Post authored by Isaac Holeman, Medic’s Chief Research Officer and Co-Founder.
Collaboration has always been the heart of the Community Health Toolkit (CHT). Fifteen partner organizations supported its launch last October, and since then, their voices and those of users and implementers around the world have inspired more than 275 features, improvements, and fixes to its Core Framework. With the support of the wider CHT community, that same resource has been independently implemented by D-Tree and Living Goods. A mobile learning platform called OppiaMobile, a new computer vision app for reading Malaria rapid diagnostic tests, and a USSD-based tool for gathering beneficiary feedback have continued to evolve through discussions by the CHT community.
Historical context: what online communities mean to our team
Medic Mobile began when a few students at Stanford and Lewis & Clark started using a free software application called FrontlineSMS to coordinate a community health program at St Gabriel’s Hospital in Malawi. We weren’t software developers or medical doctors—just passionate, thoughtful people who enjoyed tinkering and realized that we could use technology to advance health equity in hard-to-reach communities. We officially founded the non-profit in 2010, only after a few years of working together had taught us that the need for digital tools in community health was greater than we had imagined. While we’ve shared this story before, it’s perhaps less widely-known that Josh and I actually met online, thanks to a community forum. We made unlikely co-founders—we didn’t have a mutual friend or colleague in the world, and since we were both still finishing college at the time, neither of us had real work experience, a resume, or reputation to speak of. Here’s how it happened:
From 2008 to 2018, Global Health Delivery Online was an online forum where members shared practical information and discussed important issues in virtual professional communities. Each expert-led community connected people passionate about the same topic and engaged them in timely discussions on critical challenges for the delivery of quality health care to all patients. Just a few months after GHDonline got started, Josh shared this post with the community:
“I’m here with a laptop, 100 second-hand phones, and an open-source program, FrontlineSMS – which acts as a central SMS hub, coordinating the text-based communications network. The pilot’s been running for five weeks, and we’re seeing functionality develop organically from the hospital’s and CHWs’ needs…”
As a GHDonline participant, I received a summary of Josh’s post to my email inbox, and I clicked through and commented on his blog. I had been working with a few other students to initiate a project involving OpenMRS and a community health program in Burundi, and Josh’s work shaped my thinking significantly. By Thanksgiving of 2008 we had decided to start working together, though we never had a chance to meet in-person until the following February!
In the intervening years we’ve participated in many community fora, online and offline. The Global Digital Health Forum has grown from a small gathering of an emerging mHealth community of practice, to an annual mega conference. We were founding contributors to the ICT4CHW google group, along with colleagues from Dimagi and elsewhere. We continued to take part in conversations with the GHDonline community, and have been found on the OpenMRS forum, the ODK forum, and the Principles for Digital Development forum from time to time. Over the years we’ve really tried to do digital health in an open, community-oriented way. Our field keeps evolving though, and last year we started to see a shift in our community’s needs.
Recognizing important changes in the wider digital health field
The first shift was a growing appetite for more detailed, pragmatic conversations about implementing and contributing to software for community health. The software Medic develops has always been open source and co-designed with our partners. Nevertheless, we were becoming increasingly aware that governments and other technical organizations need many additional open access resources to deploy these systems independently, from technical guidance docs to design resources, tools for testing, and end-user training materials. Moreover, we heard that they wanted an open place to discuss and collaboratively develop these materials with each other. Our community had grown too large to depend on the wider digital health field’s community fora, or on a growing torrent of one-to-one conversations over Skype and email.
The second shift was an increasing recognition that our partners wanted an open space to discuss a range of technical components and other resources that they are developing and using to support community health. Medic Mobile has always used a range of third-party open source components alongside the software we develop. Yet it was a real shift for us to realize how much value we could add by facilitating conversations about how these components come together in practice, to address concrete challenges in community health. Our efforts with Oppia Mobile, the mRDT Capture app and the beneficiary feedback system have made exciting first steps in this direction.
The CHT community forum is part of a larger movement in digital health, which increasingly recognizes the value of open, collaboratively developed public goods. We’re grateful to Digital Square and the Principles of Donor Alignment in Digital Health for helping us to articulate how the public goods approach translates into greater health impact with and for hard-to-reach communities. In some respects their efforts have pushed forward our thinking, and in other respects they’ve succeeded a grasping a sentiment that has always been central to what we stand for at Medic Mobile. This much has always been true: we believe in the power of an open, online forum as a meeting place and catalyst for our collective work. There is no other kind of community in which our story would ever have been possible. Now, as a steward of the CHT, we’re hoping to create that kind of opportunity for others. If you have feedback about how we’re doing, a question, or an idea to share, I hope you’ll sign onto the forum to let us know.