Dimagi is a social enterprise founded in 2002 that designs and implements mobile health (mHealth) solutions. It has experience working in over 25 countries on a variety of mHealth projects using SMS, CommCare, and other tools. Some key points about Dimagi's work: - They have a collaborative model where a core team works with over 50 partners on projects. - Projects have addressed many areas like antenatal care, supply chain management, surveys, and more across multiple countries in Africa, Asia, and other regions. - Their CommCare platform is one of the most widely used mobile tools for frontline health workers in low-resource settings. - They emphasize an iterative design process

1. mHealth
Nuts and Bolts
Rowena Luk
May 1, 2012
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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
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3. Operational Experience (25 Countries)
Country SMS CommCare CommTrack Summary
Afghanistan X X Safe Pregnancy, RapidSMS project
Benin X Safe Pregnancy
Bangladesh X X CommCare, Strategic Consulting
Ethiopia SmartCare
Ghana X X Supply Chain Logistics
India X X Data Survey, Strategic Consulting, CommCare
Indonesia X Health SMS
Iraq X Democracy Survey
Japan Hospital IT Integration
Jordan X Democracy Survey
Kenya X SMS Clinical Trial, HMIS Strategy
Malawi X X X Supply Chain Logistics
Mexico X CommCare Epilepsy Protocol
Mozambique X ODK Household Survey, CommCare
Nigeria X SMS Bednet Tracking
Nicaragua X CommCare for Engaging Fathers
Philippines X SMS Vaccine Clinical Trial, Cold Chain Logistics
Senegal X SMS Social messaging
South Africa HIV Decision Support
Tanzania X X X CommCare Safe Pregnancy, TB, HIV, SMS Logistics
Thailand X SMS Vaccine Clinical Trial, Cold Chain Logistics
Uganda X X SMS Clinical Trial, IVR Clinical Trial, Supply Chain Logistics
United States X X SMS Adherence, Care Coordination, CommCare HIV
Zambia X SmartCare, SMS Lab Reporting, Touchscreen EMR
Zimbabwe X Democracy Content + IVR
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4. What kind of projects are using mHealth?

5. All Kinds
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6. Designing mHealth Projects
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7. Match Existing Workflows
Example: Remote Consultation
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8. Unsuccessful System
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9. Successful System
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10. Don’t Automate Broken Systems
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11. Design Under the Mango Tree
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12. Design Under the Mango Tree
Sample CommCare Implementation Plan
TimeFrame( 25 Weeks) Duration
Stage 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 - - Wk14
Training
19.TrainfullcohortofCHWs PC,DimagiFE 4 Wk1 7
Pilot
&
20.MonitorthroughCommCareHQandADM PM,PC,DimagiFE 8 Wk25
21.Projectc oordinatorfollowsupwithCHWs PC 8 Wk25
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13. What happens after?

14. Sustainability
Custom Platform Product Turnkey Product
• many codebases • many codebases • 1 codebase • 1 codebase
• new code • shared code • many installations • 1 installation
Custom Generic
High Effort Low Effort
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15. CommCare/HQ Turnkey Product
Mobile 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
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16. Shared Tools Lead to Shared Data
Shared 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
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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 tools
Contact: rluk@dimagi.com
Additional Resources:
http://www.commcarehq.org
http://www.dimagi.com
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18. Extra Slides
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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 Encouragement
Visits: who, when, duration Form updates
Registration
forms,
Client records,
Checklists &
protocols,
Multimedia
CommCare Mobile Clients (CHWs phones)
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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.
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23. Ideal vs. Actual Practice
1.Global HQ IDEAL INTERVENTION
2.In-country HQ
3.Field Managers
4.Talking to CHWs
ACTUAL INTERVENTION
5.Working with CHWs
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24. Who’s doing the content?

25. ≠
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