2021 Annual Report
Building the future:
Finding hope in challenging times
Table of Contents
Intro
Rewards and challenges in a relentless year
2021 offered a moment of exceptional contrast – a duality of challenge and achievement as the world braved another complex year in the face of devastating COVID-19 surges, the unknown of new variants, and continued loss and isolation that will echo for years to come. That duality – the bright spots and the moments of struggle – seeped into every corner of Medic’s work, into the lives of our 90+ teammates and their families, and throughout every health system we’re proud to partner with in 15 countries.
We were fully remote, yet deeply connected. The pandemic called for urgency, and we answered with thoughtful precision, building tools that are human-centered and informed by research. We prepared for national scale and focused on community-level care, listening and learning from health workers in order to design tools that are customized for their needs, in their neighborhoods, to make quality care delivery accessible to everyone.
2021 presented a coupled reality, and we’re proud of our team and partners who led with tenacity, vision, and humanity to meet adversity with opportunity. As we look back, we celebrate both the challenges and achievements that propelled us towards new areas of collaboration, stewardship, and impact.
Present urgency,
future preparedness
We translated the challenge and urgency of pandemic response into the foundations for lasting health system strengthening. As community health workers (CHWs) continue to play a pivotal role in primary care and pandemic response – and who must be paid fairly for doing so – we honed and expanded the capabilities of the Community Health Toolkit (CHT) to ensure continuity of care when and where it’s needed most.
Local ownership,
national scale
The pandemic also magnified the importance of community-level health intervention and leadership and autonomy. As of 2021, six Ministries of Health (MoHs) – Mali, Kenya, Uganda, Nepal, Niger, and Zanzibar – have selected the CHT as a tool of choice for their national community health systems. Collectively supporting more than 350,000 CHWs, these six governments are now connected by the shared goal of equipping this vital workforce with CHT-based digital tools to achieve universal health coverage in the years to come.
Flourishing vision,
steadfast values
We matured, significantly enhancing the CHT Core Framework’s well-established codebase as we scaled 59 active CHT projects – or app instances – alongside 75 community-based, international NGO, and MoH partners. Together, the CHT supported 22.7 million caring activities and more than 41,400 CHWs in 16 countries across Africa and Asia. As technical stewards of the CHT, we emphasized a deep focus on product and program quality, adding the most users to the CHT in any year since its inception.
Achievements, positives, successes, and connections outshined the challenges. The CHT became an established digital health global good, joining the ranks of world-renowned organizations using technology to strengthen and ease the burden on health systems. We held strong to our values, expanding our focus on universal health coverage, informed consent, human-centered design, and beyond.
In Medic’s 2021 annual report, we invite you to join us as we look back on a dichotomous year and the challenges and achievements we experienced – as a community – while the world mobilized to end the pandemic, prevent the next, and achieve health equity for all.
What we value
Humanity
Human-centered everything
Creativity
Bring the right things into existence
Openness
From code to communication, collaboration is key
Solidarity
Building equitable community health system together
Initiative
Self-motivated to take action
Impact
Global reach of the CHT
8,889
Total new users
The most users ever added in a single year
Caring activities per year
69.3M
Caring activities
(all-time)
41,403
Active users
(2021)
302,000
Total new households registered
6M
Households registered (all-time)
Burundi
Village Health Works (VHW) and Medic support ~200 CHWs to increase antenatal care (ANC) uptake, immunization rates for children, to report on community-based malnutrition screening and TB/HIV adherence, and to educate CHWs on COVID 19 self-care.
Democratic Republic of the Congo
In Goma, DRC, Medic, Médécins Sans Frontiéres (MSF), and the Ministry of Health assisted health workers in monitoring vulnerable population cohorts during the ongoing COVID-19 pandemic, enabling continuity of care if they are unable to continue to access regular treatment.
Ghana
Medic and Rural Health Collaborative deploy automation of antenatal care (ANC) reminders to increase uptake of ANC at the community level and increase facility-based delivery rates.
India
Barefoot College and Medic came together in 2017 to leverage low-cost mobile technology to reduce maternal and newborn mortality and morbidity in India. After registering nearly 7,000 caring activities, the project ended, as scheduled, in April 2021.
Kenya
Launching our work in 2011, Medic works alongside partners such as CMMB Kenya, Safari Doctors, Living Goods, Health Right International, Christian Aid, Kilifi Kids, Palladium Kenya, VisorTech, TotoHealth, as well as the national MOH and county governments of Siaya, Kisumu and Vihiga. CHT-based apps support more than 12,000 frontline health workers across the country.
Malawi
Medic collaborates with Partners in Health in the Neno District of Malawi supporting care coordination for ANC, PNC, IMM, IMCI, FP, NCD, TB, HIV, Malnutrition, Hospitalization, and eTrace. Medic also partners with I-TECH and Lighthouse Trust to implement ART retention programs for HIV/AIDS patients.
Mali
Medic has worked in deep collaboration with Muso since 2014 to support Muso’s health workers and supervisors while partnering on key innovation projects focused on equity and precision care. Our collaborative approach led to the CHT’s selection as the national platform for digital community health in 2021.
Nepal
For nearly a decade, Medic has worked in partnership with Nepal’s Ministry of Health and Population (MoHP) and provincial and local governments to harness technology for community health systems strengthening. Our partnerships currently support +11,000 Female Community Health Volunteers (FCHVs).
