commcare workshop_javetski and wacksmon_4.22.13
TRANSCRIPT
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“CommCare Workshop: How to Plan a
CommCare Workshop”
CORE Group Spring Pre-Meeting Workshop April 22, 2013
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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”
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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
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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
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Dimagi Product Overview
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§ 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
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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
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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
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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
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DIMAGI SOFTWARE PRODUCTS
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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
CommTrack CommConnect CommCare
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COMMCARE (DIMAGI’S MOBILE PLATFORM)
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CommCareMobile • Community Health Workers • Research Assistants • Surveyors, etc.
CommCareHQ • CHW Supervisors • Project Managers • Researchers • Dimagi Field Managers
CommCare
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CommCare: DEMO
CommCare Overview: http://tinyurl.com/crscommcare
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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
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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
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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
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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
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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.
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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
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COMMCARE EVIDENCE
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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
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Technology PlaUorm
Services & Adop4on
Innova4on & Research
Smarter Community Services
Measure
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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
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CommCare: Evidence Partner Experiment Result
ACCE
SS 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.
QUAL
ITY 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%
EXPE
RIEN
CE
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.
ACCO
UNTA
BILITY
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%.
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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
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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
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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
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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.
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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)
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COMMCONNECT (DIMAGI’S SMS TOOL)
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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)
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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
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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
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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
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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
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COMMTRACK (LOGISTICS MANAGEMENT)
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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.
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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
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CommTrack v1 (ILSGateway in Tanzania)
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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
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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.
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CommCare Pricing Packages
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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.
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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)
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CommCare: Implementation
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Agenda
Application Development 2
Implementation 3
Getting Started 1
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GETTING STARTED
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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
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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
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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
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Design Under the Mango Tree
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User-focused Design
- Rapid content prototyping
- Mature technology platform
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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
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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
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APPLICATION DEVELOPMENT
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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
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1- What do you want your application to do?
Data collection?
Counseling?
Training reinforcement? Workflow support?
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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?
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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?
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1- Worksheet
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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?
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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.
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2- Know Your Mobile Users: Language
Input
ALKA
अलका
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3- Build App: CommCareHQ.org
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3- Exchange: An Open Source App Store for CommCare (www.commcarehq.org/exchange)
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IMPLEMENTATION
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M-Health Training for an Entire Organization!
Train field supervisors
Train technical staff
Train the trainers Train the pilot CHWs Train all CHWs
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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
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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
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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
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CommCare: Impact and Tools
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TOTAL COST OF OWNERSHIP
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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
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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)
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RESEARCH
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Technology PlaUorm
Services & Adop4on
Innova4on & Research
Smarter Community Services
Measure
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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
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Active CC Investigations at a Glance Hypothesis Experiment
ACCE
SS
• 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
QUAL
ITY
• 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
EXPE
RIEN
CE • 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
ACCO
UNT-‐
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.
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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
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CHW Performance Feedback: Low Performer
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CHW Performance Feedback: High Performer
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PERFORMANCE
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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
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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
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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
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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.
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CommCare: Proof of Concept Model + Learning Collaborative Case Studies
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PROOF OF CONCEPT (POC) OVERVIEW
89 89
POC: New Approach to Starting Projects
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)
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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
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POC #2: CORE Group Learning Collaborative
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POC CASE STUDIES
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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
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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
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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
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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
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Counseling Messages 3. Counseling messages: CHV can have complete control over which messages/audio are displayed or can be automated depending on conditions.
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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
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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)
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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.
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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.).
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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
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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.
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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?
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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
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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
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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
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Breakout Session
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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
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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.
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Thank you!
Contact: [email protected] or [email protected]
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