Frequently Asked Questions

We’re building open source technology for a new model of healthcare that reaches everyone, and we’re looking for partners. The community behind the CHT has been developing these tools and resources for years, but we only announced the Community Health Toolkit, CHT community, and this site in November 2018. It’s still a work-in-progress.

We hope that the responses below will give you a clear sense of where we are today. If you have more questions or would like to take part in shaping this agenda, feel free to get in touch!


In a nutshell, what is the CHT?

The Community Health Toolkit is a collection of open source technologies, open access design, technical, and implementer resources, and a forum for our community of practice. We’re focused on community health systems designed to improve the coverage, quality, speed, and equity of primary health care. The CHT is being co-created by the community as an open-source project.

What does it mean that Medic Mobile is the CHT’s technical steward?

Medic Mobile, a US 501(c)(3) public charity incorporated in the United States, serves as the technical lead and initial steward for the Community Health Toolkit open-source project. The organization contributes open-source code, design resources, documentation, and other assets, and also facilitates contributions from others.

Since 2010, Medic Mobile’s staff of a hundred implementers, designers, developers, data scientists, and researchers has supported community health systems in more than twenty countries, making the organization one of the largest implementers of digital health systems in lower income settings. Medic Mobile developed the CHT’s core application framework, and has worked closely with a number of partners to develop and deploy reference applications that build on and extend this framework. Medic Mobile has always developed free software, but the organization is now focused on supporting a vibrant community contributing to a global public good.

Why the CHT? Why now?

Plans for redesigned community health systems are underway, organizations focused on community health are growing, and community health has fully (re)entered global policy and funding discussions. We see an unprecedented opportunity to support and scale a shared, open-source toolkit that addresses key challenges faced by health workers delivering care. The CHT will serve as a public good that can be implemented and extended by an ecosystem of governments and partners.

Our hypothesis is that investing in a shared toolkit will increase efficiency, reduce redundancy in technical efforts, and provide a platform for creative extension, integration, and research. In addition, we have recognized that the need is far greater than any one organization can support through hands-on implementation. We must equip governments and a growing community of implementers to own, scale, and extend these digital community health tools themselves.

What do you mean by “new model of healthcare”?

According to the WHO, at least half the world’s population still cannot obtain essential health services [1]. Research spanning several decades shows that community health worker (CHW) programs hold great potential to improve maternal and child health outcomes in remote and underserved communities [2]. Yet several recent studies of national scale CHW programs show that inadequately trained, equipped, or supervised CHWs may have little or no impact on child mortality [3-5]. Such health systems failures drive millions of deaths annually, but software and new models of doorstep care can make a remarkable difference. The extraordinary impact of a new model of healthcare is being demonstrated by organizations around the world, such as the members of the Community Health Impact Coalition, and it is time to scale up these “outlier” results.

The software supports community health workers, and community health teams, as they deliver care in reimagined health systems – where care begins at home, services are delivered through proactive visits, and health workers are supported with offline-first algorithms, connections to health facility teams, and data-driven performance management.

Who is it for? 

Contributors to the CHT include software developers, designers, community health experts, data scientists, M&E experts, and program managers. If you’re looking to build or deploy digital tools for community health, connect with a community of practice focused on open-source and open-access tools, or advise health systems on integrating and sustaining technology for community health, then the CHT is for you!

Within health systems, the CHT supports community health workers, supervisors, nurses, and health system managers. It can also support household caregivers and patients, and integrates with other tools and data systems.

What’s the governance structure?

At present, Medic Mobile serves as the technical lead and project steward. The governance structure for the project will evolve over time to include contributing partners and CHW representatives.

What does it mean that the CHT is “full-featured” and designed for integrated care?