Niger
Medic partners with Épicentre and Médecins Sans Frontières to develop and deploy Alerte-Niger, a program that aims to support earlier and more effective responses to epidemics of infectious diseases including COVID-19, measles, meningitis, and cholera.
Philippines
CHT Technical Partner International Care Ministries has developed a Community Health Champion (CHC) App for ANC, Postnatal Care and family planning now used by nearly 1,300 CHCs. The CHCs serve 117,341 of the 125,821 households members (93%) in households registered using the app.
Republic of South Africa
Medic is partnering with I-TECH and CHAPS on an RCT adapting a two-way texting solution to improve post-surgical follow up for voluntary medical male circumcision (VMMC).
Togo
Medic has worked with Integrate Health (IH) in Togo since 2017 to support digitally-enabled CHWs, midwives, clinical mentors, supervisors, and nurses. Health workers actively use CHT-based apps to support antenatal care (ANC), family planning, integrated community case management (ICCM), malnutrition, and postnatal care (PNC).
Uganda
Medic has worked in Uganda since 2016 in partnership with Living Goods, BRAC, Strong Minds, Intrahealth International, and Malaria Consortium. The CHT is used to support more than 11,600 community health promoters across Uganda, and has been selected as a digital community health platform of choice by the national MoH.
Tanzania - Zanzibar
Medic supports D-Tree International, who partner with the Zanzibar Ministry of Health to implement the CHT-based Jamii ni Afya app as part of their digital health program to Community Health Volunteers (CHVs) and Supervisors to provide health services within their communities.
Zimbabwe
Medic, Zim-Ttech, and the ZAZIC consortium have partnered for 3 years studying post-operative two-way texting for voluntary medical male circumcision. In collaboration with the Zimbabwe Ministry of Health, this has been scaled up to routine practice in 33 sites - resulting in over 9,000 clients enrolled and receiving telehealth care.
- Countries with active CHT implementation
- Countries where the CHT has been selected as a national platform for digital community health
Countries with active CHT implementations
Active CHT-based
apps
Unique workflows supported
by CHT-based apps
Six governments have selected the CHT as a digital community platform of choice, with roadmaps to scale to their collective 350,000 Community Health Workers.
Since 2019, Medic has accompanied the Kenyan Ministry of Health and key partners in the co-creation and operationalization of evidence-based community health digitization strategy. The MoH has selected the CHT as the host platform for the national electronic community health information system (eCHIS) to enable improvements in service delivery, data availability and quality with the overall goal of universal health coverage through scale to more than 95,000 community-level health workers over the next three years.
After many years of deep collaboration with our partner Muso, and under the leadership of the Ministry of Health and Public Hygiene, Medic encouraged the adoption of the co-designed 360° supervisor’s model at the national level and later to launch a mobile app to screen for suspected cases of COVID-19, refer for testing, and deliver basic care and health promotion messages across Mali. In 2021, based on the substantial evidence for impact in-country through our partnership with Muso, and in collaboration with UNICEF and World Bank, MoPH selected the CHT as the unique and national tool to equip all community health stakeholders. The platform is intended to scale to support more than 25,000 community health workers across the country.
After 10 years of partnership at the national and provincial level, we have recently piloted the country’s first CHT-based Android app with a cadre of professionalized community health nurses in two municipalities through ownership and leadership by Nepal’s Ministry of Health and Population (MoHP) with the intent to scale the program nationally. This partnership builds on the more than 11,000 Female Community Health Volunteers (FCHVs) who use Medic-designed SMS-based care coordination tools.
In early 2022, MoH Niger selected the CHT as the national digital tool to equip CHWs. This is the result of two years of direct engagement with the MoH to support the national COVID-19 response. At the start of the pandemic in 2020, Medic developed “Alert Niger,” a mobile application used at the national level by 64 CHWs for the coordination of Covid-19. Following this successful pilot launch, in partnership with MSF Foundation and Épicentre, Medic is now stewarding the extension of the surveillance program with a HEBS application, supporting 79 CHWs. Beehyv, an Indian start up that has strong expertise on CHT, will serve as key Technical Partner to MoH, supporting app and dashboard development as well as DHIS2 integration.
Together with BRAC, Living Goods, UNICEF, and with funding from Rockefeller and UNCDF, Medic accompanies the MoH Uganda in providing support and collaboration on the adoption of the Community Health Information System (eCHIS) for Uganda’s community health workers, the village health teams, as they deliver integrated, doorstep care for use cases such as maternal and child health, nutrition, community-based disease surveillance, and health worker performance management. Public sector CHIS powered by the CHT currently supports over 800 VHTs and 28 Health Assistants. With the CHT as a platform of choice in Uganda, there is potential to scale to support more than 150,000 community-based health workers with CHT-based apps.
D-tree International has worked alongside Zanzibar’s Ministry of Health for almost a decade of planning and development, and in August 2021, the Ministry brought its digital community health program, the CHT-based Jamii ni Afya, to full national scale, supporting 2,263 CHVs and 224 Supervisors using the CHT in 11 Districts in Zanzibar.. As a result, the Zanzibar MOH has integrated digitally-enabled CHVs into their formal Community Health Strategy and helped bring high quality health services to the doorsteps of 1.6 million people living in Zanzibar. With this accomplishment, Zanzibar has taken a huge step forward to advance UHC and become one of the world’s first examples of a government-led digital health initiative succeeding at this scale.
