Introduction
We accompanied – our technical partners building and transforming health systems to respond to COVID-19, our Ministry partners committed to maintaining essential care despite disruptions, and the Community Health Toolkit (CHT) contributors who responded quickly to the needs of health workers and supervisors, built new workflows and guides, and remained human-centered in all we do.
We launched – a new brand, a new tagline, a new website, a new release of the CHT Core Framework, and a new caring metric.
We renewed – welcoming new teammates and CHT contributors, collaborating on new research with established partners, and aligning collective goals to our organizational values.
We built tools for people who care. In our Q1 2021 impact report, explore all the ways we’re living out our values alongside our partners, health workers, and the health systems we’re proud to support.
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Introducing "caring activities": Medic's new principal metric.
The first quarter of 2021 gave us space to reflect on the role of the CHT in supporting care with and in communities. Now more than ever, the CHT can support a wide range of digital health interventions, illustrating the power and potential of open-source tools to further the reach of care for all. We’re on the path to proving that a global public good for community health can scale and positively impact millions of people’s lives.
As the CHT grows, so does the need to measure and understand it’s true impact. Our current cornerstone metric, “number of health workers supported”, which you’ll see below, is an important measure of our community’s size.
But it doesn’t convey the remarkable growth we’ve observed in the total volume of caring activity as community health systems layer on new service areas and make new investments in supervision and support. It’s time for our community to have a more inclusive metric.
To achieve this, we’ve introduced “caring activities” – a better and more comprehensive measure of all of the ways the CHT supports care today, and how we might support care in our next decade of work. Informed by feminist scholarship, care ethics, and central to Medic’s mission of supporting care at scale, learn more about our new key metric and see it in action below!
Impact Metrics
Medic and the CHT community celebrate supporting 37,161 total users across multiple health systems in 16 different countries.
In Q1 we added over 3,000 new users to our community in South Africa, Kenya, Nepal, and more. Now more than ever, we are proud to support the delivery of care to communities around the world.
Our work also reached a new and exciting milestone surpassing 50 million caring activities supported by the CHT since our inception — 52.1 million at the end of Q1 2021 — with 5.7 million caring activities supported in Q1 alone.
40,751
Total CHT users
15
Countries with active CHT implementations
92M+
All-time caring activities supported
22M
Caring activities in QX 2023
The role of the CHT and our partners in supporting care is also evident in aggregate metrics on household coverage of care with over 33% of households receiving at least one visit from a CHW per month during the quarter, the highest proportion of households ever reported since we began tracking this metric in 2019.
While the impact of the COVID-19 pandemic remains evident in a number of our priority use case impact metrics across Antenatal Care (ANC), Postnatal Care (PNC), Integrated Community Case Management (iCCM) and Acute Malnutrition, we have observed critical increases in maternal and child health metrics.
For example, nearly 80,000 pregnancies were registered via the CHT in Q1 2021, which represents an increase of over 5,000 from the previous quarter and nearly double the number reported in Q3 2020. The rate of women delivering in facilities also increased with over 93% of deliveries confirmed via the CHT occurring within a facility.
79,947
Pregnancies registered
93%
of deliveries in a facility
1.2M+
Under-5 assessments
81.1
% of under-5 assessments conducted within 72 hours.
In the face of reported disruptions to essential health services during the pandemic, the increased coverage of care for women and children signals the power of community health systems. Of the 1.2 million child assessments conducted with the support of the CHT in Q1, over 81% occurred within 72 hours of symptoms being reported – illustrating the importance of speed of care to improve child health at the last mile.
Our impact metrics and routine monitoring of the coverage, speed, and quality of care provided to communities supported by the CHT illustrate the vital importance of CHWs, particularly in maintaining continuity of care during the pandemic.
Our observations align with, and contributed to, new research from the Community Health Impact Coalition which demonstrates that CHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during COVID-19. To learn more about the role of CHWs in maintaining coverage and continuity of essential services, please read the study here.
Product Highlights
New release of the CHT Core Framework: X.X.X
The latest release of the CHT marks a significant Q1 undertaking and includes major back-end improvements, exciting new features, and updates that ensure the Core Framework is more reliable than ever. With this release, you can now use RapidPro directly as a messaging gateway for CHT apps. Also, deploying CHT apps can be automated more easily using our new GitHub Action as a building block. The release includes a lot of other improvements beneath the hood to improve performance and make it easier to build on the CHT.
