Deploying CommCare as an mHealth Tool

Key Steps

1. Planning a Project2. Identifying Key People3. Setting up a Workspace and Application4. Building an Application 5. Procuring Equipment For Deployment6. Training the Mobile Users7. Developing Custom Reports and Validating Data8. Ongoing Monitoring

Average Deployment Timeline

The following chart describes the average timeline for deployment, based on the experiences of the Millennium Villages Project (up to 150 mobile users for each deployment area):

ACTIVITIES TIME FRAME KEY PEOPLE

Step 1: Plan the project requirements 2-4 weeks Government*; Field Engineer, mHealth Specialist, Health Experts***

Step 2: Identify key team for implementation 2-3 weeks Government*; Field Engineer

Step 3: Set up a workspace and application 1 day Field Engineer; mHealth Specialist

Step 4: Build and review the application 2 weeks Field Engineer; mHealth Specialist; Health Experts***

Step 5: Procure and configure equipment 2-4 weeks Government*; Field Engineer

Step 6: Train mobile users and supervisors 3-5 days per district**

Field Engineer; mHealth Specialist; CHW Manager

Step 7: Validate data and develop custom reports 4 weeks Field Engineer; mHealth Specialist; Health Experts***

Step 8: Monitor program and conduct continuous quality improvement (including validation of reports)

Ongoing mHeath Specialist; CHW Manager; Government*

* Or other client (i.e. NGO)** Depending on number of mobile users*** Could be CHW Manager or other health experts who can advise on application and report content required

Planning a ProjectStep 1

1) ASSESSConduct needs

assessment to identify current gap, staff

expectations, available resources

2) EVALUATEAnalyze assessment

results to determine if and how CommCare

can best support your project

3) DESIGNIf CommCare will add

value to your program, specify desired

requirements and features

Conducting a Needs Assessment

Key Questions: Is CommCare right for your program? What are the data points that need to be collected through CommCare? Are current data collection methods paper-based, and does this lead to

inaccuracies and data entry errors? Can you answer how using mobile health will improve the project? Does the implementation site have mobile network coverage? Are phones available or easily procurable? Does support staff have necessary ICT technical expertise?

For more info: https://confluence.dimagi.com/display/commcarepublic/Project+Needs+Assessment

STEP

1

Choose an Appropriate CommCare Plan

Depending on the needs of the project, five different software plans are available Prices range from free to 1000+USD/mo depending on the number of users and type of

support and services needed

STEP

1

For more info: http://www.commcarehq.org/software-plans/

Key Questions for Choosing the Right Plan

What price plan can you afford? How many mobile users do you plan to have? Do you need web-based support? Do you want to build your own custom reports? Is SMS part of your project? Do you need HIPAA (confidentiality) assurance? Do you need direct support through email, site visitations and/or

application troubleshooting from Dimagi?

STEP

1

Identifying Key PeopleStep 2

Human Resources for CommCare Use

The strongest programs have good management practices and a team of dedicated staff to oversee the program

Usually, programs will have at least: Mobile users An eHealth Specialist A mobile worker manager (often with health expertise)

Some programs may have: A Field Engineer to help build the application, test the system, and conduct initial

training of trainers An M&E Coordinator for data monitoring and analysis

STEP

2

The Mobile User

The mobile user is the heart of an mHealth program

In many cases the mobile user is a Community Health Worker (CHW)

People involved in set-up and maintenance of the program should focus on how to ensure the system can be used by the mobile user

The mobile user’s main responsibilities include: Recording household visits using the mobile

application Counseling the community Providing important health services Reporting on vital events and other key health

events in the community

STEP

2

Other Key Players: Initial Set-Up

Field Engineer: The Field Engineer conducts the initial set-up and training of trainers in the field. Note that all deployment steps would be led by a Field Engineer at the outset. The Field Engineer would then simultaneously train the designated mhealth Specialist on replication and maintenance.

Health Experts: In the case of a CHW program, this would be a CHW Manager and/or other health experts who should help design the application health content and user workflows within the software based on clinical protocols. Health experts may also be asked to help define indicators required for reports.

Designated mHealth Specialist: Often a local staff member with an ICT background, the mHealth specialist learns from the Field Engineer how to maintain the system and will often assist with the initial training.