Tools
As steward of and core contributor to the CHT, Medic is committed to ensuring the platform’s capabilities and technical framework are simultaneously maintained and advanced, but also to supporting the CHT’s usability and adoption by the community at-large. It is our belief that stewarding and investing in the CHT as a digital public good is the best pathway to scale digital community health around the world – and may be the only path to local technical ownership and financial sustainability in Low- and Middle- Income Countries (LMICs).
Insights garnered through global implementation and deep collaboration lead Medic to pursue a product roadmap that accelerates growth among our network of implementing and technical partners so that others can build CHT apps with greater ease, autonomy, and speed for last mile communities.
Championing advancement of the CHT
Medic and a group of leading organizations serving last-mile communities launched the CHT as a digital global good and open-source project to support the development of digital health interventions, achieve universal health coverage and advance global health equity. We iterated on core framework versions 2.x and released versions 3.0 and 3.1.
2018
The CHT Forum was launched to serve as an open space for conversations, collaborative resource development, and free support from the CHT Community of Practice. We released core framework versions 3.2, 3.3, 3.4, 3.5, 3.6, and 3.7.
2019
The CHT Documentation website launched as a comprehensive resource to learn how to design, build, implement, and maintain CHT apps. New resources continue to be added to make app building easier, quicker, and more efficient. We released versions 3.8, 3.9, and 3.10.
2020
The CHT Community Round-up Call series launched to inform the community about recent product releases and future planned initiatives. We released versions 3.11, 3.12, and 3.13 – each of which included new features requested by both our developer community and health workers that use the tools each day.
2021
Technology stewards are people with enough experience of the workings of a community to understand its technology needs, and enough experience with technology to take leadership in addressing those needs.
Authors of Digital Habitats: Stewarding technology for communities
In 2021, Medic enhanced the CHT’s Core framework, inspired our community to think creatively by developing innovative product concepts and prototypes, and created a suite of new resources for the community. Explore some of the key initiatives and enhancements below:
Building the CHT’s next generation architecture
As deployments of CHT apps look to scale nationally, Medic has continued to make the CHT more robust by studying and overcoming potential bottlenecks. We’ve been designing a new architecture which can support horizontal scalability and delivers a significant performance improvement out of the box. Horizontal scalability is akin to a wider motorway – rather than a one-lane motorway prone to traffic jams, CHT v4.0 will have multiple lanes to spread the traffic out. The new architecture will allow for more reliable scaling of health apps, hosted by organizations other than Medic, with CHT-powered projects that are easy to set up, deploy, and maintain.Enhanced monitoring API
With CHT version 3.12, we introduced Monitoring API version 2. This API allows for collecting summary data on the current state of the CHT to help identify issues such as SMS messages not being sent, Sentinel processing delays, or elevated error rates. This can be integrated with third party tools to track metrics over time and alert maintainers if a metric crosses a given threshold. Monitoring API version 2 includes new metrics and an upgraded structure to make managing CHT instances easier than ever.Fine grained telemetry
With CHT version 3.12, Medic increased the frequency of telemetry data collection from monthly to daily. Telemetry data are metrics collected with CHT app analytics and include average “boot time” for the CHT app, average time to search contacts or reports, average sync time, etc. More frequent collection of these data points makes for precise actionable data and enables next-day responses to critical app experience issues. It also allows for precise comparisons of data over different time series. Previously, it would take a minimum of three months to measure how a change impacted users. With fine grained telemetry, we can make definitive measurements to answer questions like “How does this CHT-core upgrade actually impact user performance?” or “How does this user-training impact a form’s completion time?”Streamlining care through a household-level task page
Version 3.13 brought new features directly requested by health workers, including a new household-level task page enabling CHWs to see and complete all possible tasks in the household they are currently visiting. This improvement provides a more streamlined user interface, allowing health workers to maintain a more efficient, organized schedule while delivering care to their neighbors by increasing form completion rates and decreasing their travel distance and time.Deeper support for offline-first care
Muting – the ability to stop tasks and messages being generated for a person – are now performed on-device for offline users. Previously, muting and unmuting were performed only on the server which meant that offline users would not see the results of submitting mute/unmute reports until they were synced and processed by the server. This potentially led to incorrect tasking and patient follow-ups, incorrectly prioritized community member care, and CHW confusion as to which community members were in active need of support. Equally, if a user encountered someone who was muted but now required care, they would have to sync with the server before they could use the app to provide care to that individual. On-device muting and unmuting is a welcomed enhancement by our community.Improving data storage for increased reliability
Purging is a tool that allows you to increase performance and available disk space for offline users by removing unneeded or no longer relevant documents from a user’s device. Purging only removes documents from user’s devices – these reports are still available for online analytics and impact metrics. The purging process was greatly improved with version 3.14. Now, the purging feature detects situations where users with many records would overload the system and automatically mitigates the issue by breaking down the work into smaller units. This makes purging more reliable by default, and avoids system crashes.Continued increase in Android and ecosystem integrations
COVID-19 antigen Rapid Diagnostic Tests (RDTs) create the opportunity to collect data at a decentralized level for use in patient care, disease surveillance, and supply chain management, as well as for relevant use cases to support pandemic response. With support from FIND, Medic developed a reference workflow for administering RDTs using open-source technologies already deployed in LMICs at the community-level. The new app, powered by the CHT, has ready-to-use directly requested by health workers, including a new COVID-19 RDT workflows and allows customizations to fulfill future needs of the communities in which it is deployed.
