Introduction
In the Q3 Impact Report, we’re delighted to share the latest programmatic updates and achievements, product innovations, and CHT community highlights.
Last quarter, care provided with CHT-powered apps reached new milestones, supporting 6.1 million caring activities and empowering 14,703 new users. The total count of caring activities now stands at 108 million all-time, a testament to the global impact we’re making together. Our user base has grown to include 62,881 community health workers and their supervisors, marking a 55% increase in total users since the beginning of this year.
Our latest releases, CHT Core 4.3 and 4.4, are unlocking advancements for digital-powered, community-based care, including performance improvements, UI/UX updates, and other technical upgrades.
We proudly reaffirmed our partnership with OpenHIE to promote and adopt interoperability standards and workflows, sharing best practices with the global CHT community.
eCHIS Kenya officially launched, with a roadmap to support over 95,000 Community Health Promoters. Medic is thrilled to be at the forefront of this monumental digital health initiative. We also led an in-person user feedback research trip in Uganda and further scaled the mHealth program in Nepal.
In collaboration with Scope Impact, we’re designing and prototyping a resilience “ClimateXHealth” tool. We aim to build and test a climate and health predictive model of what variables worsen or mitigate climate-sensitive health risks.
We extended a warm welcome to Raffi Krikorian, our new Board Chairperson, we participated in side meetings at the 78th United Nations General Assembly, advocating for systems that transcend geographical boundaries, we visited the Legacy Museum in Montgomery, Alabama, and our Nairobi hub held a mid-year team meetup to celebrate, connect, and exchange ideas.
Thank you for being an integral part of the Medic community. Together, we’re supporting the professionalization of community health workers and advancing the promise of universal health coverage.
Impact
In Q3 2023, the CHT supported 6.1 million caring activities, bringing the total number of caring activities supported to 108 million caring activities all-time.
We also supported 14,703 new CHT users, the largest increase in new users ever recorded – more than double our largest expansion of users achieved in 2021. The CHT now supports 62,881 health workers and their supervisors, a 55% increase in total users supported since January 1, 2023!
108M
All-time caring activities supported
62,881
Total CHT users
14
Countries with active CHT implementations
6.1M
Caring activities in Q3 2023
Product Highlights
New Releases: CHT Core 4.4 and 4.4
In August, we released CHT Core 4.3, upgrading additional features that will increase ease for CHWs as they provide care to their communities. The features include:
- Adding phone numbers to patients when registering via SMS
- New Prometheus API endpoint
- Performance improvement for downwards replication
- 8 additional improvements, 2 security fixes, 1 performance improvement, 15 bug fixes, and 14 technical improvements
In September, we released CHT Core 4.4. The features include:
- UI/UX changes – CHT dialogs were updated to align with material guidelines
- Upgraded CouchDb to v.3.3.2
- Improved replication performance by persistent caching of purged document IDs
- 7 additional improvements, 1 security fixes, 3 performance improvements, 5 bug fixes, and 11 technical improvements
Community Spotlight
Medic and OpenHIE – a Shared Commitment to Openness and Interoperability
Medic reaffirmed our alignment with OpenHIE, renewing our partnership formally launched in 2021. OpenHIE provides a robust framework for building scalable and sustainable health information systems within the digital health ecosystem. Medic will continue to harness our extensive networks and partnerships to promote and adopt interoperability standards and workflows, sharing best practices with the global CHT community. Medic recently leveraged the power of the OpenHIE framework to develop a Loss-To-Follow-Up (LTFU) reference application, validated by Ministry of Health Kenya and adopted for their instance with AfyaKE – a facility based system.
Program Updates
Rapid Scale of Kenya’s eCHIS – Flagging Off 100,000 CHP Kits
In September 2023, His Excellency President Ruto officially launched the national scaling of eCHIS and commitment to salary all community health workers in Kenya. Known as “eCHIS Kenya”, and built with the Medic-stewarded CHT, the digital health platform will be provided to over 95,000 Community Health Promoters (CHPs) and Community Health Assistants (CHAs) across all 47 counties, placing world-class digital technology in their hands, supporting them as they provide high-quality, timely, and equitable community-based care. In October 2023, the federal government further launched the national linkage of the eCHIS platform to the Smart Primary Care Network, initiating in Kericho County. With smartphones procured, health worker training has begun at rapid pace, with nearly 25,000 frontline health workers equipped with the technology already. Medic is proud to have collaborated with the Ministry and CHU4UHC Platform partners to reach this milestone.
User Feedback Research in Uganda
Medic led an in-person user feedback research trip in Koboko and Maracha districts in Uganda. One-to-one interviews helped our team gather direct feedback from VHTs using the CHT-based electronic community health information system (eCHIS). Human-centered design is a fundamental approach we take to build and design systems that work for community health workers, partnering in solidarity with users directly at the community level.
mHealth Program Expansion in Nepal
In late 2021, the Director General Office of the Department of Health Services formally approved a pilot of a new CHT app with operational leadership from the Nursing and Social Security Division (NSSD). Medic completed the design and app development and helped launch the program in Bhaktapur and Bardibas municipalities. In Q1 2023, the program expanded to Chandragiri based on high demand for digital tools and reported success from the initial launch communities. In Q3 2023, the program further expanded to Waling Municipality in Syangja District, Gandaki Province. Waling has been previously collaborating with Medic on the traditional SMS-based mHealth program. With orientation on the new Android app now complete, 14 Community Health Nurses (CHNs) and 1 Community Health Officer (CHO) are ready to begin using the technology to deliver advanced health care in the community.
