Introduction
As we close Q1 2024, we are elated to share that the Community Health Toolkit (CHT) now supports over 131,000 health workers globally!
As this report highlights, each one of these users is at the heart of everything we design and develop. That’s why, when health workers in Malawi told us they needed a barcode scanning feature to pull up patient records, or a two-way texting system with appointment reminders, we built it for them, and with them.
It meant that when the Ministry of Health of Togo selected Medic to design a national electronic community health information system, we ensured that it met the needs of local communities and the health workers who care for them.
It’s also why we recently immersed ourselves in the experience of community health workers in Kenya and Uganda during site visits, and why we’re working on features that make it easier to find and fix user experience challenges as fast as possible.
As the CHT user base continues to grow with six nationally scaling programs, human-centered design will always be a core part of our commitment to improving care delivery and achieving universal health coverage.
Impact
In Q1 2024, we welcomed 56,514 new users to the Community Health Toolkit, now supporting 131,755 community health workers and their supervisors across 18 countries.
The CHT supported these health workers in performing 11.3 million caring activities, from screening for malnutrition and immunizations to registering pregnancies and performing perinatal check-ups.
128.3M
All-time caring activities supported
131K
Total CHT users
6.9M
All-time households registered
11.3M
Caring activities in Q1 2024
Product Highlights
New Release: CHT Core 4.6.0
The CHT Core Framework v4.6 is here! Some highlights include:
Complex forms are now much faster - up to 60% when coming from older CHT versions!
In app building you can now restrict contact selection to specific contacts, likely members of the household.
There are now officially published configuration files that can be used to ease hosting CHT apps with Kubernetes (our recommended hosting technology).
There are bug fixes and security enhancements, including a script for bulk password changes which is particularly important for large deployments
Improving the CHT: Apdex
In Q1, our Product Team also worked on features that make it easier to understand where health workers are experiencing slow speeds as they interact with their CHT apps.
Starting in v4.7.0, the CHT will collect client Apdex, which is a standard way of evaluating how users perceive a web application, based on how fast pages load. Apdex data will be used to identify slow areas of the app and direct our future efforts towards making the CHT faster for all health workers.
Community Spotlight
Spotlight on... SunyaEK: Championing open-source solutions in Nepal
Strategic collaboration between open-source digital projects, and regional and local technical organizations, is critical in ensuring Ministries of Health and digital implementers can build robust, interoperable, and sustainable health information systems.
Medic has collaborated with SunyaEK since 2021, supporting them to build internal capacity to independently develop, deploy, and support CHT tools. SunyaEK also supports the Ministry of Health of Nepal and other non-profit organizations to deploy open-source tools like Bahmni, an electronic health information and medical record system built as a distribution of OpenMRS.
Since 2022, Medic and SunyaEK have been supporting the Nepali Nursing and Social Security Division (NSSD) to design, configure, deploy, and enhance the first CHT Android-based app to support community health nurses (CHNs) and community health officers (CHOs) as they provide doorstep services in Nepal. SunyaEK has also supported the Possible Health team to transition its Community Health Support Program in Dolakha municipality (Nepal) from a Software as a Service (SaaS) digital health platform to the open-source CHT.
These tools will bolster the government’s mission of ensuring quality service delivery in Nepal. United in our mission to deliver cost-effective, sustainable, and scalable digital tools, Medic and SunyaEK look to establish an even stronger partnership in years to come.
CHT v4.6 in action: Testing feedback from Swiss TPH
Days after v4.6 of CHT Core was released, the team at Swiss TPH working on digital clinical decision support algorithms (CDSAs) jumped in to test it out.
They couldn’t believe that version 4.6 improved performance of their algorithms, cutting screen loading time by half compared to v4.5, and took to the CHT Forum to share their findings.
For end-users of CDSAs, this translates into reducing the overall consultation time (reducing the loading screen time and transition time from page to page), and improving the user experience and efficiency in the health system.
This is critical as slow-loading forms or long transitions between pages can lead to users who are frustrated, or less likely to use the tool.
Program Updates
Spotlight on... 🇰🇪 Togo
In Togo, we have partnered with Integrate Health since 2017. By leveraging the Community Health Toolkit, and working with Medic to build up their in-house technical expertise, Integrate Health developed their mobile app Tonoudayo. This CHT app is now self-hosted by Integrate Health, supporting 212 health workers with plans to scale up to 1,000 users in 2024.
In September 2023, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministère de la Santé et de l’Hygiène Publique Togo selected Medic to design its national electronic Community Health Information System (eCHIS), known as SanteComTogo.
Medic designed the eCHIS with UHC tracer service and commodity management workflows and in Q1 2024, the Ministry of Health launched a pilot of the program with approximately 1,000 users. When funding is secured, the Ministry aims to train and support up to 8,000 professionalized community health workers over the next three years, leveraging this smart technology to deliver equitable care and advance universal health coverage.