Dimagi, Inc.: Payment would be given to Dimagi based on a contract, depending on the type of plan. In some cases, Dimagi can be directly contracted to provide their own field engineers for initial set-up. Dimagi will also provide some remote support in the first year of deployment.

Telecommunications Provider: A regular (i.e. monthly) voice, data, and SMS plan will have to be purchased through a telecommunications company – ideally with an auto-recharge system. If available, the option to set up a “closed user group” to facilitate communication among mobile users and project staff should also be considered.

STEP

2

Other Key Players: Maintenance

Designated mHealth Specialist: Once initial set-up is complete, the mHealth Specialist will be key in ensuring technical maintenance of the CommCare system. His/her main responsibilities usually include:

Handling technical troubleshooting issues, both hardware and software Conducting trainings on CommCare Handling acquisition and set-up of new and replacement phones, solar chargers, and other technical

equipment as needed Editing and updating the application Designing and validating reports for monitoring user performance and health outcomes Providing feedback to the CHW Manager on CommCare usage and supporting CHW Manager in leveraging

mHealth system for improvement of service delivery Designated mobile worker manager: In the case of a CHW program, a CHW Manager plays

this role as the primary manager or supervisor of the mobile users. S/he ensures that the program meets the original programmatic goals. His/her main responsibilities in regards to the CommCare program usually include:

Overseeing the mobile users’ utilization of the mobile phones and applications towards health programmatic needs

Monitoring performance of mobile users and arranging for trainings or coaching by the mHealth specialist as necessary

Monitoring and analyzing data from the CommCare system to improve the health service delivery

STEP

2

Setting Up a Workspace and Application (for a CHW Program)Step 3

Setting up a CommCareHQ Workspace

Set up a workspace within CommCare HQ with a secure login and password for all appropriate users

There are two ways to start building and modifying an application to fit your needs: 1. Download an existing application from https://www.commcarehq.org/exchange/ and

modify it to fit existing needs 2. Build your own application

Tip: Because CommCare is always is changing as improvements are made, it is important to track updates that might affect the steps outlined here. An easy way to do this is to sign up for the CommCare Product Update at the bottom of Dimagi’s website: http://www.dimagi.com/.

STEP

3

For more info: https://confluence.dimagi.com/display/commcarepublic/Building+A+Blank+App+or+Starting+From+The+Exchange

The CommCare Exchange

The CommCare Exchange is an application inventory which allows you to choose any existing application built and published by another organization using CommCare

Applications on the Exchange are organized by theme (WASH, child health, maternal health) and organization

After downloading the application, you can modify the application using CommCareHQ’s formbuilder to fit your program’s needs (application content, language, multimedia, etc.)

https://confluence.dimagi.com/display/commcarep

ublic/Form+Builder

STEP

3

For more info: https://confluence.dimagi.com/display/commcarepublic/Building+A+Blank+App+or+Starting+From+The+Exchange

Note that a copy of the MVP application for maternal and child health can be found here: https://www.commcarehq.org/exchange/ae5f99ea661d4534b81462c9ffff1365/info/

Building Your Own Application

Alternatively, you can build your own application

Usually, an organization with the capacity to build an application already has familiarity with the tools or was trained by a Field Engineer

While this method gives you the freedom to design content specifically for your project, it requires careful planning and building

STEP

3

for more info: https://confluence.dimagi.com/display/commcarepublic/Application+Building

Modules: A set of forms related to one topic area, often based on case type

Forms: A series of questions and prompts the user views on the phone

Questions to be added in the forms

Note: A “case” is anything you want to follow over time – often a patient.

Building Your Own Application (continued)

The most important steps to developing an application include:1. Defining the requirements of the project

Beneficiaries, users, and data needs

2. Defining and building the application workflow Major events, modules, and forms needed

3. Defining and enhancing the application content Specific questions, skip logic, and calculations needed Develop and add in the multimedia content, job aids, instructional prompts, etc.

STEP

3

for more info: https://confluence.dimagi.com/display/commcarepublic/Application+Building

Defining the Requirements

The first step to building the application is to define the beneficiaries, users, and key functionality: Who is using the application to collect data?

CHWs, doctors, nurses, etc. What type of cases will you have?

Children, pregnant women, households, TB patients, etc. Does each type of case require a different form with a different set of

questions? Do cases need to be linked to one another? For example:

Households create child or pregnancy cases Pregnancy cases create child cases

Will the application be used primarily for data collection, or also as a job aid? What language should the application be in? What additional resources (i.e. multimedia for counseling) need to be

included?