Collaboration with the Digital Health Ecosystem
Building on more than 7 years of community and solidarity, in September 2021, we launched an official partnership with OpenHIE: a community of people building an open framework to support implementation teams as they develop health information exchanges (HIEs) in their regions. We’re thrilled to serve as an exemplar of OpenHIE’s mission, vision, and values through the adoption of its standards and workflows outlined in their Architecture Specification – while also sharing learnings within the CHT community.Increased data and flexibility for profiles, tasks, target calculation
A new client side API is available for app developers which makes more data available for use in contact summaries, tasks and targets, and standardizes the access to this data. After consultation with CHT community members, we enabled app developers to have additional options for how to display overdue tasks. By default, an overdue task is simply displayed as “due today”. Alternatively, the configuration allows for displaying the number of days passed since the task’s due date, allowing health workers and supervisors to have increased visibility into task prioritization. This is critical to ensure households are receiving the care and follow-up they need.
Engaging and supporting the CHT community of practice
Throughout the year, we developed new resources including tutorials, guides, and videos that make it easier for app developers to build CHT apps. We also increased Medic-led technical support through the CHT Forum.
In December, our community team hosted the first-ever CHT Roundup Call. With the goal of informing the CHT community about recent product releases, updates about new and ongoing product initiatives, and upcoming CHT projects, we welcomed more than 50 attendees and engaged in insightful, timely dialogue. Future calls will provide more opportunities for community members to present on the work they are doing, not only to share knowledge and experiences, but to also unearth new opportunities for collaboration across the CHT community.
We now support nine Technical Partners, including the Palladium Group with prototypes and documentation to deploy CHT servers in clinics throughout Kenya; Living Goods to build their internal capacity to independently design, develop, and deploy workflows on their “Smart Health” app; and Beehyv to lead the initial configuration of the CHT’s health facility event based surveillance (HEBS) workflows. In total, partner-led deployments supported 33% of all CHT users, who logged 59% of all 2021 caring activities. This incredible level of support from Technical Partners demonstrates the scale and impact that they are leading.
Building the CHT’s next generation architecture
As deployments of CHT apps look to scale nationally, Medic has continued to make the CHT more robust by studying and overcoming potential bottlenecks.
We’ve been designing a new architecture which can support horizontal scalability and delivers a significant performance improvement out of the box. Horizontal scalability is akin to a wider motorway – rather than a one-lane motorway prone to traffic jams, CHT v4.0 will have multiple lanes to spread the traffic out. The new architecture will allow for more reliable scaling of health apps, hosted by organizations other than Medic, with CHT-powered projects that are easy to set up, deploy, and maintain.
Enhanced monitoring API
With CHT version 3.12, we introduced Monitoring API version 2. This API allows for collecting summary data on the current state of the CHT to help identify issues such as SMS messages not being sent, Sentinel processing delays, or elevated error rates. This can be integrated with third party tools to track metrics over time and alert maintainers if a metric crosses a given threshold. Monitoring API version 2 includes new metrics and an upgraded structure to make managing CHT instances easier than ever.
Fine grained telemetry
With CHT version 3.12, Medic increased the frequency of telemetry data collection from monthly to daily. Telemetry data are metrics collected with CHT app analytics and include average “boot time” for the CHT app, average time to search contacts or reports, average sync time, etc. More frequent collection of these data points makes for precise actionable data and enables next-day responses to critical app experience issues. It also allows for precise comparisons of data over different time series. Previously, it would take a minimum of three months to measure how a change impacted users. With fine grained telemetry, we can make definitive measurements to answer questions like “How does this CHT-core upgrade actually impact user performance?” or “How does this user-training impact a form’s completion time?”
Streamlining care through a household-level task page
Version 3.13 brought new features directly requested by health workers, including a new household-level task page enabling CHWs to see and complete all possible tasks in the household they are currently visiting. This improvement provides a more streamlined user interface, allowing health workers to maintain a more efficient, organized schedule while delivering care to their neighbors by increasing form completion rates and decreasing their travel distance and time.
Deeper support for offline-first care
Muting – the ability to stop tasks and messages being generated for a person – are now performed on-device for offline users. Previously, muting and unmuting were performed only on the server which meant that offline users would not see the results of submitting mute/unmute reports until they were synced and processed by the server. This potentially led to incorrect tasking and patient follow-ups, incorrectly prioritized community member care, and CHW confusion as to which community members were in active need of support. Equally, if a user encountered someone who was muted but now required care, they would have to sync with the server before they could use the app to provide care to that individual. On-device muting and unmuting is a welcomed enhancement by our community.
Improving data storage for increased reliability
Purging is a tool that allows you to increase performance and available disk space for offline users by removing unneeded or no longer relevant documents from a user’s device. Purging only removes documents from user’s devices – these reports are still available for online analytics and impact metrics.
The purging process was greatly improved with version 3.14. Now, the purging feature detects situations where users with many records would overload the system and automatically mitigates the issue by breaking down the work into smaller units. This makes purging more reliable by default, and avoids system crashes.
