Center for Health Market Innovations (CHMI)

Programs

CommCare

last updated Apr 5, 2012

Overview

Implementing organization: 
D-tree International
Implementation Partner(s): 
Dimagi Inc., Pathfinder International, University of Washington
Legal Status: 
Private (not-for-profit)
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Donor
Funders: 
IDRC, Microsoft Research., The Fulbright Program, The National Science Foundation, The U.S President’s Emergency Plan for AIDS Relief

Technology

Technology Used: 
Phones › Apps/Software, Computer › Apps/Software, PDA/Tablet › Apps/Software, Phones › Internet, Computer › Internet, PDA/Tablet › Internet, Phones › SMS/MMS (Text Message), Remote Diagnostic Tool
Technology Partner(s): 
Dimagi Inc.

Scale

Number of Clients Served: 
300 home based care providers trained and using the application
Upscaling: 
CommCare is currently being piloted in ten countries by 19 public health organizations. Forms for over 90,000 home visits have been submitted thus far. The majority of these projects are tailored to strengthen community-based efforts to improve maternal and child health. Dimagi has recently launched a cloud-based, enterprise level platform to deploy CommCare globally (www.commcarehq.org). The platform includes two-way synchronization of client data which allows data to be shared between CHWs, promotes links between community- and clinic-based health, and restores a CHWs data in case of phone damage or loss. They are focusing their immediate scale up efforts in India to deploy CommCare with the new Accredited Social Health Activist (ASHA) program. Over 750,000 ASHAs have already been trained and are financially incentivized to conduct community-based interventions known to improve maternal and child health.
Summary: 

This mobile-phone based application aims to enable community health workers to provide better, more efficient care while also enabling better supervision and coordination of community health programs. A phone running the software will assist them to manage household visits and plan their day, while at the same time collecting and reporting data that will help monitor and evaluate community health programs. The target is to have 1,400 health workers using CommCare by 2014.

Program goals/rationale: 

Home Based Care Providers (HBCPs) play a vital role in serving poor and rural populations suffering from diseases such as HIV as well as providing preventative services such as mosquito nets, oral rehydration solution and family planning. HBCPs are typically in the best position to promote preventive care and convey important health information, and are often the only health workers with sufficient time to get to know the patient and understand their challenges. HBCPs can encourage prompt care-seeking behavior, and detect and refer those at risk for tuberculosis, malaria, and other important diseases related to HIV. Finally, HBCPs also have the potential to collect information that is needed at the national level about disease burden and barriers to adopting necessary health practices. HBCPs, however, often receive relatively little medical training, have high turnover, and have limited opportunities to reinforce their knowledge once they begin working in the field. They typically lack effective tools required to maintain the longitudinal records required to provide truly effective care. Furthermore, while living in the communities they serve is the key to the effectiveness of HBCPs, it also makes community health programs extremely difficult to organize and manage.

Key program components: 

Dimagi and D-Tree international are leading CommCare, a mobile-phone based application that will enable CHWs to provide better, more efficient care while also enabling better supervision and coordination of community health programs. Dimagi is leading the development of the open source, phone and web-based application, building on years of experience in mobile health. D-Tree International, a frequent partner and implementer with Dimagi, is leading the implementation of CommCare deployments, currently focused in Tanzania. This effort is a collaboration with local researchers and implementing organizations, and will be built on top of the open source JavaROSA platform.

CommCare is a case management solution for CHWs. Each CHW is equipped with an inexpensive phone running our free and open source software that contains registration forms, checklists, danger sign monitoring, and educational prompts. CommCare helps manage enrollment, support, and tracking of all of the CHW’s clients and activities. CommCare captures data from each home visit and sends the data to our central cloud, CommCareHQ for program improvement, health surveillance, and workflow interventions. CommCare is easily customizable for widely different environments; it can run on inexpensive Java-enabled phones or higher-end Android phones, easily handle multiple languages, and incorporate multimedia elements for low-literate users.

CommCare collects and reports data that helps monitor and evaluate community health programs themselves. It has several levels of functionality eventually (not all of which are fully developed ):

  • Household visit tracking: The HBCP will record every household visit in CommCare, which will be relayed back to a central server over the cellular network. Even this simple information can help a HBCP ensure they visit each household frequently enough, as well as provide HBCP supervisors with key information about the activity of their HBCPs.

  • Household visit support and data collection: CommCare will present a checklist of activities to the HBCP for each visit, as well as collect data, such as information about any births or deaths since the previous visit. The content of the checklist and questions will be easily customizable to meet the needs of each program.

  • Followups: Many household visits result in the HBCP advising their clients to do something or go somewhere, such as to go to a clinic for testing or treatment. During a visit, the HBCP will record their recommendations in CommCare. At the next visit, CommCare will prompt the HBCP to follow up, e.g., to see if the person did indeed go to the clinic for testing.

  • Record keeping: CommCare will maintain household house records (e.g., number of mosquito nets, presence of pit latrine, etc), as well as information about each member of the household (e.g., age, immunization and weight for children, family planning method for adults, etc).

  • Health protocols: CommCare will guide a HBCP step-by-step through relevant health protocols, such as TB and malaria screenings, and refer people to appropriate clinics or testing.

  • Day planning: CommCare will help a HBCP plan their day. For example, if a member of a household is referred for a TB test, CommCare can direct the HBCP to follow up on that household after 1 week.

  • Data exploration: HBCPs will also be able to use CommCare to explore trends in their activity, and compare data on their clients and activities to those of other HBCPs in the country.

Additional Information

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Improving Standards of Care with Mobile Applications In Tanzania.pdf159.76 KB
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