The CHT supports an exceptional range of features and health service areas, including comprehensive RMNCH services, Early Child Development, HIV and TB services, VMMC, NCDs, and more. The community health core framework supports this range of interventions through five highly-configurable areas of functionality: Messaging, Task and Schedule Management, Decision Support Workflows, Longitudinal Person Profiles, and Analytics. The Oppia Mobile app can be used to support learning content and quizzes, and additional functionality is available through integrations with other apps.
For broad perspective, the World Health Organization’s Classification of Digital Health Interventions outlines 87 categories of digital health intervention; each category represents a discrete functionality of a digital technology to achieve health sector objectives. Across dozens of projects, the software that powers the Community Health Toolkit has been used to support 46 of these categories of functionality, including 28 of the 32 interventions for care providers. Since the toolkit is designed for integrated care, most implementations support bundles of 10-30 areas of functionality in an integrated manner.

How mature is the technology? Is it ready for scale?

According to statistics tracked by OpenHub.net, the core of the software framework that powers the CHT is in the top 10% globally of large and highly active open source projects, with 25 developers contributing code in the last 12 months and stable or growing year-on-year contributions for over five years. The broader CHT community includes core developers, quality assurance engineers, site reliability engineers focused on deploying at scale, and application developers. This means that dozens of developers based in Africa, Asia, and around the world are making hundreds of code contributions to CHT software every single month, not to mention the many insights that designers and implementers provide.

As of November 2018, more than 24,000 health workers were using digital health interventions powered by the CHT to support care for 12 million people. Collectively, these health systems conduct over 1 million house visits per month. This makes the CHT the most widely used open source software toolkit that maintains a focus on designing for advanced community health systems.

Where’s the evidence of impact for the CHT?

One of the most distinctive aspects of the CHT community is our focus on rigorous science that spans the disciplines of global health, computer science, and human-centered design. Rigorous health systems and engineering research is absolutely vital if we are to design digital tools that not only are user-friendly, but that also can improve the accessibility, quality, speed, and equity of health services. The organizations that participate in the CHT conducted seminal studies on digital decision support (D-Tree), text messaging for care coordination (Medic Mobile), and precision performance analytics in community health (Muso and Medic Mobile). Most of this research was carried out in close partnership with ministries of health and other local partners. Much of it was conducted by academics affiliated with the leading universities whose logos you can find on our home page. In the coming months we hope to offer more information about the evidence we’ve accumulated to date, and about the ambitious R&D agenda we have underway. In the meantime, the following paragraph highlights a few key findings. 

In an early pilot study in Malawi, our disease surveillance tools were used to double the number of patients being treated for tuberculosis in a referral hospital’s catchment area [6]. The following year, an independent study of a replication site in Malawi showed that interactive text messaging was 134 times faster and four times less expensive than status quo means of submitting reports or asking supervisors for support [7]. Our decision-support technology is based on findings from a number of studies, including a cluster-randomized trial in Tanzania which found that digital decision support workflows can significantly increase quality of care [8, 9]. A recent RCT in Mali showed that using personalized analytics for precision performance management can significantly increase health worker activity, without compromising the speed or quality of care [10]. The benefits of longitudinal patient records are also widely documented, though few organizations have managed to support such systems at scale in LMIC, from the patient’s doorstep to frontline facilities. Building on these findings and rich, human-centered insights about the working lives of care providers, we have developed a unique delivery model focused on scale and replicable impact. 

Is the CHT meant to be a comprehensive list of all the tools and resources that can be used for community health? What is not included? 

We’re not trying to create a comprehensive yellow pages-style directory for community health—the CHT is a more focused project. We’re going to focus on the tools and resources that align with the CHT principles and that are needed to support our growing community of practice. Technologies that are proprietary, not open access (i.e., charge recurring user fees), or not committed to UHC and human-centered design are not a good fit.

Our main goal is to enable a broader range of implementing organizations to customize and deploy digital tools for community health in the ways that Medic Mobile and other CHT community members have to date. The Community Health Application Framework, which Medic Mobile and many others have been building since 2011, is at the center of this work. Developers who use the core framework and write application code to build custom Reference Applications are making important contributions to the CHT.

The CHT effort is also concerned with standalone tools that we’ve used in a complementary way, either to support community health services (e.g. OppiaMobile) or to integrate community health with the rest of the health system (e.g. info on DHIS2 integration).