Continued increase in Android and ecosystem integrations
COVID-19 antigen Rapid Diagnostic Tests (RDTs) create the opportunity to collect data at a decentralized level for use in patient care, disease surveillance, and supply chain management, as well as for relevant use cases to support pandemic response. With support from FIND, Medic developed a reference workflow for administering RDTs using open-source technologies already deployed in LMICs at the community-level. The new app, powered by the CHT, has ready-to-use directly requested by health workers, including a new COVID-19 RDT workflows and allows customizations to fulfill future needs of the communities in which it is deployed.
Collaboration with the Digital Health Ecosystem
Building on more than 7 years of community and solidarity, in September 2021, we launched an official partnership with OpenHIE: a community of people building an open framework to support implementation teams as they develop health information exchanges (HIEs) in their regions. We’re thrilled to serve as an exemplar of OpenHIE’s mission, vision, and values through the adoption of its standards and workflows outlined in their Architecture Specification – while also sharing learnings within the CHT community.
Increased data and flexibility for profiles, tasks, target calculation
A new client side API is available for app developers which makes more data available for use in contact summaries, tasks and targets, and standardizes the access to this data.
After consultation with CHT community members, we enabled app developers to have additional options for how to display overdue tasks. By default, an overdue task is simply displayed as “due today”. Alternatively, the configuration allows for displaying the number of days passed since the task’s due date, allowing health workers and supervisors to have increased visibility into task prioritization. This is critical to ensure households are receiving the care and follow-up they need.
Engaging and supporting the CHT community of practice
Throughout the year, we developed new resources including tutorials, guides, and videos that make it easier for app developers to build CHT apps. We also increased Medic-led technical support through the CHT Forum.
In December, our community team hosted the first-ever CHT Roundup Call. With the goal of informing the CHT community about recent product releases, updates about new and ongoing product initiatives, and upcoming CHT projects, we welcomed more than 50 attendees and engaged in insightful, timely dialogue. Future calls will provide more opportunities for community members to present on the work they are doing, not only to share knowledge and experiences, but to also unearth new opportunities for collaboration across the CHT community.
We now support nine Technical Partners, including the Palladium Group with prototypes and documentation to deploy CHT servers in clinics throughout Kenya; Living Goods to build their internal capacity to independently design, develop, and deploy workflows on their “Smart Health” app; and Beehyv to lead the initial configuration of the CHT’s health facility event based surveillance (HEBS) workflows. In total, partner-led deployments supported 33% of all CHT users, who logged 59% of all 2021 caring activities. This incredible level of support from Technical Partners demonstrates the scale and impact that they are leading.
Community Health Information Systems Technical Working Group – Leveraging OpenHIE
Medic participated in a collaborative technical working group with Dimagi, Ona, the Community Health Impact Coalition (CHIC) to review the current state of community health information systems (CHIS) interoperability. By leveraging Instant OpenHIE’s off the shelf readiness, coupled with the use of HAPI FHIR as an industry standard back end, the consortium created a prototypical Lost to Follow-Up use case, published on the OpenHIE wiki. The technical outputs of this working group can be found on GitHub.
Accompaniment
Continued partnership, new opportunities
Over more than a decade, Medic and the CHT have supported more than 120 digital community health initiatives, bringing learnings from each to our open source community of practice. Leading with our values, we work in solidarity with highly impactful NGOs as they implement sophisticated and highly-supported community health systems in contexts where such success should be impossible.
In 2021, we bolstered our efforts and expanded our stewardship, focusing on the roles of companion and champion as we accompanied MoH partners in nationally-coordinated pandemic response and health system strengthening. We continued to design for ease-of-use while preparing for scale, and national recognition of the CHT is proof that this dichotomy is working.
Below, Medic teammates – service designers, project managers, program heads, and more – tell the story of accompaniment in crisis. From challenge to achievement, product launch to CHW training, explore how Medic and our partners responded with long-term vision, investing in direct, community-led care.
A closer look: Celebrating collaboration and impact
Mali
The Government of Mali is reforming its health system, placing a priority on complete digitization of community health. With this advancement, they seek to improve planning, implementation, monitoring, and reporting on progress towards maternal and child health outcomes, while also recognizing CHWs as a key force in the country’s formal health system. Mali is the first nation in West Africa to adopt digital community health tools, a landmark achievement made possible – in part – by Medic’s steadfast partnership with Muso and a consortium approach to national adoption alongside UNICEF, World Bank, and others. This ground-breaking approach aims to establish a proven model for duplication and adoption across West Africa.
In selecting the CHT as the national platform for digital community health in 2021, the Malian government leaned on the demonstrated impact from years of collaboration and research between Medic and Muso as well as the acute and effective digital COVID-19 response app that was hosted on the CHT. Our team now joins an elevated collaborative effort to build and scale the platform to more than 25,000 CHWs in the years ahead.
Malawi
Malawians face a daunting HIV epidemic, a growing non-communicable disease (NCD) burden, and high rates of infant and maternal mortality, while access to decentralized, high-quality care is scarce or unaffordable for most people. Even those who can pay for treatment are often unable to reach clinics, especially over mountainous terrain and rugged roads in remote areas.
Since 2017, Medic has worked in solidarity with Partners in Health (PIH) in Malawi. Together in 2021, we more than doubled the number of health workers supported by CHT-supported apps in Malawi, expanding from two to five facility catchment areas in Malawi’s Neno and Dambe districts, increasing access to care to thousands of households. This progress was made possible through a shared commitment to collaboration, openness, and the urgent need to provide quality care.
