Annex 5 - Global Platforms

There are a number of software platforms that can be used to create specific and bespoke digital tools for interventions. As these platforms become more widely used and invested in, they themselves evolve into something more powerful - with more functionality and expertise in how to enable the development of effective tools. Critically, they are also largely interoperable with each other, as well as with national systems such as DHIS2 – so the more they are used the more effective they become together. Whilst all are free and open source, there can be some ongoing maintenance / management / server costs. In fact, in order to ensure they continue to evolve and maximise their potential (make continuous incremental improvements and maintain data protection etc) this is something that is necessary in most instances.

Commcare, Dimagi

Dimagi’s primary product, CommCare (www.commcarehq.org), is a user-configurable, open source platform that enables anyone to build mobile applications to support data collection, counselling, behaviour change, and a variety of other functions. It is the most widely-used offline data collection and service delivery platform. It has multi-platform functionality and can be used via mobile, web, and messaging platforms with bi-directional communication analytics which integrate directly with analytics tools for monitoring. It is interoperable with many of the other platforms detailed here.

With an average cost $2 per user per month, one study found the use of CommCare to be more cost-effective than certain vaccines, including the cholera vaccine. ReMiND (India) incurs an incremental cost of USD $205 per DALY averted and USD $5,865 per death averted.

It terms of reach and sustainability it has been deployed in some form in over 80 countries, nine of which that have made national scale commitments: Guatemala, Senegal, Burkina Faso, Benin, Ethiopia, India, Malawi, Mozambique, South Africa. Partners/clients include Unicef, BMGF, USAID, CRS, IRC, Partners in health, Oikoi, Abt, DSME, One Acre Fund, Medic Mobile, Rockefeller Foundation.

Community Health Toolkit, Medic Mobile

The toolkit is open source platform which enables apps to be developed within it based on an existing blueprint. The products/apps serve as a public good for global health. Apps which can be developed in any language and the software supports health workers delivering equitable care that reaches everyone. It is interoperable with Moodle which can be used as back end with offline use and embedded gaming features.

Examples of its widespread implementation have helped health workers ensure safe deliveries, track outbreaks faster, treat various illnesses door-to-door, keep stock of essential medicines, and communicate about emergencies. Functionality includes messaging, digital decision support, data collection, task and schedule management, patient files and analytics. Health worker performance management functions allows users to take action based on real-time health worker performance indicators. It also allows health workers to view their own performance and compare to goals, peers, and previous time periods.

In terms of interoperability and sustainability, Medic Mobile's approach involves looking with a health system lens to support basic building blocks and aligning with national strategies to create more impact compared to just standalone tech projects.

In terms of reach it has been very successful, with 33,000 HCWs using it in 15 countries, resulting in "over 1 million caring activities supported per month". Partners include University of Washington, d.tree, Harvard Medical School, I-TECH, Last Mile Health, Living Goods, Oppia Mobile and others.

OpenSRP

Developed by a consortium of technology, implementation and academic partners, led by WHO’s Department of Reproductive Health and Research. An open source mobile health platform that allows frontline healthcare workers to electronically register and track the health of their entire client population. Used for health programme areas such as HIV, TB, Malaria, Reproductive, Maternal, Child and Adolescent Health, HPV and Child Immunization. It simultaneously provides programme managers and policymakers with current data for decision-making. The COVID-19 track and trace application is currently being tested and deployed in Indonesia with 200 healthcare workers.

It has won awards and UNICEF, Gates and Gavi have all invested in it. Gavi’s initiative on Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) recognized OpenSRP as one of the “pacesetter” innovations of 2018.

In 2018, the Digital Square Global Goods mechanism selected OpenSRP as a mature software “global good.” Managed by PATH and supported by Gates, among other funding partners, the Digital Square Global Goods mechanism invests in scalable and interoperable digital health solutions that add value to countries’ health systems.

It complements and adds value to other “global good” digital health information systems, including medical records systems (OpenMRS), health management information systems (DHIS2), logistics information systems (OpenLMIS), and messaging platforms (RapidPro) that are often deployed at scale – and some of which are detailed here. It has Bluetooth data transfer for low connectivity environments

It has been used across a variety of countries including Bangladesh, Pakistan, Indonesia, Tanzania and Zambia. Partners include mPower, Johns Hopkins University, Ona, Harvard University School of Public Health, Interactive Research and Development, Summit Institute, and Interactive Health Solutions under the THRIVE research study.

RapidPRO

Developed by UNICEF, building on some of the issues they had with RapidSMS in operating in difficult environments, and allows the user to easily design, pilot, and scale services that connect directly with a mobile phone user without the help of a software developer. It collects data via short message service (SMS) and other communication channels to enable real-time data collection and mass-communication with target end-users, including beneficiaries and frontline workers. RapidPro also powers U-Report, UNICEF’s youth, and citizen engagement platform.

It is now used in 36 countries for real-time monitoring. It has significant reach as it integrates interoperably with widely used social media messaging platforms, including Facebook Messenger, Telegram, WhatsApp and Viber, as well as with DHIS2 and OpenMRS. Many of the digital health interventions powered by RapidPro have been linked into foundational digital health systems such as the DHIS2 and OpenMRS, resulting in easy user experiences for governments and reducing duplication and costs.

In Pakistan in 2018, families of 37 million children in 163 districts across Pakistan were reached through real-time information to increase demand for routine immunization with an initial focus in poorly performing polio tier 1 districts. Other initiatives have helped to coordinate cash assistance programmes; monitor water, sanitation, hygiene and nutrition interventions; and provide early detection and response to children with disabilities.

DHIS2 Tracker

Managed by the Health Information Systems Program (HISP) at the University of Oslo, this is an extension of DHIS2. Whereas DHIS2 is a HMIS system used for managing aggregated data, DHIS2 Tracker is used for individual patient level data at health facility/ community level. They now have COVID specific applications that are used for COVID-19 Case Management including screening and testing, contact registration and follow-up, port of entry screening and follow-up and as a surveillance system.

It is interoperable with DHIS2 as well as Electronic Medical Record (EMR) systems to allow for the sharing of clinical health data across facilities. It works via a mobile app called DHIS2 Capture. It is flexible and can be introduced as a pilot scheme initially, before being scaled up. Scaling up leads to increased operational costs in terms of support, devices and connectivity.

In Ghana, introduction of the DHIS2 Tracker has reduced health care worker workload by reducing reliance on paper based systems ensuring complete and timely reporting from the health facilities. Furthermore, Palestine's Maternal and Child Health (MCH) eRegistry has been used in more than 50,000 maternal health visits across 220 clinics in the West Bank and Gaza. The success of this eRegistry has led the Ministry of Health to adopt DHIS2 for routine reporting and disease surveillance as well.

It has now been deployed in 52 countries with Covid-19 specific apps deployed in 32 of them.

Open Data Kit (ODK)

Managed by Narfundi, ODK is a free open source suite of tools that allows data collection using Android mobile devices and data submission to an online server. It has been used for event-based Surveillance System and Healthcare Worker Training and Monitoring. ODK build is a drag and drop web-based form designer, best used for designing simple forms.

It is excellent for difficult operating environments as it can be used without an internet connection or mobile carrier service at the time of data collection. In Somalia, contact tracing data from 4,000 healthcare workers trained by WHO flows through ODK.

It has been deployed in about a dozen countries and has 400,000 monthly users