Is the CHT interoperable with other tools and digital health systems?

Designing a community health app that integrates with the broader digital health ecosystem is a powerful opportunity to support more integrated and proactive patient care. The CHT is designed to complement standalone apps that run on the health workers’ phone, and to support more complex backend integrations.

In the coming months we plan to release more documentation about integrations with biometrics tools, a computer vision app that reads rapid diagnostic tests, electronic health records systems (such as OpenMRS), and health information management systems (such as DHIS2). If you have questions about integrations or think a tool is a good candidate for inclusion in the CHT, we’d love to hear from you!

How is this funded? What’s the sustainability plan? 

Support from many organizations and funding partners over the past decade has made the CHT possible. Looking forward, a coalition of major global health funders recently signed a pledge to invest in digital health in a manner that advances global public goods. Many funders see this approach as an opportunity to catalyze greater and more efficient government investment in digital health. As a global public good, the Community Health Toolkit is well suited to this vision of increasing cooperation and minimizing redundant technical work. As an open community, we’re featuring contributions from diverse types of organizations in a manner that will help these organizations access the funding that is being mobilized for global public goods.

Our aim here is bigger than supporting individual organizations though; we’d like to help change the funding model for the digital health ecosystem as a whole. By setting up a growing number of organizations to win digital health grants and government contracts for their own self-directed uses of and contributions to the CHT, we can nudge the digital health field in a direction that unlocks more resources without increasing fragmentation. This transition is possible in part because funders are recognizing that this is a more efficient way to channel resources, and just as importantly because the core framework that powers the CHT is mature enough that there’s a strong value proposition for developers to build on top of a shared toolkit rather than starting from scratch.


References

  1. World Health Organization. Tracking universal health coverage: 2017 global monitoring report.

  2. Ballard M, Montgomery P. Systematic review of interventions for improving the performance of community health workers in low-income and middle-income countries. BMJ Open. 2017 Oct 25;7(10):e014216.

  3. Amouzou A, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victoria CG, Bryce J, 2016. Independent evaluation of the integrated Community Case Management of Childhood Illness strategy in Malawi using a national evaluation platform design. Am J Trop Med Hyg 94 (3): 574-583. https://doi.org/10.4269/ajtmh.15-058

  4. Munos M, Guiella G, Roberton T, Maïga A, Tiendrebeogo A, Tam Y, Bryce J, and B Banza. 2016. Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso. Am. J. Trop. Med. Hyg., 94 (3): 585-595. https://doi.org/10.4269/ajtmh.15-0585

  5. Amouzou A, Hazel E, Shaw B, Miller NP, Tafesse M, Mekonnen Y, Moulton LH, Bryce J, Black RE. 2016. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial. Am. J. Trop. Med. Hyg., 94(3), 2016, pp. 596-604. https://doi.org/10.4269/ajtmh.15-0586

  6. Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and Healthcare. 2010;18(2):137–44. https://doi.org/10.3233/THC-2010-0576

  7. Lemay NV, Sullivan T, Jumbe B, Perry CP. Reaching remote health workers in Malawi: baseline assessment of a pilot mHealth intervention. Journal of health communication. 2012;17 Suppl 1(May 2012):105–17. https://doi.org/10.1080/10810730.2011.649106

  8. Mitchell, M., Hedt-Gauthier, B. L., Msellemu, D., Nkaka, M., & Lesh, N. (2013). Using electronic technology to improve clinical care – results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania. BMC Medical Informatics & Decision Making, 13(95), 1–8. http://doi.org/10.1186/1472-6947-13-95

  9. Keitel K, D’Acremont V. Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools. Clinical Microbiology and Infection. 2018 Aug 1;24(8):845-55. https://doi.org/10.1016/j.cmi.2018.04.014

  10. Whidden C, Kayentao K, Liu JX, Lee S, Keita Y, Diakité D, Keita A, Diarra S, Edwards J, Yembrick A, Holeman I. Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial. Journal of global health. 2018 Dec;8(2). https://doi.org/10.7189/jogh.08.020418