In Malawi, Medic also partners with University of Washington’s International Training and Education Center for Health (I-TECH) and Lighthouse Trust to implement an mHealth retention intervention using two-way texting (2wT) between new antiretroviral treatment (ART) patients and HIV clinic staff to improve retention of patients on ART and reduce the healthcare workload in high-burden public HIV clinics in Malawi.
Uganda
The Ugandan health sector faces severe health worker shortages, with 70% of doctors and 40% of nurses and midwives based in urban areas, serving only 12% of the population. Since 2001, Uganda has leveraged a model of community-based health workers who serve on Village Health Teams (VHTs) to bridge the gap in essential care. However, limited resourcing has left the VHT model insufficient to address basic health needs for the majority of Ugandans. Now with approximately 180,000 VHTs, the Government of Uganda is working to unify the national approach to community health, offering a standard package of essential health services, with a goal of digitally supporting all VHTs with a centralized platform for community-based care.
Medic’s work in Uganda began in 2016 when we launched a groundbreaking partnership with Living Goods and soon after with BRAC Uganda in 2017. Both NGOs are crucial stakeholders who have developed robust CHW supportive programs in the past decade. Today, more than 11,000 health workers leverage CHT-based digital tools implemented by Living Goods, BRAC Uganda, Malaria Consortium, and the Ugandan Ministry of Health. In 2021, the MoH selected the CHT as a platform of choice as they pilot potential solutions for a centralized electronic community health information system (eCHIS).
Research
Incubating moonshots, foundational breakthroughs
Medic Labs has a distinctive niche as a multidisciplinary R&D team embedded within an open source community that ships digital health products at scale. In 2021, we focused on a range of compelling examples of how we are creating space to explore new technologies, cultivate new partnerships, and accelerate groundbreaking discoveries for our field.
More than ever, there are signals that our work is not only relevant to health systems but also rigorous enough to establish a scientific foundation for long term health system transformation. Our published work has not only withstood the scrutiny of scientific peer review, it also was cited 300 times in 2021. Our 2020 article on human-centered design has been downloaded 11,000 times; our 2020 article on CHWs and pandemic response has been downloaded 16,800 times, placing these articles in the top 2-3% of scientific outputs globally.
In 2021, Medic Labs continued exploring conversational messaging, data quality, geospatial data and pandemic preparedness. We began new work on data-driven interfaces as well as informed consent and the social determinants of health. We launched new studies or published scientific articles in each of these areas. Explore some of the key initiatives and enhancements below:
Building on our landmark COVID-19 collaboration with Dimagi, we published a new report on pandemic preparedness: How Investments in Frontline Digital Tools Can Prepare Us for the Next Pandemic. The report explores how improving digital platforms for frontline health workers can help us to better prepare for future pandemics, by focusing on 1) early detection and containment, 2) fast and effective response, and 3) holistic system strengthening.
In continued partnership, Dimagi and Medic developed shared algorithms for data quality and supervisory alerts that could be applied cross-platform. The algorithms are designed in such a way that they are platform agnostic; i.e., the code neither depend on, nor has any knowledge of, the platforms or their respective data models.
In collaboration with researchers at the University of Washington’s Department of Human-Centered Design & Engineering, we conducted an extensive literature review as well as a comprehensive analysis of internal documents relevant to privacy and data sharing in the CHT community. The results of this work were published in the prestigious Computer Human Interaction conference in May 2021: Towards Responsible Data Practices in Digital Health: A Case Study of an Open Source Community’s Journey.
Through a pilot implementation with Partners In Health (PIH) in Malawi, we implemented a GPS data collection form where health workers are actively prompted to capture their current location data while also capturing the GPS location data in the background (passively, and also explored the use of a subjective socioeconomic status (SES) data – a new self reported social index. The SES assessment was deployed as part of a larger household survey, and was administered to over 6,500 households.
Our geospatial data work has shown to be an entry point for incorporating an informed consent workflow for CHT users enrolling new households or patients for care, or returning to households to collect new patient or household data.
In a foundational randomized trial in Zimbabwe, researchers at Medic and The University of Washington demonstrated that post-surgical patient follow up via SMS was as safe as follow up care at the clinic, and that the transition to SMS enabled an 85% reduction in unnecessary clinic visits. Thanks to the reduction in unnecessary visits, this approach to messaging with patients was cheaper than standard care, and a further usability study found that it was preferred by patients and providers alike.
This study informed a range of new features and enhancements to the CHT’s core framework. The most significant of these improvements came with CHT Core Framework release 3.11.0 in the first quarter of 2021, which included support for interoperability with the widely used open source messaging platform RapidPro. With RapidPro integration, we are able to support more nuanced conversational messaging flows, integrate natural language processing techniques, and benefit from default integrations with a wide range of messaging platforms including SMS aggregators, Telegram, the Meta (Facebook) Messenger app, and WhatsApp. This is the same technology used for this purpose by many of Medic’s peers in the digital health community, including for example Praekelt and a large number of UNICEF country offices.
In 2021 the Medic Labs team and collaborators at Muso published a study which shows the importance of thoughtful user interface improvements to advance universal health coverage. The resulting new feature, called Universal Health Coverage Mode (or UHC Mode) ended up focusing on how information is displayed in the list of patients that CHWs use to scan and organize who they will visit day to day.
