Case Studies


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

BlackBerry Dictations

by Rowena Luk on 9 September 2010

In the fast-paced environment of some of Boston’s busiest hospitals, it’s difficult to walk the line between keeping complete medical records while squeezing in precious face time with every patient. This is particularly difficult for specializations such as orthopaedic surgery, where a clinician is often on the wards or in the operating room for much of the day, and not in front of a computer.

To help address this problem, Dimagi is working with Boston Medical Center (BMC) to develop a BlackBerry dictation application. This system is integrated with the hospital information systems so that a clinician can record a note and have it automatically transcribed and appended to a given medical record, even while he’s still walking around the hospitals wards. In fact, the device keeps track of which patients are in which bed on each floor, so that the doctor can easily pull up pertinent information on his device as he is doing the rounds. All this data is securely captured and transmitted using BlackBerry’s secure infrastructure.

CommCare Afghanistan

by Rowena Luk on

Working with World Vision, Dimagi is currently developing a Pregnancy, Newborn, and Postpartum module for use by community health workers in Western Afghanistan. Apart from the challenges of working in a post-conflict zone, this project presents unique considerations with regards to literacy and gender, which directly impact when and how mobile phones can be most helpful. For example, many of the female health workers have never had a chance to go to school, and are at a particular disadvantage with regards to learning, recalling, and educating others about critical health practices. In this vein, Dimagi is extending the CommCare platform in a new direction, to support audio and visual prompts which will make it possible for illiterate and low-literate health workers to learn, share, and collect information.

Health workers are presented with a culturally-appropriate icon, which prompts questions about danger signs, interventions, and preventative health practices. For further context, they can press a button on the mobile phone which will deliver a local-language audio prompt loud enough for her to play this information to mothers and children in the community. While this tool helps her to make sure she covers all the relevant topics and recommends appropriate interventions, it is also collecting data about the community and the visits which can be relayed back to supervisors and managers.

Integrating audio and visual prompts has opened up an exciting realm of possibilities for CommCare.

  • Audio prompts are not confined to the limited screen size of the visual prompts. Audio prompts, supplementing icons or text, can provide more contextual information, the ‘why’ and the ‘how’ about community health interventions.
  • A cell phone keypad or screen is targeted at one person, the user of the cell phone. However, initial assessments of CHWs using these phones during site visits reveals that the audio prompt immediately makes the experience of using the phone more inclusive. Instead of a screen which only the CHWs can see, other members of the community can now hear the same message. This presents an interesting opportunity to target specific health education messages directly to communities of any literacy level, while reinforcing the lessons that the CHWs are trying to spread.
  • With images, or even videos, on the phone, it is now possible to draw in the influence of local figureheads, who can advocate for better health practices with greater authority and influence. Particularly with young, female CHWs, who may face resistance from senior male members of the community, the pictures and video has helped to strengthen their voices in the community.

Cervical Cancer Screening

by Dan Myung on 8 October 2009


Cervical cancer causes more premature deaths than any other malignancy in the developing world. More than 80% of the half-million new cases each year occur in developing nations; 20% of the 250,000 annual deaths are in sub-Saharan Africa.

Cervical cancer continues to be the leading cause of cancer related morbidity and mortality among women worldwide, especially in developing countries.

Since 2006, the Center for Infectious Disease Research in Zambia (CIDRZ), in conjunction with the Zambian Ministry of Health (MOH) have been fielding a “see and treat” cervical cancer prevention program in Zambia called Electronic Cervical Cancer Control, or EC3.

Nurses have been the backbone of providing these services in over 15 clinics currently operating in the program, along with a single tertiary hospital-based referral center.

Seeking to expand their service nationally and internationally, Dimagi collaborated closely with the EC3 program to address these specific needs:

  • Improve the processes to centrally monitor the decisions of independent and often remote clinics
  • Overcome unreliable communication networks in order to provide rapid expert medical advice for test results and treatment decisions
  • Provide a framework for continued education for doctors and nurses alike, regardless of location

The result of our collaboration is a Django-based web application that is both portable for a local clinic setting, but also scalable to become an international referral/consultation system.

Features of the system include:

  • Simple web-based interface for image upload
  • Support for mobile phone based image upload
  • Various levels of access control for doctors, nurses, and other providers to manage photos and diagnoses
  • Encrypted photographs and patient data storage system
  • Offline synchronization framework for poor connectivity usage
  • SMS alerts for critical events

Tostan Senegal

by Rowena Luk on 9 September 2009

Leveraging the expertise in SMS services which we have developed over many of our projects, Dimagi is currently working with Tostan International and UNICEF to develop a system which will manage text message communications among over 200 villages in West Africa. The system is specifically designed to support rural villagers with limited literacy. It provides them with an easy, supportive interface to register, broadcast messages, send alerts, have discussions, and share information at both the village and regional levels. What’s more, the system is designed from the ground up to support them in their local language, and is currently operating in English, French, and 3 West African tribal languages (Wolof, Pulaar, and Jola).

Our primary implementing partner for this project is Tostan, an organization internationally recognized for its success in getting rural communities to renounce harmful cultural practices. In so doing, they have worked with over a hundred thousand West Africans to improve their level of sanitation, hygiene, and preventive health. The Jokko Initiative– which means ‘communication’ in Wolof –is just the next step in their ongoing strategy to provide tools and training to help these communities help themselves.

By working with Tostan and The Jokko Initiative, we at Dimagi recognize that improving health outcomes doesn’t just happen in the clinical setting; it has to do with raising awareness and changing health practices everywhere.