How do you begin to build a national community health app like this? Service Designer Louis Anato explains how the design of SanteComTogo was driven by community health workers.
Around the world ...
In 🇰🇪 Kenya, we received support from USAID through HealthIT, a local implementation mechanism, to continue scaling and enhancing the national eCHIS platform. Together with HealthIT, we’re optimizing existing workflows and introducing new ones focusing on cancer, eye care, and oral health. We’re also working on improving analytics, and strengthening technical and infrastructure support through building and devolving capacity to the counties and MoH ICT teams respectively.
As a long-standing advocate of professionalized health workers, we were also honored to join the Kenyan Ministry of Health as it launched stipend payments for Community Health Promoters in February. This is a critical step in making sure that health workers are recognized and fairly compensated for the crucial role they play in advancing universal health coverage. Our Program Head for East Africa Simon Mbae was in attendance to celebrate this milestone.
In🇳🇵Nepal, Medic joined a team from the Ministry of Health and Population on a visit to Bardibas Municipality, where we’ve been active since 2022. The team met with some of the 15 CHT users there, oversaw training for new users, and provided programmatic support and feedback. We shadowed Female Community Health Workers (FCHVs) during house visits to better understand how they use the CHT to provide care. The visit revealed that consistent community engagement has been instrumental in building trust and cooperation between community health workers, the CHT, and the citizens of Bardibas.
Innovation
📱 2-way texting: Supporting follow-up care in Southern Africa
Since 2007, the United Nations and the World Health Organization have recommended voluntary male medical circumcision to prevent HIV transmission between women and men.
The decision has since been associated with a 60% decrease in the risk of heterosexual infection and is still considered an important intervention.
With leadership from the International Training and Education Center for Health (I-TECH) at the University of Washington, Medic designed and deployed a CHT-based two-way texting (2wT) application to help nurses check up on post-surgery male circumcision patients in Zimbabwe and South Africa. The initial and follow-up trials showed that 2wT was equally as safe as in-person visits but significantly more efficient, reducing the number of trips by 85% and saving two USD per client.
In the spirit of openness, in Q1, I-TECH open-sourced the 2wT app for public use. As an open-source resource, anyone can adapt the app for their own specific needs, benefitting from years of user-informed enhancements. Local partners in Zimbabwe and South Africa will assume long-term maintenance of these 2wT apps.
📱 Barcode scanning in Malawi
Antiretroviral therapy (ART) increases survival and quality of life for people living with HIV. But, with 20 million people receiving the treatment globally as of 2022, this also leads to higher healthcare costs, crowded facilities and longer waiting times.
Together with Lighthouse Trust and I-TECH, we leveraged the CHT to design and develop the Community-based ART REtention and Suppression (CARES) app for the nurse-led community ART program (NCAP) in Lilongwe, Malawi. CARES aims to improve follow-up processes, viral load monitoring and rapid identification of risks such as low-level viremia. This means optimizing health delivery, without adding to the workloads of healthcare workers.
In Malawi, patients are issued a health passport with a unique barcode – which they take with them to medical appointments.
We released a feature for the app that would enable nurses to scan this barcode and quickly and accurately bring up a patient’s record. This reduces the likelihood of entering information on the wrong patient profile and serves as another exciting step towards integration across healthcare systems.
We were able to use telemetry – a way of gathering performance data for remote monitoring and analysis – to monitor the success of the feature, and when we followed up with users, they described it as “straightforward” and “familiar”, reducing time and errors when searching for patients.
Recent Publications and Blogs
We co-created a two-way texting system in Malawi with Lighthouse Trust and I-TECH, providing tailored motivation messages and visit reminders for clinical teams. It’s showing promising results in antiretroviral therapy.
How do we immerse ourselves in the day-to-day experiences of community health workers to understand their needs? UX/UI researcher Ziithe explains.
Internal Updates
Global team retreat
In February, our global team met in Penang, Malaysia, for our annual retreat. With over 90 teammates spread across 32 cities worldwide, the annual retreat is an important opportunity to connect on critical programmatic priorities, celebrate our shared achievements from the past year, and recharge together as we enter the new year.
Fast Forward 10th anniversary
Our Director of External Affairs, Jeff Jacobs, and Philanthropy Manager, Kaitlyn Neel, represented Medic at Fast Forward’s first-ever alumni retreat and 10-year anniversary celebration in San Francisco.
Medic was an alumnus of the 2014 Fast Forward accelerator in 2014, which opened many doors to high-caliber partnerships and collaboration. We joined fellow peers breaking ground on climate, health, education, and other crucial issues to reflect on the community’s collective achievements over the past decade.
New Team Members
Sugat Bajracharya
Senior Software Developer - Nepal
Tom Wier
Senior Software Developer - Uganda
Alassane Ndoye
App Developer - Senegal