Q1 2022 Report
Continued impact with new horizons
We went live with the first-ever Community Health Toolkit (CHT) Android App in Nepal, released CHT version 3.14, and advanced a new research-driven pilot to support HIV patients.
We also hosted a Skoll World Forum Ecosystem event: Building & Sustaining Public Health Infrastructure through Digital Global Goods. Our new CEO Dr. Krishna Jafa was joined on “stage” by Dr. Sitienei of MoH Kenya, Kanishka Katara from Living Goods, and Tara Herrick at PATH, in a panel hosted by our very own new board member Wambui Kinya! The group discussed enabling inclusive innovation as a path to strengthening local capacity to create, implement, and scale country-based digital health solutions – such as the CHT.
Throughout this report, we invite you to learn more about our exciting product updates, our incredible growing community, and the future of the CHT as we amplify our engagements across 16 countries.
In Q1, the CHT supported 5.8 million caring activities and more than 37,300 Community Health Workers.
Medic and our partners supported a total of 5.8 million caring activities in Q1 2022, unlocking yet another milestone: the CHT has supported over 75.6 million caring activities since monitoring began in 2014.
As the third year of the pandemic wanes and ministries of health transition their use of the CHT from urgent COVID-19 response to long-term health system infrastructure, several COVID-19 specific projects have now closed. The net reduction of 4,007 active CHT users coincides with these project closures and was forecasted in advance. Even with these COVID-19 project closures, we continue to support active projects in 16 countries and proudly engage and enable a network of 37,396 CHT users with world-class technology.
Total CHT users
Countries with active CHT implementations
All-time caring activities supported
Caring activities this quarter
In Q1 2022, across our partners, CHWs registered 51,876 new households and conducted two million household visits, advancing access to care for hundreds of thousands of people. Our quarterly household coverage rate, on aggregate, remains 29.4%, on par with the prior two quarters.
Increasing care for all
The CHT was used to provide 5.8 million caring activities across Medic-supported and community-supported deployments, despite a planned reduction of actively supported health workers. This means, on average, each health worker individually completed 25% more health caring activities in Q1 2022 compared to Q4 2021. Each one of those activities represents additional health care moments provided to families in need, keeping them healthy, happy, and thriving.
% of deliveries in a facility
% of under-5 assessments conducted within 72 hours
The cadre of health workers using tools created with the CHT maintained critical gains in coverage, speed, and quality of care for mothers and infants across the communities they serve. Over 97% of PNC visits occured on-time (within 48 hours of birth), 93% of registered deliveries occurred in a facility, and 82% of under-five child assessments occurred within 72 hours of symptom onset.
4 UX/UI updates, 6 technical improvements,1 world class toolkit
In Q1, Medic’s product team released version 3.14 of CHT-Core, once again progressing the functionality of the CHT’s core framework. Version 3.14 brought new visuals, new date formats that are more reflective of the countries and cultures where we work, improved server-side purging, and an improved login experience.
User experience matters
CHT Apps are offline-first, and sync data periodically when a connection is available. The sync status is shown in the menu so that users know when they last fully synced. To give more control to users over the sync progress, they can trigger a sync to start immediately. That experience was improved in the 3.14 release by providing more detailed feedback on the sync status through a subtle yet noticeable message at the bottom of the app that displays for a short period of time. Aside from providing quick feedback to users, a failed sync also provides an easy option to retry the sync. This means that a CHW seeking to sync their latest reports can do so more effectively, with clear confirmation when it succeeds.
Sync in progress:
Sync failed (with retry option):
For years, the CHT has supported recording answers to date questions in forms using the Bikram Sambat calendar, such as when a user selects the Nepali locale. However, although the dates displayed throughout the app were shown in Nepali, they used the Gregorian calendar with the year as 2022, instead of 2079, for example. We set out to change how dates are displayed for Female Community Health Workers (FCHVs) in Nepal (and other cultures that use the Bikram Sambat calendar). The application has now been updated to also use the Bikram Sambat format when displaying dates. सफलता! सफलता प्राप्त भयो! (“Saphalatā prāpta bhayō” – success!)
Before version 3.14, the labels for the main tabs in the CHT app (Messages, Tasks, Reports, People, Targets) were hidden on devices with very small screens. This was done to save valuable screen space, but user studies found that there was confusion in the tab meanings when the text was left out. To remedy this, tab labels are now always included, and done in a way that doesn’t sacrifice screen space.
