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