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Staff Blog

Life in the Clouds—Boosting Haitian Health Care Through Technology

by Therese Cafaro

1 April 2015

 

Ketcia Orvillus (PHoto Credit: Therese Cafaro, USAID)

Ketcia Orvillus (PHoto Credit: Therese Cafaro, USAID)

This was originally published in the March/April online edition of USAID Frontlines

Robin, a small rural Haitian community, is only one and a half hours outside of Port-au-Prince, but may as well be a world away. The usual congestion, chaos and dust that coats the capital city gives way to open vistas of greenery, the occasional sounds of cows or goats, and clean, crisp air. Here, 37-year-old community health worker Ketcia Ovillus does her work, walking on unpaved mountain roads that sometimes seem to touch the sky to reach patients in distant villages.

Born and raised in Robin, Ovillus has been delivering the Government of Haiti’s primary package of health care services to her neighbors for the last four years. She is one of only five community health workers serving Robin’s 9,000 residents. She spends hours traversing the rough terrain to visit her patients in the mornings and returns to the dispensary by afternoon to assist medical staff there.

“Since I started this work, I’ve never had a bad day,” Ovillus says. “My days have all been good. I’m helping people.”

Ketcia Orvillus enters data into her handheld device between home visits. (Photo Credit:  Therese Cafaro, USAID)

Ketcia Orvillus enters data into her handheld device between home visits. (Photo Credit: Therese Cafaro, USAID)

Ovillus was trained by Pathfinder International, a USAID-funded partner, to work within a network of health care facilities under a program called Services de Santé de Qualité pour Haiti in Haiti’s Central and South departments (SSQH-CS).

Since April 2014, her ability to track the myriad details about her patients’ lives got easier with new technology adopted by her employer. CommCare, an application developed by Dimagi in partnership with SSQH, is deployed on Android smartphones or on locally produced tablets called Surtabs. The app enables health workers to improve referrals between the community and medical facilities where more highly trained medical staff reside. In addition, the app is a job aid that reinforces counseling through Creole audio messages, supports health best practices, and improves the speed of data transmission when compared to a paper-based system.

Smart phone applications used in field work are not new to Haiti. However, the intuitiveness and dexterity of the CommCare app is. Instead of old-fashioned, multiple choice surveys that offer a snapshot of a person’s health at any given point, Ovillus’ tablet has “smart forms” that link to earlier health histories provided by patients, avoiding asking the same question twice, and giving a more in-depth view of someone’s health over time.

Another feature performs immediate calculations. For example, when Ovillus enters a child’s age and weight, malnutrition markers show up. On this day, all the infants checked were healthy, but responses from one of the mothers triggered a reminder that a certain vaccination was available for a child at the dispensary.

A new mother in Robin, Haiti, watches her 4-month-old daughter resting peacefully under a mosquito net during a home health care visit. (Photo Credit: Therese Cafaro, USAID)

A new mother in Robin, Haiti, watches her 4-month-old daughter resting peacefully under a mosquito net during a home health care visit. (Photo Credit: Therese Cafaro, USAID)

The CommCare app also helps monitor whether patients attend scheduled medical appointments. “I see you missed your appointment with the doctor in Robin,” Ovillus tells a patient.

“I am making another one for you right now for tomorrow, and you will go this time,” she says in a firm but gentle voice. Then she holds up her phone and plays an audio message about the importance of getting all of the available vaccinations.

 

“These are easily damaged,” Ovillus says, while recording a child’s weight in a large paper registry, “But with this [an Android smartphone-sized device], the information is always there when you need it.”

The ability to track patients between the community and facility becomes critical when dealing with at-risk patients, including patients with HIV or tuberculosis.

Because data doesn’t need to be uploaded to the CommCare cloud on an ongoing basis, Ovillus can continue visiting patients and collecting information with little or no Internet connectivity. Then, when possible, she can upload her data to the CommCare registry.