STEP

3

Designing the Workflow

What are the CHW’s tasks during household visit? The structure of the application should reflect how the CHW performs their

responsibilities For example, if the CHW provides different services to children, pregnant women, and

the household generally, then the application modules should reflect this workflow What events should prompt the CHW to open a new case or close an

existing one? For example, a new child case might be registered when a pregnancy case is closed. Or a

child case might be closed if the child is deceased Does the CHW need the option to edit data they have entered?

STEP

3

For more info: https://confluence.dimagi.com/display/commcarepublic/General+Workflow+Suggestions

Defining the Application Content

The last step of preparing an application is to define the content: What questions will the CHW be asking? In what order do you want the questions to be asked? What questions will be mandatory or optional? What is the skip logic that will be built in (i.e. – when some questions only

appear based on answers to previous questions)? Will you require GPS tracking or location selections? What case properties will be attached to each case? What multimedia and counseling messages need to be prepared?

Tip: It is important to review application content with relevant stakeholders to ensure that the content is in accordance with local protocols and that program objectives are being met.

STEP

3

For more info: https://confluence.dimagi.com/display/commcarepublic/General+Workflow+Suggestions

Building an ApplicationStep 4

Preparing to Build an Application

Even people without experience in programming or mobile application development will find CommCare’s application builder to be user-friendly and intuitive

First, make sure that you have a project plan, work flow is designed, and application content is ready

(Optional) It may help to layout the question sequence first using an Excel template

See an example from Dimagi here: https://confluence.dimagi.com/download/attachments/5899647/commcare_definiton_template_pregnancy_checklist.xlsx?version=1&modificationDate=1323198581000&api=v2

STEP

4

For more info: https://confluence.dimagi.com/display/commcarepublic/Beginner+Tutorial

Starting out with the Application Builder

After selecting “New Application” under the “Applications” tab on the home screen, you will have the option to start with a blank application or build off of the templates available

For any project intended to follow a case over time, the “Case Management” template will be most appropriate

STEP

4

Survey: Recommended for one-time data collection

Case Management: Recommended for tracking information over time

Blank Application: Build your own application from scratch

Setting up the Application

On the Settings page, change the name of the application to suit the application’s use

Remember, this is not the name of a form or module, this is the entire application’s name

It is always important to remember the difference between a form, module, and application

A module contains forms and refers to one kind of entity for whom information is being tracked (often a type of “case”), such as a pregnant women, children, or households

Forms are questionnaires within that subset, such as registrations, visits, and edits

An application can hold multiple modules, which can hold multiple forms. A form contains multiple questions

STEP

4

Example Application Design from MVPSTEP

4MVP

Maternal & Child Health Application

Child

VisitClose

Edit

Household

VisitClose

Edit

Pregnancy

VisitOutcome

Edit

Modules

Forms

Application

Building the Application

Now that your application has a name and you have designed the workflow (modules and forms), you are now ready to build questions

Refer to https://confluence.dimagi.com/display/commcarepublic/Beginner+Tutorial+Part+2+-+Navigating+and+Preparing+the+Application+Builder for application building tips and tutorials

STEP

4

Deploying and Testing the Application

You are now ready to deploy and test the application for use. Click on “deploy” to make a new version of the application!

When testing, be sure to check: Are registration, editing, and

closing of cases working properly?

Are form questions appearing in the right order?

Are any validation conditions or calculated values working correctly?

Is multimedia appearing or playing on the phone correctly?

STEP

4

Installing on an Android Phone

In most cases, an Android phone will be used for deployment, which allows user-friendly functionalities such as:

Larger screens Touch screens Better audio and video capability

Refer to https://confluence.dimagi.com/display/commcarepublic/Install+CommCareODK+for+Android+Smartphones for installation guidelines for Android phones

Refer to https://confluence.dimagi.com/pages/viewpage.action?pageId=5636127 for installation guidelines for other types of phones, including Java and Nokia phones

STEP

4

Using the Application on the Mobile Device

Touch screen Decision algorithm Multimedia Validation rules

STEP

4

Adding Mobile Users

To set up individual workers on CommCare they have to be added to the system as “mobile users”

Mobile users can be added under the “User” tab on CommCareHQ

Each mobile worker should be given a unique username and password

The mobile worker will use this username and password to log into the CommCare application on their phone

Mobile workers can also be added to groups for reporting and supervision purposes

STEP

4

Equipment for DeploymentStep 5

Initial Equipment

The following materials are needed to run a successful mHealth project: Mobile phones Solar chargers SIM cards Screen protectors (especially for touch screens) Training materials Laptop for eHealth Specialist SD Cards (in case of corrupted SD cards)

Remember to always budget for backup!