An updated CHT product roadmap
We are actively supporting national community health information system (CHIS) scale ups in many countries. To better support these Ministries of Health and our partners who are leveraging the CHT to build these systems, we are zeroing in on three principles to advance our work in the near-term.
LOCAL OWNERSHIP TOWARD NATIONAL SCALE
We believe the impact of the CHT is significantly greater with a strong and capable CHT community, where local technical and implementing partners are able to independently build, manage, and own their deployments. Medic’s role as steward of the CHT is to help the broader community deploy and sustain digital health apps. As part of this work, we will soon release the next generation of CHT infrastructure that will be easier to manage and scale nationally, as well as explore improvements to user management.
CONNECTING WORKFLOWS AND DATA TO THE WIDER HEALTH ECOSYSTEM
It is important for patients to have a great experience throughout the wider health system, and that requires that health systems be grounded in community health. The CHT already supports many integrations, and we are looking at making it even easier for last-mile workflows to connect with the broader health system.
SUPPORTING CARE TEAMS AT SCALE
Aside from having health workflows functioning well at national scale, we want to ensure that people are being well supported in providing care, and continue working towards Universal Health Coverage (UHC). We are also making it easier for CHWs to orient themselves to updates to their apps or workflows, and doing user research to explore other opportunities for improvements.
For more information on future plans for the CHT, check out the updated roadmap. It is public to encourage discussion, and organized around product initiatives: specific improvement areas that align with the medium and long-term vision for the CHT. We invite you to explore the roadmap and share your thoughts, feedback, and opinions.
CHT Round-ups: full steam ahead
Last quarter, we introduced our new CHT Round-up calls, a monthly series to inform and connect with the CHT community. Since we launched this community outreach approach in December, we have seen tremendous engagement, received strong positive feedback, and introduced new segments during the calls to incorporate and celebrate more community voices.
Learn more about the CHT Round-ups in a recent blog post by our Community Team! Sam Mbuthia, Head of Community of Medic, and Antony Khaemba, Relationship Manager, provide a quick recap of how the calls are progressing, with insights and stories from partners leveraging the CHT around the world.
As the scale and reach of the CHT has grown over the years, so too has Medic’s role as technical steward and community champion. As of Q1, six Ministries of Health have selected the CHT as a digital community health platform of choice (Kenya, Mali, Nepal, Niger, Uganda, and Zanzibar). Medic and the CHT community are supporting these government agencies to deploy and scale CHT-based tools alongside public and private implementing and technical partners. Below, we share a few highlights and milestones from some of these projects.
CHT Android app goes live in Nepal
As noted last quarter, Medic recently responded to a new opportunity to partner with the Nursing and Social Security Division (NSSD) of the Department of Health Services at the Ministry of Health and Population (MoHP). The aim is to equip community-based nurses with digital tools. This resulting new app is the first-ever CHT Android app within the nation and marks the beginning of a new chapter of Medic’s decade-long engagement with the national government. In Q1, 25 nurses in two municipalities – Bhaktapur and Bardibas – were onboarded, trained, and began live reporting. Future training schedules are forthcoming and designs of new use cases for newborn deliveries, family planning, and ANC are underway.
In Kenya, our approach to a sustainable national adoption of a CHT-powered electronic community health information system (eCHIS) is hinged on building strategic partnerships, providing technical assistance, supporting capacity building, and advocacy. Our MoH accompaniment approach is informed by a consultative forum between the MoH and Medic that was held in Nairobi in February 2022. Medic is providing technical assistance in developing and digitizing an eCHIS pilot evaluation tool as well as drafting a county readiness assessment that will inform future scaling of the pilot. Additionally, Medic has been advocating with both technical and implementing partners regarding transition planning for long-term eCHIS adoption. These efforts are aligned with MoH’s vision of one MoH owned and led eCHIS.
In a bid to facilitate full ownership of the eCHIS, Medic facilitated CHT core knowledge transfer to MoH and partners in Q1 through capacity building sessions. A total of five app developers completed training sessions that focused on CHT application configuration, deployment, and support.