Ketcia Orvillus weighs a 2-year-old during a home visit. (Photo Credit: Therese Cafaro, USAID)

Ketcia Orvillus weighs a 2-year-old during a home visit. (Photo Credit: Therese Cafaro, USAID)

Although the information she collects mirrors the reporting she must do for the Ministry of Health’s Haitian Health Information System (DHIS2), at present, all data have to be written into paper registries and then reentered into a computer at the central level. The hope is to integrate DHIS2 and CommCare so that their information is compatible, not duplicative and available the moment it is recorded. If it works, health workers could immediately access information for all kinds of uses, such as to inform a doctor before making a referral, give an implementing partner a community or facility level health snapshot or indicate to the Ministry of Health where funds need to be directed.

CommCare is like a notebook, and the modules of information it contains are like subject tabs that can be modified according to the needs of each rural or urban community it serves. At present, there are approximately 300 community health workers who have been trained to use the CommCare app nationwide. The goal is to have 2,000 such workers trained by 2016 with the CommCare app integrated into their training program, which means that the innovative technology could touch as many as 2 million people.

“Not everyone has the money for health care, but these people know that now there is someone looking after them and it gives comfort,” says Orvillus. “Plus, I’m so pleased to have this [the handheld device] because it improves the quality of the services I can bring.”

Ketcia Orvillus moves onto her last home visit—she does 10 to 15 a day—carrying vaccinations for children in a gray thermal box. (Photo Credit: Therese Cafaro, USAID)

Ketcia Orvillus moves onto her last home visit—she does 10 to 15 a day—carrying vaccinations for children in a gray thermal box. (Photo Credit: Therese Cafaro, USAID)

Dr. Jean Max Leilo Joseph, SSQH-CS’s technical director and community health worker trainer, added, “And her presence is even more appreciated by the people, as they now have more faith in a system that appears to be making positive, durable changes.”

As he watches Orvillus depart on her final visit of the day, Joseph says, “I’m proud we’re doing a job that meets the real needs of the community. But I’m even more proud to be a part of the solution to deliver better health care to all Haitians.”

Her work now keeps Orvillus close to a greater expanse of clouds—in the sky, as she makes her rounds on Haiti’s rough and dusty mountain roads, and in the digital cloud, where high-tech is redefining health care for the island nation.


Recognizing International Women’s Day at Dimagi

by Kyla Johnson

8 March 2015

 

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International Women’s Day, which takes place annually on March 8th, is a day to celebrate the economic, political and social achievements of women past, present and future.  To help commemorate this day, a few of the women of Dimagi were asked to write a response to the prompt “How does Dimagi have an impact on the lives of women?”   Their answers, featured below, demonstrate how Dimagi’s mobile technology solutions, our project implementation services, and even our work culture all have a positive effect on women worldwide.


 

“What makes Dimagi stand out is not just the software we deliver to women as a job aid, but the fact that we count them, train them, and eventually empower them with information that make them stronger in everyday life.”

-Mengji Chen, Senior Program Analyst


 “Some of my favorite moments at Dimagi have been watching community health workers’ reactions after the first few days of using CommCare. They often exhibit a newfound sense of empowerment, and tell stories about how using CommCare in their communities makes them feel more respected and valued. While this excitement is universal, it’s particularly palpable and powerful for female frontline workers. Women will describe feeling much more confident in the services that they are delivering thanks to CommCare. For them, CommCare becomes very personal in that it can help reduce doubts clients have in their service delivery, doubts that often exist because they happen to be women. By equipping women with mobile phones that run CommCare, clients can often abandon these doubts. CommCare enables them to see beyond stereotypes and, for the first time, fully see how smart and valuable female frontline workers are in their entirety.” 

-Gillian Javetski, Director of Communications


 “Women make up a large portion of health workers using our CommCare applications. So we put women at the center of our design process, understanding that through our mHealth deployments this may be the first time they have access to technology and ownership of their own phone. Though our software has been designed for low-literate, less tech savvy users, it’s true that they have to learn how to type on a phone to register cases. A major focus of our trainings is teaching women to learn how to type.

This example demonstrates what I find most incredible about our work – seeing how women discover new technology and the world of possibilities it can open up for them in this increasingly mobilized world. In our small ways, it might be that our work with women is disrupting one of many structural barriers women face in accessing technology and information.”

