In 2008, I worked for Uganda Chartered HealthNet, deploying PDAs to health workers, so that health records could be transferred to the Ministry of Health using a gprs-enabled access point mounted at a wall in the health facility. We were leaders in the work to digitize health records. OpenMRS was in its infancy while DHIS2 had just been released. The platform that would change the way we support frontline health workers was named GATHERdata. Meanwhile another company, FrontlineSMS was threatening to move our cheese. Frankly the writing had been on the wall. SMS was gaining traction. Essentially, any health worker anywhere, could send in a report without needing a central place to “sync” data. (Can you imagine we did that over an infrared beam??). Here you can see Dr. Elioda Tumwesigye, rally community health workers.
In the same year, i joined an africa-wide advocacy association, the Free Software and Open Source Foundation for Africa – FOSSFA. People always wonder, what is the difference between Free Software, and Open Source software. According to the Free Software Foundation, for a piece of software to be considered truly “free,” its license must guarantee four essential freedoms to its users:
- The freedom to run the program as you wish, for any purpose.
- The freedom to study how the program works, and change it so it does your computing as you wish. Access to the source code is a precondition for this.
- The freedom to redistribute copies so you can help others
- The freedom to distribute copies of your modified versions to others. By doing this you can give the whole community a chance to benefit from your changes. (Again, access to the source code is a precondition for this).
When you make access to the source code possible, you make it open. When you allow modifications to come right back in, and also be available to everyone else, you become truly open, and truly free. By this time, you are going to need a community, as you will no-longer retain the capacity to work on the tools alone.
First it was hardware – PDAs to Smartphones, and then delivery (from infrared beams, to SMS, to native apps) now the shift (4IR) is to think platform (OpenMRS, DHIS2 and, gladly, Community Health Management System). But can a platform for healthcare tools be free, and open source?
Since 2010, Medic Mobile (formerly FrontlineSMS:Medic) has supported community health systems in more than 23 countries and is one of the largest implementer of digital health systems in lower-income settings. Medic builds mobile applications for community health workers (CHWs), household caregivers, and patients. We see communication gaps through the eyes of health workers and patients, and employ a human-centered design approach to co-designing health care delivery systems with local implementing partners. Medic Mobile has worked with over 60 partners across Africa, Asia, Latin America, and the US. Based in San Francisco with regional offices in Africa and Asia, Medic Mobile’s technology supports over 25,000 front-line health workers, workers as they coordinate care for over 14 million families in some of the worlds hardest-to-reach communities.
The open-source software that Medic Mobile stewards, contributes to, and deploys is called the Community Health Toolkit. The CHT, a global public good to advance Universal Health Coverage (UHC), can be configured in each health system to serve the needs of that health system.
The CHT has been designed as a care-first platform, solving problems for CHWs and families. Care guides allow health workers to confidently treat at the doorstep and build credibility in their community. Tasks help direct health workers back to the right homes at the right times. Making work visible enables fair pay. It’s obvious, but this utility to people has been key to its adoption and use. Tools can be set out to collect data. Platforms, on the other hand, are set out to solve people’s problems. System owners get high-quality, longitudinal data as a by-product.
We have designed for and developed tools for Improving child health (Immunization, Nutrition, Integrated community case management), Reducing maternal and neonatal mortality (Antenatal care (ANC), Postnatal care (PNC), Family planning) and Strengthening community health systems (Health worker performance, Health system performance, Outbreak surveillance, Direct to Client Communication, Supervision). The platform includes analytics for more complex data visualization and analysis (including geospatial data and map-based visualizations). Medic Mobile’s web-based dashboard pulls data automatically, and can be accessed securely through a web-based login.
The questions for digital tools for the future are going to be beyond just measuring and managing towards quantity at the provider, manager, and health system levels; and we start to look at performance in regards to speed of care (after onset of first symptom), (universal health) coverage, quality of care, and equity (getting care today, to the family that needs it the most today). Platforms in healthcare should extend to allowing patients to provide feedback on services provided at the home and in health facilities.
The well manicured grass felt bouncy as we queued up to shake President Obama’s hand, and take a picture. It was when he saw the sticker on the back of my phone, “We Are All health Workers” – that he got interested, arranged for us to meet separately, so I could share with him what that was all about. This is how I got to share the story of my work.
The alarm always rings, at the best part of the dream. Time check, 515am.