social business: a new perspective on healthcare delivery
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Social Business: A New Perspective on Healthcare Delivery
SARAH HODSDON, DIMAGI PROGRAM ANALYST
MAY 1, 2014
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“We deliver open and innovative technology to help underserved communities around the world”
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A leader in open source mobile technology This means that our code is free on the Internet Anyone can download, use, or modify our code
We focus on creating solutions for frontline workers in resource-limited settings
We make software solutions that do not require software developers to deploy
170+ active projects in 40 countries
Work across multiple sectors, including health, agriculture, microfinance, etc.
Partners: Foundations, governments, NGOs, and grassroots organizations
Team of 80+ with scientists, public health experts, physicians, engineers and field consultants
Dimagi
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Principles
Care about impact, team satisfaction, profit … in that order
Invest profit smartly for impact and team satisfaction
Be the leading high-value technology provider for frontline programs
Be open, transparent, and collaborative
Demand efficiency and utilize a product-oriented approach
Generate internal and external evidence of impact
Scale only as fast as we can maintain our culture
If we have to choose, we choose empathy over scale
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Healthcare access is limited in most parts of the world.
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Improve last mile logistics
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Current data systems cannot support the workforce
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“Extending the reach of the public health system through a well-trained and
supported community health workforce is a crucial step in meeting the MDGs, strengthening health systems, and
increasing quality health care.”
One Million Community Health Worker Campaign Technical Task Force Report
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mHealth for Community Health Workers
Health records
Patient ID & tracking Supply tracking
Monitoring & Evaluation
Checklists & Protocols
Education & TrainingData Collection
Counselling Messages
Surveillance?
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Frontline Workers
Health
Logistics
Agriculture
Education and TrainingGender Equality &
Women’s EmpowermentFinancial Services for the PoorWater & Sanitation
Humanitarian Response
Governance and Accountability
In emerging markets, frontline workers support development across sectors
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LogisticsCommunicationData and Workflow
Dimagi Products – Powered by CommCare
• Data collection and case management
solution
• Java feature phones or Android
smartphones & tablets
• Secure and scalable
• 2-way SMS-based applications
• Any SMS-enabled mobile device.
• SMS point of service logistics
management systems
• Manage inventory and logistics for
remote sites.
Implementation Services: technology enablement, design, and support
CommTrackCommConnectCommCare
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What Can You Do With CommCare?Step 1: Build or customize a mobile app
Step 2: Download the app onto a phone
Step 3: View real-time data in online reports
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Community Health Challenges
Accountability- Monitoring reports delayed
- Only aggregate data delivered- Data quality low
Access- Many eligible
beneficiaries not enrolled- Missed visits and
referrals - Inefficiency
- High CHW attrition
Quality- Short visits
- Key steps skipped- Sensitive issues avoided
- Insufficient training
Experience- Job aids left at home
- Low credibility- Messages not engaging
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CommCare Solution
Accountability+ Use real time monitoring of daily activity of each CHW
+ Dimagi’s Active Data Management improves workforce performance and efficiency
+ Increase the credibility and confidence of communities in health services
Access+ Increase timeliness + Increase enrollment+ Increase retention+ Increase access to services for rural and
indigenous communities
Quality+ Checklists improve
performance
+ Decision support increase adherence to
protocols
+ Video, audio convey sensitive topics in authoritative voice
Experience+ Audio, images, and video are easy to carry
on phone+ Phone adds credibility
+ Audio and video engage clients more than paper
materials
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The result? Stronger healthcare workersData collection Counseling
Workflow supportTraining reinforcement
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Design Under the Mango Tree
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Good Design Takeaways
Requires being with users (in the field)
Watching prototypes in use
Creating a relationship to get honest feedback
Design does not just apply to technology
When design is done right, technology is often the easy part
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1/1/2005 1/1/2006 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1/2011 1/1/2012 1/1/2013
# of Cumulati
ve Beneficiaries trackedRe
venu
e ($
)Dimagi Revenue and # of Cases Tracked
Revenue* Cases (Approx. Beneficiaries)
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Rapidly Scaling
Business model Open source code
Low hosting fees for our cloud-based server Start-up & support service packages
Web enabled application building tools, CommCare Exchange (an App Store to support diffusion), Offer “Proof of concept” packages to help organizations get started with mServices
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Difficulty in Donor-driven Sector
Many Large NGOs are heavily driven by Large donors 3 to 5 year plans, many deliverables determined up front
Once a grant is awarded: There is not a strong incentive to adapt and admit your original approach was
not correct:• Do what you said you were going to do• Spend what you said you were going to spend
Therefore Duplication of innovation Lack of collaboration Lack of adjustment to realities on the ground Lack of innovation after the plan is in place
Image Credit http://bluebuddies.com/Smurfs_Color_Smurfs_Pictures.htm
But, not unique to Donor Sector
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What are the learnings for impact measurement & action?
Ideal: Collect Data to Measure Impact – CommCare is primarily a Management
Information System (MIS) Do something with the data to improve service delivery on the ground (reminders
for visits, performance benchmarking, targeted real time feedback)
Challenges: As a technology service provider, you are an enabler / amplifier of existing
programs, and dependent on things outside of our control (and even outside our clients)
Baselines are tough to find
Learnings: Don’t Automate Broken Systems A versatile, open source product can help achieve scale and sustainability. (It’s OK
to start small.)
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Broader Lessons Learned
A single solution for both high-performers and low-performers is complex:We warn our partners that our solutions won’t work for every
user
Constraints support innovation: Simplifying our interface for low literate users in Afghanistan
and adding audio became one of our most popular features
Co-design is not just about technology and/or products
It’s okay, (if not better sometimes) to say no
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Pregnant women that have access to
CommCare are 20% more likely to access antenatal care & 22% more
likely to have skilled deliveries.
With CommCare, health workers
completed 20% more of protocols and increased their
knowledge of health danger signs by
22%.
CommCare improves health
workers’ credibility, as well as client and
family members’ engagement.
CommCare reduced the average time it took to submit data
to a program coordinator from 45 days to 8 hours.
Access Quality Experience Accountability
[Afghanistan, 2013] [India, 2012]
[Tanzania, 2008] [multiple studies] [India, 2012]
Measuring Impact
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Other Ways to Measure Impact: Research
85% More timely Visits Randomized Controlled Trial
B. DeRenzi, L. Findlater, G. Borriello, J. Jackson, J. Payne, B. Birnbaum, T. Parikh, N. Lesh, “Improving Community Health Worker Performance Through Automated SMS”, ICTD 2012, to
appear
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Examples of Dimagi Projects
Maternal Health: Pathfinder is deploying CommCare to 2,400 health workers in Haiti to register, track, and treat pregnant women.
Child Health: Terre Des Hommes is rolling out eIMCI application to 400 health clinics in Burkina Faso to strengthen referral systems.
Nutrition: World Vision has deployed a maternal health CommCare application in nine countries to screen children for nutrition status and related illness, plus immunization status.
Logistics/Supply Chain: John Snow International is tracking medical supplies in 8,600 facilities in Tanzania, Malawi, and Ghana with CommTrack.
Family Planning: University Research Coalition is using CommCare in Benin to promote family planning and track FP commodities and pricing.
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