-Mohini Bhavsar, Senior Regional Manager – West Africa


“Dimagi impacts the lives of women all around the world, including the lives of the women that work here. It has created a space where my fellow Dimagi women and I are taking on active roles that include managing teams and projects, coding, research coordination, and working as member of the communication team in a company that sits within the male-dominated field of technology. And while Dimagi has provided these opportunities and the ability to begin closing the gender divide in tech, I would like to think that the women working here are also having a positive impact on Dimagi!”

-Meryn Robinson, Research Coordinator


“The women and men who work at Dimagi are engineers, public health and development specialists, business and partnership strategists. One thing they have in common is that they are among the most supportive coworkers I’ve met. In the few months I’ve worked here, Dimagi has shown itself to be as committed to creating a culture of inclusiveness and equality within the company as it is driven to creating impact in the world. This culture helps me be a happier employee- and woman!”

-Gayatri Jayal, Field Manager


“I can’t speak for Dimagi’s impact on “women” broadly, but I will say that Dimagi’s work has affected me deeply as a woman. Whenever I have had the chance to observe female frontline workers use CommCare — whether it’s at a maternity hospital, a gender-based violence clinic, or a micropharmacy — I have felt inspired by and connected to their obvious enthusiasm to make a difference. Dimagi’s emphasis on empowering frontline workers is just the beginning of a chain reaction in women’s leadership.”

-Arya Shekar, Director of Legal Affairs


As International Women’s Day comes to a close, Dimagi recognizes that through our mobile solutions, women around the world have become more empowered. Our entire team, (which bolsters close to a 50/50 male/female ratio) works tirelessly to ensure our projects create the most impact in the lives of the people that need it most. For more information on International Women’s Day, please visit www.un.org/en/events/womensday/


What did I learn in 15 months at Dimagi?

by Devika

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Devika is a second year Field Manager in Dimagi’s India office. Devika wrote the following blog post about her last year and a bit at Dimagi for her own personal blog. We’re reposting it below. 

I was sitting in a mango orchard with my colleagues last week and started thinking how much life has changed since I joined Dimagi. From December 2013 to now, I  have travelled to 3 countries in Africa and the Middle East and 9 states in India. During those travels and trainings, I have altered intrinsically. So what changed?

  1. I’ve learnt to work with tasks where you don’t have all the answers yet. Be it working on an app or Dimagi’s business model, I’ve seen people find answers along the way. You don’t need to wait for all pieces to fall into place to start.
  2. From my previous job to this one, the management style is radically different. Most managers at Dimagi care about support more than supervision. They trust me to work independently, take decisions and execute them. Of course, they always get regular updates and give feedback. And are available to reach out to in case of any issues.
  3. Both management and other teams like finance, operations and HR make our life so easy that I wonder how I’ll react to bureaucracy now. I have become so unused to red tape and tedious processes that I might have to reprogram myself if I end up in a more structured organisation later on. The structure of Dimagi came out of its focus on team satisfaction and hiring the right people. In 2008, the CEO Jon Jackson said that we’d rather be a company of 15 people who love their jobs than 100 people who like their jobs. Dimagi just crossed 100 people last year but that culture has been preserved.
  4. The people I have been around have made me a more open, liberal individual. There are lots of nationalities in the team and diverse backgrounds. It’s created a safe space where you can be yourself and are not expected to fit in any mold.
  5. Working hard or being smart is not equivalent to being serious is another takeaway. Sometimes when I go into work mode, I tend to focus so intensively that there’s little place left for light-hearted banter or lingering over a meal. Seeing people effortlessly switch between personal and professional or even better run on both tracks parallely, has been an education. Not just for how I work but it’s also shaped the lens with which I view someone new.
  6. I have met and worked with scores of people over the last year. Other than how I work, it has increased my patience and adaptability. When you are in a long discussion about a nonprofit’s workflow or train 30 people in two days, patience is a necessary virtue. The first time I moved out of India, I landed in francophone Niger that is unfortunately placed last on the UN human development index. I don’t speak French and had never eaten African food before. For a full month, I was closely guarded by armed men because of high security risk. Despite all this, when I look back, only pleasant memories linger. In the interest of full disclosure, I can also remember the frustration at lack of internet in my hotel. But other than that, those were good times.
These are my musings about the last 450 days. In the next 450, I expect to apply to business school, see one of my apps go to national scale and grow into new responsibilities at Dimagi. And of course, travel a lot more!