The study found that use of UHC Mode more than doubled the odds of, and increased by 13 percentage points, minimum expected home visit coverage. This finding is striking in part because the control group in this study was using a CHT app that would be considered sophisticated by most community health programs anywhere in the world. This is an important departure from most of the scientific literature on digital health, which tends to evaluate the impact of a specific digital intervention relative to an antiquated version of “standard care,” where standard care relies on paper-based information systems and lacks the most basic benefits of digital transformation.
Medic, DataKind, BRAC, and Living Goods are collaborating to support the Intelligent Community Health Systems (iCoHS) initiative, which is led by UNICEF and financially supported by The Rockefeller Foundation. In 2021 we conducted an exploratory study in Uganda on the (CHT) platform as deployed by BRAC.
In September co-authors from DataKind and Medic published a peer-reviewed article on this topic, Pathways to Increasing Trust in Public Health Data: An Exploratory Analysis of Quality Issues and Potential Remediation for Data Collected Using the Community Health Toolkit.
Building on our landmark COVID-19 collaboration with Dimagi, we published a new report on pandemic preparedness: How Investments in Frontline Digital Tools Can Prepare Us for the Next Pandemic. The report explores how improving digital platforms for frontline health workers can help us to better prepare for future pandemics, by focusing on 1) early detection and containment, 2) fast and effective response, and 3) holistic system strengthening.
In continued partnership, Dimagi and Medic developed shared algorithms for data quality and supervisory alerts that could be applied cross-platform. The algorithms are designed in such a way that they are platform agnostic; i.e., the code neither depend on, nor has any knowledge of, the platforms or their respective data models.
In collaboration with researchers at the University of Washington’s Department of Human-Centered Design & Engineering, we conducted an extensive literature review as well as a comprehensive analysis of internal documents relevant to privacy and data sharing in the CHT community. The results of this work were published in the prestigious Computer Human Interaction conference in May 2021: Towards Responsible Data Practices in Digital Health: A Case Study of an Open Source Community’s Journey.
Through a pilot implementation with Partners In Health (PIH) in Malawi, we implemented a GPS data collection form where health workers are actively prompted to capture their current location data while also capturing the GPS location data in the background (passively, and also explored the use of a subjective socioeconomic status (SES) data – a new self reported social index. The SES assessment was deployed as part of a larger household survey, and was administered to over 6,500 households.
Our geospatial data work has shown to be an entry point for incorporating an informed consent workflow for CHT users enrolling new households or patients for care, or returning to households to collect new patient or household data.
In a foundational randomized trial in Zimbabwe, researchers at Medic and The University of Washington demonstrated that post-surgical patient follow up via SMS was as safe as follow up care at the clinic, and that the transition to SMS enabled an 85% reduction in unnecessary clinic visits. Thanks to the reduction in unnecessary visits, this approach to messaging with patients was cheaper than standard care, and a further usability study found that it was preferred by patients and providers alike.
This study informed a range of new features and enhancements to the CHT’s core framework. The most significant of these improvements came with CHT Core Framework release 3.11.0 in the first quarter of 2021, which included support for interoperability with the widely used open source messaging platform RapidPro. With RapidPro integration, we are able to support more nuanced conversational messaging flows, integrate natural language processing techniques, and benefit from default integrations with a wide range of messaging platforms including SMS aggregators, Telegram, the Meta (Facebook) Messenger app, and WhatsApp. This is the same technology used for this purpose by many of Medic’s peers in the digital health community, including for example Praekelt and a large number of UNICEF country offices.
In 2021 the Medic Labs team and collaborators at Muso published a study which shows the importance of thoughtful user interface improvements to advance universal health coverage. The resulting new feature, called Universal Health Coverage Mode (or UHC Mode) ended up focusing on how information is displayed in the list of patients that CHWs use to scan and organize who they will visit day to day.
The study found that use of UHC Mode more than doubled the odds of, and increased by 13 percentage points, minimum expected home visit coverage. This finding is striking in part because the control group in this study was using a CHT app that would be considered sophisticated by most community health programs anywhere in the world. This is an important departure from most of the scientific literature on digital health, which tends to evaluate the impact of a specific digital intervention relative to an antiquated version of “standard care,” where standard care relies on paper-based information systems and lacks the most basic benefits of digital transformation.
Medic, DataKind, BRAC, and Living Goods are collaborating to support the Intelligent Community Health Systems (iCoHS) initiative, which is led by UNICEF and financially supported by The Rockefeller Foundation. In 2021 we conducted an exploratory study in Uganda on the (CHT) platform as deployed by BRAC.
In September co-authors from DataKind and Medic published a peer-reviewed article on this topic, Pathways to Increasing Trust in Public Health Data: An Exploratory Analysis of Quality Issues and Potential Remediation for Data Collected Using the Community Health Toolkit.
Team
Fully remote, deeply connected
Medic was a remote-first culture well before the pandemic’s impact on life and work as we all know it – a team of veteran champions of Slack emojis, chai happy hours, and cross-team strategic goal-setting. We live our values in our work, and in the way we collaborate internally – emphasizing humanity, compassion, and a belief that we are both tech for good and tech as good. Globally dispersed with flexible schedules in every time zone, here’s how our team stayed connected and motivated – through challenge and change – in another remote year.