**Optional Product Successes
In addition to core development, we also supported capacity building, external grants, and partnership expansion throughout Q1. Product-related highlights include:
- A prototype integration with Cloudworks and the Rapid Diagnostic Toolkit, through a collaboration with Dimagi.
- In collaboration with Dimagi and ONA, we set up an interoperability proof of concept for Community Health Information Systems using FHIR and OpenHIE.
- We supported the Palladium Group with prototypes and new documentation in their efforts to deploy CHT servers completely offline in clinics throughout Kenya.
- With the support of partners, we completed field sessions with users about improving the user experience of CHT apps. The feedback will help us update components of CHT apps to make them easier to use for existing and new users.
- A new “how to” guide for building and publishing Android Applications.
** Second Optional Product feature
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.
Community Spotlight
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 infrastructurethat 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!
Program Updates
Spotlight on Nepal: Strategic collaboration and a shared vision for sustainable health systems
In Q1, we continued our deep commitment to accompany our partners in creating, owning, and sustaining systems independently. Our long-term goal in Nepal includes complete ownership of the mHealth program by the Ministry of Health and Population (MoHP) and sub-national governments, with the program predominantly funded by the government budget and supported by national technical solution providers. With that vision, we developed a three-year program strategy in Nepal, shining light on a promising, collaborative path towards health equity across Nepal.
As part of the mHealth scale-up, 1,059 new users completed training and began actively using tools built from the CHT in Q1, spanning Sindhuli, Sunsari, Morang, Dankuta, and Panchthar.
As part of the mHealth scale-up, 1,059 new users completed training and began actively using tools built from the CHT in Q1, spanning Sindhuli, Sunsari, Morang, Dankuta, and Panchthar.
For health facilities and municipality teams, we developed a user reference manual and tutorial videos to facilitate easy learning and adoption of data visualization dashboards. These analytics dashboards provide supervisors and local governments with real-time data for more effective decision-making and program planning, supportive supervision, and ultimately enhance program ownership and accountability. These training materials are freely available and do not require an in-person component.
As we look to the remainder of 2021, Medic will conduct review meetings in districts where mHealth deployments were completed before 2020. This one-time event at the local level will invite FCHV supervisors and the health team from the local government (95 municipalities and 688 health facilities) to: review program progress, create an opportunity to strengthen and reinforce our relationship with local governments, and provide a quick refresher on SMS-based tools as well as an on-site orientation on the health facility and municipality-level dashboards.
Research Initiatives
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.
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.
Hot off the press
In September, we donated 177 mobile phones to the Medic-supported CMMB program based in Kitui County, Kenya.
This donation was successful due to the burgeoning partnership with CircleIT – a B Corporation based in Oklahoma City, USA. Read more of the day’s events and the dreams of CHVs here.
Medic’s Ugandan teammates Brian Ssennoga and Joviah Tuhaise contributed to the UNCDF digital white paper dubbed
“Investing in Digitalizing healthcare: The UNCDF way”. The paper provides a lens at the UNCDF digital ‘Leaving no one behind in the digital era’ strategy which is supporting the growth of an inclusive digital economy with a focus on key sectors, including the health sector.
Our service delivery team is our main point of contact with community health workers (CHWs). Through them, we are able to build tools that directly address the needs of our CHWs. Read more in our Q&A with Jane Katanu, Service Design Manager.
Internal Updates
Celebrating women at Medic
On March 10, in honor of International Women’s Day, our team hosted a fireside chat featuring a panel of ten geographically and culturally diverse women on teams across the organization. We spoke with panelists about their experience as women in the workplace, stereotypes they’ve faced and barriers they’ve overcome, as well as the people and the moments that inspire them. We remain inspired by the incredible women at our organization, and we’re committed to improving gender equity in both our organization’s impact and in how our team operates in pursuit of our mission.
New Team Members
Hiell Avissoudo
Project Manager
Elias Waly Ba
App Developer
Fredrick Muiru
App Developer