Medic Labs Initiatives
ClimateXHealth Resilience Tool for Community Health Workers
Climate change has been declared the biggest global health threat of the 21st century. Rising temperatures, extreme weather events, excess rain and flooding, rising air pollution, and climate-related natural disasters are contributing to water scarcity, increased transmission of waterborne diseases, expansion of disease-carrying vectors like mosquitoes, an increase in respiratory problems, and more direct injuries from catastrophic hurricanes, floods, and wildfires – amplifying the strain on already fragile health systems.
In partnership with Scope Impact, Medic is designing and prototyping a resilience “ClimateXHealth” tool. Our research began in Sindhupalchowk District, a population that is vulnerable against climate change-associated flood and landslide events. Through qualitative research with Female Community Health Volunteers (FCHVs), we are exploring their understanding of and experience with responding to climate change-related health hazards, and gathering direct feedback from these likely users of the prototype tool.
In a recent blog by Service Designer Lal Kunwar, we discuss how this community experiences climate-related threats and how our research collaborative aims to improve awareness, counseling, and rapid response.
Recent Publications and Blogs
We are excited to announce the release of CHT Watchdog, a new and powerful open-source solution for monitoring CHT deployments and receiving push alerts when attention is needed from a CHT administrator.
By equipping Community Health Promoters (CHPs) with powerful digital tools, Kenya is transforming the way healthcare is delivered at the household level.
Medic’s CEO Dr. Krishna Jafa, Dr. Tom Frieden, and Chen Chen share how 6 million CHWs globally provide a line of communication, education, outreach, and support between health services and the communities they serve. It’s a job, not a side hustle — they need to be compensated.
We explore how Open Health Information Exchange (OpenHIE) provides a modular framework for developing interoperable, scalable, and sustainable health information systems (for systems to successfully exchange data, a standard format of this data must be adhered to).
In 2021, Medic and OpenHIE established a formal partnership to collaborate on data exchange standardization. We are thrilled to renew our partnership for an additional three years.
Voluntary medical male circumcision (MC) is a biomedical HIV prevention method that requires post-operative follow-up for healing confirmation. Recent research found that a two-way texting (2wT) app providing SMS-based telehealth for MC patients was safe and reduced provider workload. We evaluated 2wT usability among MC clients in South Africa assigned the 2wT intervention within a larger randomized controlled trial (RCT) of 2wT safety and workload.
Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient’s perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi.
Team News
Welcomed New Vision and Leadership to Medic’s Board of Directors
As of 28 July, Raffi Krikorian expanded his role on Medic’s Board of Directors as incoming Board Chairperson, succeeding long-time Board Chair Greg Ennis. Since joining Medic’s Board in 2020, Raffi has been instrumental in supporting Medic to sharpen its long-term technical vision and strategy and navigate the trade-offs between scale and extensibility. A builder and empowering force for change, Raffi currently serves as the Chief Technology Officer at Emerson Collective, with previous leadership roles at Twitter, the Democratic National Committee, and Uber. Medic thanks Greg for his 12-year tenure, serving as a thoughtful strategic partner, trusted mentor, and dedicated advocate for community health workers and Medic’s pursuit to revolutionize digitized community-based health.
Selected by Amazon Web Services (AWS) Health Equity Initiative
Medic was selected as part of the Amazon Web Services (AWS) Health Equity Initiative, a $40 million, three-year commitment, supporting organizations that are developing solutions to advance health equity. Medic will receive computing credits and technical expertise from Amazon Web Services to support scaling the Community Health Toolkit (CHT) – an investment in the CHT as a digital public good advancing the promise of universal health coverage. Medic extends its sincere gratitude to AWS for this remarkable opportunity. Together, we are dedicated to making a meaningful impact and advancing health equity on a global scale.
Attended the 78th United Nations General Assembly
Where you live should not determine whether you live. In solidarity and aligned advocacy with the Community Health Impact Coalition, our global partners, and international collaborators, we need to be building systems that shift paradigms rather than maintaining paradigms that reinforce existing system failures. Further, universal health coverage and global health security are flipped sides of the same coin, we address one by solving the other. Medic teammates met with our community health delivery partners, we attended insightful workshops and events, and we connected with our core donors and digital health ecosystem allies to advance the CHT as an open source tool for advancing community health information systems.
Visited the Legacy Museum: from Enslavement to Mass Incarceration in Montgomery, Alabama, USA
Teammates from 12 cities and 3 countries gathered in Atlanta, Georgia for team connection, co-working, and community service. In Atlanta, we volunteered at Our Giving Garden, a community garden that grows and donates over 2000 kg of produce and eggs each year to help food-insecure families have nutritious and free options each week. We then traveled on to Montgomery, Alabama for an exploration of the United State’s history of racial injustice at The Legacy Museum and National Memorial for Peace and Justice. This trip of service and learning is an integral part of Medic’s core beliefs and values – a dedication to human-centered approaches, solidarity with communities we serve and who have been impacted by generations of colonialism, and openness to listen, reflect, and take action to create a more equitable world.
Enjoyed Time Together in Nairobi
Our Nairobi, Kenya hub held a mid-year Team Meetup on September 15th at The Forest, an adventure center with exhilarating activities. Celebrating the launch of the national scale of Kenya’s electronic community health information system – built with the Medic-stewarded Community Health Toolkit, this Meetup was a chance to catch-up, exchange ideas, and set the stage for our next big achievements in Kenya and around the world.
Spoke at the Medic East Africa Conference
Our Senior Project Manager Philip Ngari attended and spoke at the Medic East Africa Medical Expo & Conference by Informa Markets, co-located with Medlab East Africa. There were ample moments to celebrate digitisation of community health services, including through EMR interoperability, affordable medical equipment, and cross-functional collaboration with the private sector.
New Team Members
Rafa Edwards
Quality Assurance Engineer
Louis Anato
Service Designer
Mansour Diop
Service Designer
Benjamin Kiarie
Software Developer
Alex Kombo
App Developer Manager