From MIT: Continuing CommCare in Togo

This blog post was written by MIT students that are implementing a CommCare project in Togo through the organization Globe Med.  The blog post below was originally featured on MIT Globe Med’s website.  It was written as part of a blog series of Globe Med’s work using CommCare this summer, CommCare blogs, followed by another set of blogs from the original implementing group of MIT students this past spring. 

After arriving in Togo last Thursday and spending the weekend getting acquainted with the clinic, this week we began working on our CommCare project at Association Éspoir Pour Demain (AED)! To begin, I would like to introduce myself. My name is Kristen and I am a rising junior at MIT. This summer, I am spending 10 weeks in the north of Togo working with my teammates Maggie (another rising junior at MIT), Emma (a 2014 MIT graduate), and Alicia (another 2014 MIT graduate) on the roll-out of CommCare, a mobile health platform designed to facilitate the collection and transfer of patient information. We are all members of a student group called GlobeMed, a national organization that partners university chapters with health focused organizations around the world. GlobeMed fundraises for our partner throughout the year, then sends a group of students to Togo over the summer and January term to implement projects.

GlobeMed at MIT’s partner is Hope Through Health, a US-based nonprofit that supports a system of HIV clinics centered in Kara, Togo. Together, the clinics are called Association Espoir pour Demain (AED), which in French means Society of Hope for Tomorrow. AED, currently the only provider of comprehensive HIV care in the northern part of Togo, delivers treatment for ~2,000 patients and provides the surrounding community with services such as the Orphan and Vulnerable Children Program, the Prevention of Mother to Child Transmission Program, and Psychosocial Counseling. AED relies in part on its Community Health Worker program to ensure every patient is receiving adequate care. Through this program, trained members of the local community act as medical liaisons—visiting patients in their homes to check-up on them, help them understand their condition and ensure that they know how to take care of themselves effectively.

One of the challenges that AED is currently faced with is how to efficiently access and evaluate the information Community Health Workers (CHWs) gather on home visits. A pregnant woman, for example, might be visited by her CHW every month throughout the duration of her pregnancy. By the time she gives birth, her CHW has created a detailed timeline of her condition and symptoms. But as it is now, very little of the information ever reaches the CHW Director and medical professionals at the clinic. Rather, all the information is handwritten by the CHWs in notebooks and submitted to the CHW Director at the end of each month for review. With over 200 patients receiving home visits, converting the information contained in notebooks into a useful form is nearly impossible and much of it is never referenced again. If this information were more accessible, it could be used to help facilitate patient follow-up and arrange additional care for patients with concerns.

Similarly, patients who have just started anti-retroviral (ARV) medications are visited by CHWs for the first several months of their treatment. At each visit, the CHW records the patient’s CD4 count and any other relevant medical observations or statistics in his or her notebook. In the early stages of ARV treatment, it is not uncommon for patients to experience significant side effects with a particular ARV regimen; often the drugs need to be adjusted before they work well for that particular patient. The amount of time that it takes to establish a treatment regimen that works for a particular demographic of patients could be calculated and improved if medical professionals were able to immediately examine the data collected by CHWs on their visits. But currently, given the lack of formal data collection and analysis, this sort of information is essentially inaccessible.

To help address these challenges, our goal this summer is to implement a mobile health system that will allow the clinic to:

1)   Utilize aggregate data for monitoring and improvement purposes

2)   Incorporate CHW-gathered data into patient medical records

Over the past six months, GlobeMed at MIT has been exploring CommCare, a mobile health platform that allows users to easily create complicated forms to be filled out via mobile phones. The administrator builds forms using the CommCare HQ website. At each home visit, the CHW submits the CommCare form that is applicable to that particular patient, and when the phone has 3G service or access to a wireless connection, it uploads the data to the server. Once the form is uploaded to the CommCa  re server, clinic staff can download this data in the form of excel spreadsheets and use it to perform analysis. The forms are capable of complex logic; they can be written so that if you answer that the patient is up to date on vaccinations, for instance, it will not ask which vaccines she is missing. The forms can also utilize and reference data from previous form submissions. So, if a patient needs a CD4 test every 6 months, the form will only remind the patient of his next visit if it is within the next 2 months. Additionally, forms can also be designed to include pictures and videos for educational purposes.

The CommCare project was initiated here at AED last January, when a group of three students from GlobeMed at MIT traveled to Kara for four weeks during our January term. They were able to convert all twenty of the paper forms in use at the time into CommCare forms, and provide basic training for all the CHWs at the main clinic in Kara on how to use Android phones and the CommCare application. With limited time and only one phone, however, they were unable to launch the program to its full potential. Over this past semester we obtained a generous donation from Mozilla of 16 Android phones, which we will be setting up and leaving with the CHWs at the clinic. We have also worked as a team to complete two manuals, one for the CHW Director describing how to build forms on CommCare HQ, and one for the CHWs describing how to use the phones and the CommCare application. For the summer, we have three primary goals:

1)   Streamline the forms to eliminate redundant questions and improve data flow to enable regular review and analysis (the forms were essentially transcribed from existing paper forms, and thus can be made more efficient in a digital version).

2)   Train all CHWs to ensure they are comfortable using the Android phones at their patient visits and that they fully understand how to use the CommCare application and complete each of the forms. Additionally, we want to ensure the CHWs understand why we are using CommCare and how it can help make their jobs more effective.

3)   Work with the CHW Director to help her gain mastery of the CommCare system so that she will be able to create new forms and modify existing forms after we leave. Our project will only be useful if the clinic staff have the ability to adapt the system to meet the clinic’s changing needs.

At this point, things are still in the early stages, but we are all very excited to be here and can’t wait to get started. Check back here throughout the summer to see how we’re progressing!