Q4 2021 Report


Wrapping up 2021 with collective momentum and long-term vision.

In Q4, the Medic team had our eyes on the 2021 finish line – pushing significant projects and partnerships forward to close out a challenging, rewarding year. Together, we joined partners in celebrating UHC Day, made strides towards national-level adoption of the Community Health Toolkit (CHT) in Nepal, dedicated time to engaging with the CHT open-source community, celebrated new partnership opportunities and award nominations – and so much more. 

We also had time to rest and reset, thanks to the values-aligned benefits and culture of our global team, connected across 20+ countries. Q4 offered moments of pride and the promise of long-term, shared vision alongside our partners and the communities we serve. 

In our Q4 2021 impact report, explore our end-of-year momentum and how the Medic team and CHT community set the stage for an even more impactful 2022.

our impact

In Q4, the CHT supported 5.1 million caring activities and more than 41,400 community health workers.

As we look back on our impact across the CHT network in Q4 2021, we find ourselves returning to milestones that are reflective of our organizational values. 

There have been key gains in coverage, speed, and quality of care across our CHT partners, as well as milestones in the number of community health workers (CHWs) supported across our network and the number of caring activities supported by the tools built with the CHT. 

As we reflect on our impact, the CHT supported 5.1 million caring activities in Q4 2021, with 22.7 million caring activities supported over the course of the year in communities and facilities in 15 different countries.  

More than 41,400 CHWs now use the CHT to support care in their communities, reflecting key gains in established partnerships in Nepal and new opportunities in East Africa. This represents a gain of over 1,500 new users in Q4 and more than 7,300 net new users added to the CHT network over the course of the year. 


Total CHT users


New CHT users


All-time caring activities supported


Caring activities this quarter

While the COVID-19 pandemic continues to impact the health of the world, our partners are also returning to and further investing in provision of household-based care as a critical pillar of achieving universal health coverage (UHC). 

In Q4 2021, across our partners, CHWs registered more than 56,800 new households and conducted two million household visits, advancing access to care for hundreds of thousands of people.


Increasing coverage for children under five-years-old

Over 4.2 million under-5 assessments were conducted with the CHT in 2021 – the most assessments ever reported, representing 18% of all caring activities supported via the CHT in 2021. ​


Pregnancies registered


% of deliveries in a facility


Under-5 assessments


% of under-5 assessments conducted within 72 hours

As CHWs supported by the CHT continue to provide essential services, we want to highlight a number of other key metrics of care coverage across antenatal care (ANC), postnatal care (PNC), and integrated community case management (iCCM) in Q4: 

  • 72,069 pregnancies registered
  • 93.4% of deliveries in-facility
  • 97.7% of PNC visits on-time in Q4 (highest of the year!)
  • 817,054 iCCM assessments conducted, contributing to the highest number of iCCM assessments ever captured by the CHT in 2021
  • 87% of iCCM visits within 72 hours of symptom onset (highest of the year!)

As the second year of the COVID-19 pandemic wanes, it’s clear that continuity of care can not only be maintained, but that programs supported by the CHT are beginning to see gains.

product highlights

Using the CHT to support COVID-19 vaccine workflows

COVID-19 vaccine reference app

In Q4, the Medic team designed a COVID-19 vaccine workflow for CHWs based on WHO resources. CHT apps can support vaccine rollouts by helping CHWs through different scenarios to educate and encourage patients to get vaccinated. A reference app will be made available in early 2022 that will include key configuration aspects that can be used by existing and new deployments.

 Local ownership at national scale 

As deployments of CHT apps look to scale nationally, the Medic team has continued to make the CHT more robust by studying and overcoming potential bottlenecks. One area that is undergoing major effort is how CHT servers are set up internally. After studying the scalability of CHT infrastructure, the team has been designing and implementing the next generation of the CHT infrastructure that will be able to scale horizontally rather than more difficult and costly vertical scaling. This means that the load can be more easily managed and distributed to avoid the most significant scalability bottleneck. In 2022, we will be releasing the first stage of this improvement as v4.0, after which further infrastructure improvements will be easier to roll out incrementally.