Intelligent digital tools to address community health bottlenecks in Uganda
With funding from UNICEF and The Rockefeller Foundation, Living Goods is leading a consortium including BRAC, Medic, and DataKind to support the MoH to use digital health technologies to sustainably address these bottlenecks. As a technical partner in the consortium, Medic led the technical service design and development of the eCHIS. In Q1, a two-week in-person training was completed in Lamwo and Ntungamo districts with district leadership engagement, MOU signing, field visits to health facilities, and CHW training sessions. In total, 253 CHWs grouped within Village Health Teams (VHTs) were trained.
West Africa: a new frontier in digital health
In West Africa, we are simultaneously launching two new CHT-equipped health worker programs on behalf of the Governments of Mali and Niger. Building on our in-country partnerships with Muso in Mali and Médecins Sans Frontières in Niger and DRC, and alongside UNICEF and World Bank, Medic was selected to deploy the CHT and provide technical support, training, and ongoing maintenance to operationalize each government’s digital information system. Year one of the projects are projected to onboard 2,500 community health workers in Mali and 300 in Niger who will support maternal and child health care for their communities.
Community-based ART in Malawi: CARES project
LightHouse Malawi’s differentiated service delivery model – a nurse-led, community-based antiretroviral therapy (ART) program referred to as “NCAP”, delivers ART and rapid assessment for 2,400 stable patients. However, without an electronic medical records (EMR) system, nurses compile paper records and transfer data collected on tablets manually. This process impacts both continuity of care as well as quality of care for patients due to suboptimal patient health tracking and follow-up. Despite the eligibility of more than 5,000 patients, without an EMR system, LightHouse has been unable to expand services to support more patients living with HIV.
Launched in March 2022, and in partnership the National Institutes of Health (NIH), the Government of Malawi, the University of Washington’s International Training and Education Center for Health (I-Tech), and LightHouse, Medic began creating a Community-based ART Retention and Suppression (CARES) App to provide an EMR-like point of care system. Notably, the CARES app operates “offline-first” and does not rely on consistent electricity or internet network – both barriers to the successful adoption of digital health technology at scale. The CARES App provides real-time care advantages for patient assessment over time, and improves outcomes as automatic data syncing reduces errors and workload for the nurses.
Welcoming Dr. Krishna Jafa, Chief Executive Officer
We are elated to introduce Dr. Krishna Jafa as Medic’s new CEO! A physician, epidemiologist, and public health executive, Krishna brings 25 years of deep expertise in health system design and strengthening, digital health innovation, and complex global partnerships on the frontier of public health progress. 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.
Evolving our Board of Directors
Our Board of Directors provide strategic guidance and governance, carry out fiduciary duties, and ensure long-term organizational health while modeling Medic’s values of openness, humanity, solidarity, initiative, and creativity. We are thrilled to welcome two new directors to Medic’s board: Wambui Kinya and Dykki Settle.
As of Q1, Dr. Naveen Rao, Senior Vice President of the Health Initiative at The Rockefeller Foundation, and Dr. Isaac Holeman, Medic co-founder and Clinical Assistant Professor of Global Health and the University of Washington have concluded their terms on the board. We are grateful for their individual contributions, advocacy, allyship, and commitment to open-source digital tools.
Celebrating our co-founder's next adventure
Dr. Isaac Holeman transitioned out of his role as Chief Research Officer in January to pursue a long-time dream of writing a book about human-centered design as well as to focus on his faculty member position at The University of Washington. After 12 years of service, there are not enough words of gratitude to honor Isaac’s legacy and inspiration as a driving force that powered Medic’s growth and enabled its evolution for years to come. From everyone at Medic, we wish Isaac success, joy, and luck in his next adventure!
Enjoying in-person time together, again
As we cautiously step into year three of the pandemic, international and domestic travel has resumed at Medic – ending a two-year hiatus. As with the entire world, we are monitoring the COVID-19 situation and will adjust our policies accordingly. For now, it’s business as usual. The entire West Africa Team and several teammates from Benin, Cameroon, Guinea, and Kenya met to prepare for the launch of two new projects in Mali and Niger… and also had time for a quick game of basketball.
NEW TEAM MEMBERS
Senior Officer, Monitoring and Evalution
Edem Elvis Dorkendoo
Mouhamadou Bassirou Diouf