§ Sharing the reports with the mHealth Learning
Collaborative: It's a good opportunity to introduce
yourself to other Learning Collaborative members and to
ask and answer questions.
§ Exchange visit with Food for the Hungry, Mozambique:
FH has a similar application which is to improve
nutritional surveillance of children under 5 years of age
within Palma district by allowing.
1. Real time reporting of Z scores to mothers (with follow-up
action, including referrals);
2. Real-time and accurate aggregate reporting of nutrition status
to FH, District, and CDC

107. 107
Learning Collaborative Project #2
Project Name: Reducing Maternal
Mortality in Panchagarh District
Organization: World Renew
Location: Panchagarh District,
Bangladesh
Focus Area: Maternal Health
Language: English

108. 108
World Renew’s Maternal Health Application
Application Purpose:
§ To track and provide counseling
messages to pregnant women in
antenatal, birth preparation, and
post-partum stages
Application Details:
§ Tracks and collects data about
pregnant women and babies
§ Provides appropriate antenatal,
birth preparation, and post-
partum counseling

109. 109
Breakout Session

110. 110
Benefits
of
CommCare
Barriers
to
Implemen)ng
CommCare
Improved care and quality of service
delivered by FLWs
Lack of on-the-ground infrastructure
(network and electricity availability)
Improved
experience/access
to
care
for
FLW
clients
Government/health system barriers
Increased productivity/performance
of the FLWs
Lack of program staff capacity
Improved supervision of FLWs
Lack of technology/computer
programmer staff capacity
Increased efficiency and timeliness of
reporting from the field
Lack of mHealth budgeting/finance
capacity
M&E of program interventions and
data analysis
Lack of interest/understanding/
commitment from organizational
leadership
Other
Lack
of
donor
interest/funding
Cost of deploying technology
Inability to scale after pilot
Other

111. 111
Breakout Session
For the final part of this workshop, we will be
discussing the following:
1) What are some benefits that CommCare (or
mHealth in general) could bring to your
organization’s projects?
2) What are some barriers you would foresee in
implementing an mHealth solution like CommCare?
3) Having discussed the benefits and barriers to
implementing mHealth, develop some guidelines
that bring up points a manager thinking about
employing mHealth should consider.

112. 112
Thank you!
Contact: gjavetski@dimagi.com or jwacksman@dimagi.com
Additional Videos:
CommCare Overview Video: http://youtu.be/ZpfvISKxylE
CommCare Demo Video with multi-lingual support from India: http://youtu.be/30Ftk6STM3U
Recorded Webex of CommCare Presentation given to NetHope: http://bit.ly/tiLaYy
Additional Resources:
http://groups.google.com/group/ict4chw
http://www.commcarehq.org
http://www.dimagi.com