In parallel, the Medic team has also been working with partners to design and implement other improvements for large deployments. These improvements will make it simpler for program administrators to manage users, easier to roll out app changes remotely when in-person training isn’t feasible, and reduce the time needed to aggregate and analyze data. 

Stay tuned, as we will be discussing the release of these features on the CHT Forum and on the upcoming CHT Roundup Calls!


Sharing insights and expertise on the inaugural CHT Roundup Call

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.

“The inaugural CHT roundup community call had over 50 participants who contributed great comments, questions, and ideas. This incredible participation from the community underscored the need for frequent engagement between community members beyond emails and CHT Forum discussions.”
Samuel Mbuthia
Head of Community at Medic

program updates

“People don’t suffer needlessly awaiting treatment.” How an app, built with the CHT, supports disease surveillance and COVID-19 response in Niger

Grappling with the imminent need for COVID-19 surveillance in 2020, Medic, The MSF Foundation, and Epicentre came together under the leadership of Niger’s Ministry of Health to build and launch Alerte-Covid19: a CHT-built app designed to support Niger’s health teams as they coordinate rapid response and investigations of suspected COVID-19 cases.

With near-immediate success, the app became the foundation for Alerte-Niger, a program that aims to support earlier and more effective responses to epidemics of other infectious diseases – like measles, meningitis, and cholera – well beyond the COVID-19 pandemic.

In Q4, The MSF Foundation traveled to the Maradi region to connect with the users and champions of Alerte-Niger. In a new video, see this evolving collaboration in action.

CHT adoption at the national level in Nepal: Equipping nurses to provide doorstep care

In 2021, we focused on strengthening national and local partnerships to strongly position the CHT as the tool of choice for community health programming in Nepal. In Q2, we rapidly responded to a new opportunity to partner with the Nursing and Social Security Division (NSSD) of the Department of Health Services, Ministry of Health and Population (MoHP). Tasked with rolling out strategies and implementing federal programs associated with CHWs (including FCHVs), NSSD is leading the design and implementation of a pilot project to deploy community-based nurses to provide doorstep care.

One of the project’s key features is equipping the nurses with digital tools, and we’re thrilled that NSSD decided to adopt the CHT. In Q3, the Director General Office of the Department of Health Services formally approved a pilot of the NSSD-CHT app in two municipalities: Bhaktapur and Bardibas. Both municipalities have hired a new cadre of health workers, and our product and app services teams completed the design and app development for the baseline study, pregnancy workflow, and several rounds of internal testing. In November, NSSD conducted external testing, which garnered positive results. 

“The new app, built with the CHT, will ensure universal health coverage in Nepal's healthcare system. This will benefit Nepal's overall health system, particularly the maternal and child health sector in the digital arena. This app will support care coordination among CHWs, health workers, and service recipients. We’re proud to work alongside municipalities and community leaders to ensure access to quality health is possible.”
Dr. Niraj Kumar Nakarmi
Project Manager, Nepal

Deployment and training kicked off in December, with a total of 24 new users (community health nurses). This will complete a critical milestone on our deployment timeline and sets the stage for continued scale in 2022.

research initiatives

Data integrity tooling to advance precision community health

In Q4, the research team at Medic performed an exploratory data analysis (EDA) on an additional deployment of the CHT to better understand types of data quality issues and their pervasiveness. Generally, the EDA realized results that were similar to those reported in the previous work except for errors on instrument calibration that did not occur in the period covered by the extended EDA. 

The Q4 study was augmented with user experience (UX) research that saw users not only express their data quality pain points but also prioritize the identified inconsistent and problematic (IoP) data for inclusion in the data quality toolkit currently under development.

Learn more in a blog post by Chrisgone Adede, Senior Researcher, Data Science.

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