Dimagi

BHOMA project featured on couchone.com

by Cory Zue on 26 October 2010

Dimagi’s BHOMA project was featured as a case study on couchone today.  In it, we discuss how a technology called CouchDB was used to build the BHOMA system. You can read the full text of the case study below or on couchone’s page at http://www.couchone.com/case-study-dimagi.

Dimagi: A Case Study

BHOMA (Better Health Outcomes through Mentoring and Assessments) is a large research project tasked with improving maternal and child mortality rates in rural Zambia through standardized interventions in clinic care and community health. This requires building a distributed health data capture system, designed and implemented by Dimagi and CIDRZ. This initiative faces many of the same technology challenges encountered in low-resource Africa: limited computer resources, intermittent power, and above all, extremely unreliable internet.

Dimagi needed to leverage the most common modern communications device in many rural communities – the cell phone. But they faced a major hurdle: How to get important and timely patient information from clinics (with no reliable internet connection), to health workers in small communities so they could follow-up with patients in their area. Further, they had to solve how to get information collected on cell phones back to the clinics to monitor patient outcomes.

Solution

Dimagi became interested in CouchDB after learning about its replication technology. They needed a fully off-line system for each of their clinics, because the only network connection any of them had was an unreliable GPRS modem on the local cellular network. Network outages and latency could not be allowed to disrupt clinic operations.

By standing up a lightweight server at each clinic, backed by a CouchDB datastore, BHOMA was able to ensure constant uptime in the clinics – providing power was up. Each clinic replicates over the modem’s connection to their national CouchDB database. Because of CouchDB’s continuous replication and optimized synchronization, Dimagi didn’t have to worry about writing complicated sync protocols. Filtered replication allowed them to send only the appropriate data to each clinic, drastically reducing the bandwidth required to sync with the central server. The two-way replication also allowed for data collected on CHWs’ cell phones to propagate back to the clinic, for timely patient updates.

Results

Dimagi became interested in CouchDB after learning about its replication technology. They needed a fully off-line system for each of their clinics, because the only network connection any of them had was an unreliable GPRS modem on the local cellular network. Network outages and latency could not be allowed to disrupt clinic operations.

By standing up a lightweight server at each clinic, backed by a CouchDB datastore, BHOMA was able to ensure constant uptime in the clinics – providing power was up. Each clinic replicates over the modem’s connection to their national CouchDB database. Because of CouchDB’s continuous replication and optimized synchronization, Dimagi didn’t have to worry about writing complicated sync protocols. Filtered replication allowed them to send only the appropriate data to each clinic, drastically reducing the bandwidth required to sync with the central server. The two-way replication also allowed for data collected on CHWs’ cell phones to propagate back to the clinic, for timely patient updates.


BHOMA

by Cory Zue on 13 October 2010

How do you get urgent information about patients from rural clinics to the community health workers in their villages, when distance, travel times, difficult terrain, and busy schedules all stand in your way?

One popular practice is to send a bush note: a scrap of paper with a note on it that passes from hand to hand as people head in the general direction of where it needs to go. This communication pathway can work well, but is subject to many potential problems – you don’t know who will read the note, how long it might take, or whether it will ever find its intended recipient.

Dimagi is working with the Center for Infectious Disease Research in Zambia (CIDRZ) on the BHOMA* project, which aims to use technology to fill this gap. The BHOMA system allows a clinic to have a fully functional patient data-entry system, with local records and reports available from a simple touchscreen interface all while remaining completely offline.

Each clinic is also able to connect to the internet via a modem and the local cellular network to securely sync the records to a central server. Meanwhile, community health workers (CHWs) in the villages running CommCare on their phones can pull patient follow-ups from the server and make sure that the clinic outcomes are resolved or handled in a timely manner. Using technology and the cell network, the new “bush note” can travel at the speed of data.

BHOMA is part of a 5 year study aimed at improving maternal and child health through standardized protocols and follow-ups. It is being incrementally rolled out to 55 clinics in rural Zambia. As usual, all of the technology for the project is free and open source.

*Better Health Outcomes through Mentoring and Assessments


Dimagi awarded Development Innovation Venture grant from USAID

by Jonathan Jackson on 10 October 2010

Dimagi was awarded one of eight development innovation ventures grants from USAID. The project will support our continued effort to adapt our CommCare platform for wide-scale use within the Accredited Social Health Activist (ASHA) program in India. More information about enrolling on our advisory committee or becoming a beta testing will be released shortly.

Press Release from USAID.

Article on american.gov about Dimagi and the DIV program