Avoiding mHealth “Pilotitis” Doesn’t Mean You Shouldn’t Start Small

The blog post below by Dimagi’s CSO Neal Lesh was originally featured in Maternal Health Task Force’s Tech4MH blog. Thanks to the team at MHTF for highlighting Dimagi’s work! 

Since 2008, Dimagi has helped organizations in 30 countries set up mobile projects with CommCare, an open source mobile platform that supports frontline workers (FLWs). CommCare is actively being used by over 130 frontline programs across numerous development sectors. One of the most compelling and common uses is to support FLWs who provide vital maternal health services such as registering clients, keeping track of their antenatal care visits, counseling them on the importance of delivery in a facility and calculating due dates of expectant mothers. Thanks to support from USAID’s Development Innovation Ventures, Dimagi will launch at least 40 new frontline programs in 2013 to use CommCare in India alone, a majority of which are focused on maternal health.

Technology is never the whole answer, but can be an essential component of empowering FLWs and improving the maternal health services they offer. Our goal is to help frontline programs reach sustained impact at scale by making it as easy as possible to start small while being able to go big. Why start small? Within mHealth, pilots have gotten a bad name. This is for good reason, given the many projects that been declared a success only because they started, regardless of whether they can or do continue. Indeed, many of our partners will tell us that we can start working with a small number of FLWs as long as we don’t call it a pilot.

However, mHealth applications, like most technology, take time and field iteration to develop. mHealth is still a young field, and iteration is necessary to develop usable systems. Organizational capacity to utilize mHealth takes time to develop too. Most organizations we work with do not fully appreciate what they are getting into until they’ve used CommCare for a while.

One way we make it easy to start small is by, where funding allows, offering Proof of Concept (POC) packages that include 10 free phones and about a month of remote and one-site support from Dimagi’s experienced team. One thing that initially surprised us is how popular the POC packages are. To date, over 68 organizations in 18 countries have started using CommCare through POC packages. We get a large number of applications when we put out RFAs for them, even from huge development organizations with sizeable annual budgets (100 million+). We’ve come to realize that the POC packages are popular because they remove much of the perceived risk for somebody within an organization to initiate an mHealth project.

The key thing that allows us to easily start small but go big is that we offer CommCare through a Software as a Service (SaaS) product hosted on our cloud server. All 130 of the frontline programs using CommCare are running on the same platform. Anybody can visit www.commcarehq.org, create an account, and develop their own CommCare application or customize a pre-exisisting application from CommCare Exchange, the first open source mHealth app store.

One such example of a customized app is the Reducing Maternal and Newborn Deaths (ReMiND) pregnancy app developed by Catholic Relief Services (CRS) in partnership with Dimagi to support the delivery of prenatal and postnatal care in the northern Indian state of Uttar Pradesh. Following initial testing and refining with 10 government-selected FLWs, the app has been scaled up to 271 FLWs, who are using audio and visual prompts to systematically counsel and assess women and babies for danger signs. FLW supervisors are also alerted when visits are missed. The latest edition of the ReMiND application also includes customized SMS reminders that target specific clients, based upon computer-detected newborn dangers signs that are gathered from survey answers. The CRS site has become a strong innovation test bed and an increasingly well-known example globally of mHealth as a supportive supervision tool. The project is currently assessing how direct-to-FLW feedback improves FLW motivation and performance.

Over the next year, we will be supporting CommCare and MOTECH Suite (an integrated set of tools for FLWs, of which CommCare is one component) in several maternal health programs at large scale in India, Haiti, and other countries. In every case, we will start or have started small, and are very excited to being big.




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