CommCare Dresses, and Deploying mHealth in Senegal

by Mohini Bhavasar, Dimagi West Africa

24 February 2015
Patrick Keating, Field Manager in West Africa observes a Matron conducting a consultation and helps her with a question.

Patrick Keating, Field Manager in West Africa observes a Matron conducting a consultation and helps her with a question.

This week, I had the pleasure of meeting a matrone in Senegal (women in villages who provide pregnancy counseling to younger women) as part of a field visit with the local NGO, Africare. She was one of 30 matrones my Dimagi West Africa colleagues Carla Legros and Patrick Keating trained in Ziguinchor, Senegal for Africare’s CCHT project.

As part of the project, our team developed two CommCare applications. The first application is used by matrones to monitor completion of antenatal care check-ups, help identify pregnancy danger signs, and trigger referrals. The second application is by nurses, who see referral cases created by the matrones, as long as there their phones have synced via an Internet connection. After the training, the matrones had gone out to the market to buy themselves a beautiful blue and white patterned local fabrique to… wait for it… make themselves dresses with blue and white patterns that resemble the CommCare logo. The matrone I met even modeled her CommCare dress for me!

Read the rest of this post…


10 Things That Made Us Tick in 2014

by Gillian Javetski

16 February 2015

If 2013 was the year of rapid growth at Dimagi, then 2014 was even faster. Our CEO Jonathan Jackson touches upon this growth in his annual letter, focusing on how he’ll remember 2014 as the year that Dimagi hit 100 people. In addition to growing the size of our company, a lot of other big milestones occurred in 2014. The list below includes just a few of them (enjoy!)

  • We hit a big self-starter milestone. By the end of 2014, 40% of all CommCare projects were being run by self-starters, meaning organizations that developed and launched CommCare applications without any in-person help from Dimagi. This includes groups like Aquaya in SenegalMIT GlobeMed in Togo, Civic Hire in Haiti, and Lift II in Malawi. Reaching this number means a lot to us, and shows CommCare’s development into a sustainable, accessible platform.
  • We begun scaling CommCare nationally in Haiti through a project with Pathfinder and URC, our biggest CommCare deployment to date. Haiti set the tone for taking on more nationally scaling CommCare projects, including one in Mozambique with Ariel Glaser.
  • We launched projects in new sectors, including social apps project in India, a cash transfer app for WFP in Zambia, and our first regional microfinance project with Small Enterprise Foundation in South Africa. Dimagi also hosted its first mEducation roundtable and women’s empowerment workshop. We also tested and validated several CommCare uses cases, including warehouse storage for agricultural programs and CommCare for Sales Agents. We talked about our findings in these new sectors at this year’s Global mHealth Forum in DC.
  • We focused on maturity and how to achieve economies of scale. This lead to us developing and testing our maturity model in South Africa. We’re excited to introduce it to the world in March.
  • We grew our logistics work with our logistics platform, CommTrack. The first CommTrack v.2 project was launched in Senegal. We also helped organizations in India and Nepal deploy proof of concepts for logistics using both CommCare and CommTrack.
  • We established new teams like our R&D team and our data research team. Our R&D team is testing and developing CommCare features in Burkina Faso and India, while our data analyzed CommCare trends, some of which can be seen in their “Under the Data Tree” blog series.
  • We grew our team, including hitting the triple digits. But our growth in size didn’t stop us from prioritizing spending time with each other. In 2014, we had our second Away Month in Guatemala, the first West Africa Summit, and our first tech team summit.

Want to learn more about any of these 10 things? Feel free to email me at gjavetski@dimagi.com.