94
Total Teammates
19
Countries
21
New Hires
13
Time Zones
of Medic teammates identify as persons of color
of our CXO team identify as women
of Medic teammates live in countries where the CHT is used
of our strategy team identify as women
Connection
20 different types of engagement events, teammates bonded and connected with the mission and one another virtually like never before
Keeping humanity at our core, teammates achieved professional growth without sacrificing work/life balance
I'm honored to be on the MoH Mali project team. When you're on a crew like this, aside from real world deadlines, you're working with world class people, solving real problems for the Ministry of Health. They're not abstract hypothetical problems, but ones you know if you're able to deliver on, are directly increasing the quality of care for all. 
As a member of the People Operations Team, with engagement as a core priority, I had the opportunity to interview a CHW to learn how she uses the CHT in her work. I was able to share this interview with the global team, celebrating the health worker, and honoring our core values of humanity and solidarity! 
Due to COVID-19, Medic’s standard in-person engagement switched to remote sessions. To address challenges like “no-shows”, poor internet connection, and a lack of human connection, we conducted a digital literacy assessment to understand the ecosystem in which the users operate. Now we know how to better engage users remotely and in different locations! 
In the second year of a fully remote team, Medic created dedicated time for teammates (who have never met in person) to get to know each other, relax, and play games. Through these interactions, I was able to build relationships and feel more connected to global teammates who I had not interacted with previously. 
I felt connected to Medic’s work in 2021 because I was given more agency over my day-to-day responsibilities. Feeling valued kept me engaged and it made me feel like I can have more impact with and for the communities we serve. 
In 2021, I worked with the West Africa team extensively, but I’m not a native French speaker. Machine language translators were helpful, but the team was so patient with me – they cleared up confusing translations, provided important context, and even switched to English so I could follow conversations during meetings. The team is amazing! 
In 2021, there was increased collaboration across and within teams, helping us better respond to incidents. We invested heavily in quality of CHT apps in 2020 and this gave us a solid foundation on which to iterate. 
COVID-19 restrictions and working virtually helped me appreciate our increased focus on research and context-driven m-health solutions. These challenges brought out the best of our global family at Medic, collaboratively innovating our ways of working to help us remain useful, especially to our partners! 
To know what we do helps so many people in the world makes me feel grateful to have the opportunity to be here and try to be impactful on my own. My manager and teammates have been fundamental in supporting me and helping me every day. 
2021 was a big year for me, within Medic. I stepped into a new role and I had more opportunities to collaborate with teammates remotely. I felt very connected, despite remaining fully remote! 
Last year, our team enhanced our collaboration approach internally and with external partners, which led to shipping new products faster. For example, we developed a patient screening tool for Covid-19 self assessment and other ailments. The real-time observation of this impactful tool within the communities we serve made me proud of Medic and the work I contribute. 
Ecosystem
Committed collaboration, dedicated support
Our work is made possible by a community of dedicated and innovative coalitions, implementers, and philanthropic partners who share our passion for creating global goods and value openness and collaboration. Our partners are allies in the movement for global health equity aimed at transforming health systems and reimagining the role of technology in providing just, quality care that reaches everyone.
Meet the board
- Greg Ennis (Board Chair), Managing Director, Peninsula Ventures
- Brittany Hume Charm, VP, Strategic Partnerships, The Health Initiative
- Raffi Krikorian, Chief Technology Officer & Managing Director, Emerson Collective
- Dykki Settle, PATH’s Chief Digital Officer and Co-Lead of PATH’s Center of Digital and Data Excellence
- Josh Nesbit, Co-Founder, Widespread Care; Former Co-Founder & Chief Executive Officer, Medic
- Amy Norris, Chief Legal Counsel, Clif Bar & Company
- Robin Bruce, President, Dovetail Impact Foundation
- Wambui Kinya, Regional Managing Director, EMEA for Elephant Ventures
- Greg Ennis (Board Chair), Managing Director, Peninsula Ventures
- Brittany Hume Charm, VP, Strategic Partnerships, The Health Initiative
- Raffi Krikorian, Chief Technology Officer & Managing Director, Emerson Collective
- Dykki Settle, PATH’s Chief Digital Officer and Co-Lead of PATH’s Center of Digital and Data Excellence
- Josh Nesbit, Co-Founder, Widespread Care; Former Co-Founder & Chief Executive Officer, Medic
- Amy Norris, Chief Legal Counsel, Clif Bar & Company
- Robin Bruce, President, Dovetail Impact Foundation
- Wambui Kinya, Regional Managing Director, EMEA for Elephant Ventures
In 2022, we’re focused on thriving. We’ll use our human-centered approach to shape the wider digital health ecosystem while continuously working to position the CHT as the leading digital public good in community health. As we begin to imagine a future alongside the perpetual presence of COVID-19, our collective work to achieve universal health coverage, health worker rights, and health equity for all continues.
Chief Executive Officer
New leadership, enduring mission
The power of our community, teammates, and shared values outshined the challenges of 2021, and we kicked off a new year with energy and transformed leadership.
In March, we welcomed Dr. Krishna Jafa as Medic’s new CEO. A physician, epidemiologist, and public health executive, Krishna joins us with 25 years of deep expertise in health system design and strengthening, digital health innovation, and global partnerships. As a visible and visionary leader in the movement for global health equity, Krishna will build community, create space and momentum for change, and continue the legacy of values-driven leadership into our second decade of work.
Financials