STEP

5

Recurring Costs

Below is a list of recurring inputs essential for a successful project: Monthly data plans Monthly voice plans Closed user group for free calling among users Monthly subscription to CommCare plan

STEP

5

Training the Mobile UsersStep 6

Training Components: For Mobile UsersSTEP

6

For more info: https://confluence.dimagi.com/display/commcarepublic/Training

Topic Example Lessons

Roles and Responsibilities Responsibilities of a CHWUsing mHealth as a CHW

Basic Phone Usage Manipulating the TouchscreenHow to Recharge DataConnecting to the Network

Application Usage Logging into the Application Navigating the ModulesCase List and DetailsValidation and Display ConditionsPlaying Multimedia

Troubleshooting Forms Not SendingLosing DataApplication Crashing

Training Components: For SupervisorsSTEP

6Topic Example Modules

Roles and Responsibilities Responsibilities of a Supervisor

Basic Phone Usage Manipulating the TouchscreenHow to Recharge DataConnecting to the Network

Application Usage Logging into the ApplicationNavigating the ModulesCase List and DetailsValidation and Display ConditionsPlaying Multimedia

Troubleshooting Forms Not SendingLosing DataApplication Crashes

Interpreting and Analyzing the Data Using CommCare HQHow to Download DataHow to View Reports

Developing Custom Reports and Validating DataStep 7

Reports Development

One of the most powerful tools in CommCare is the ability to make data submissions available to program managers in real-time

All CommCare submissions can be exported in a CSV or Excel file A limited number of automatic reports for monitoring mobile user

activity are also available on CommCareHQ Data will be most user-friendly and programmatically impactful

through the development of reports. This will require defining indicators that the health program managers, the government, and other stakeholders want to monitor (ideally done during the project planning stage)

Refer to the “Data Usage” guide for an in-depth look at how to use CommCare data and build your own reports

Example reports include those monitoring: Worker activity (i.e. number of daily form submissions) Worker performance (i.e. percentage of households receiving visits, accurate

treatment of disease) Health trends (i.e. community deaths, malaria rates)

STEP

7

For more info: https://confluence.dimagi.com/display/commcarepublic/Monitoring+Your+Project

Data Validation

One key role of the mHealth Specialist and CHW Manager in the first few weeks of deployment is to ensure that data collected by mobile users is accurately reflected in reports

Comparing report indicator values to raw data exports can help:1. Identify errors in indicator definition or backend report generation2. Identify user errors preventing accurate data capture in the reports3. Validate CommCare data against other data collection tools – i.e. community vital

statistic records

STEP

7

Project & Data Quality Monitoring

The last step to deploying CommCare is to put a strong monitoring and program support system in place. Data monitoring includes reviewing data submissions to:

Ensure regular user of mobile system by users Find data entry errors in mobile user submissions Identify errors in application use Support mobile worker efficiency

Program monitoring requires protocols for: Efficiently tracking and responding to technical issues by

reported by users Ensuring proper use of mobile equipment by users Collecting feedback to identify necessary improvements to

the application, reports, or mobile user support system Incorporating real-time data-based indicators into program

decision making

STEP

7

For more info: https://confluence.dimagi.com/display/commcarepublic/Monitoring+Your+Project

Ongoing MonitoringStep 8

Program Monitoring: Ongoing Activities

Technical Functionality Health Program Functionality

The mHealth Specialist should:

Conduct continuous monitoring of data for

irregularities and troubleshoot as needed

Assist with equipment and data plan

replenishments as needed

Manage system updates

Assist health managers in accessing and using

the data from the CommCare system

The CHW Manager should:

Consume the data, and monitor and respond to

performance of the mobile user

Monitor any health content updates needed for

CommCare and request the mHealth Specialist

for support to roll out new updates

Use the data for decision-making on health

programs

Ensure that other team members are using the

CommCare system to improve health decision-

making both at point-of-care and for operations

STEP

8