The Global Digital Health Forum (GDHF) is a celebrated event in the Dimagi calendar, as we look forward to the opportunity to participate in transformative digital health conversation each year. This year we are thrilled that for the first time since COVID-19, the Forum will offer both an in-person and virtual experience, with the theme of ‘Driving Effective and Equitable Digital Health Innovation’.
We are once again honored to have representation from various team members, and we look forward to sharing our experiences and learnings in working with partners towards our vision of a world where everyone has access to the services they need to thrive. A theme for many of our presentations this year is ‘improving Frontline Worker jobs to improve health outcomes’, which is a key component of our recently released five-year strategy to achieve high-impact growth.
Dimagi Happy Hour
We will be hosting a happy hour Monday December 5, from 8 – 11pm within walking distance of the conference venue in Arlington, VA. We would love to see you there. Sign up to attend here.
Presentations & Sessions from Dimagi
Here is a rundown of a few of the sessions we’ll be participating in for 2022:
Is the Digital Health Community Creating Better Jobs for Users? – Jonathan Jackson, CEO and co-founder and Gillian Javetski, Chief of Staff
At Dimagi, we spend significant time designing digital tools with our users, primarily community health workers (CHWs). It’s why we like to think that “Design with the User” is the first Principle of Digital Development – because it’s the most important.
Satisfying users is by no means unique to our industry. Silicon Valley often talks about how technology should “delight” customers. But unlike TikTok, we limit our efforts to build user loyalty to the design stage, despite best practice. A major customer service study had one takeaway for customer service strategies: “Delighting customers doesn’t build loyalty; reducing their effort—the work they must do to get their problem solved—does.”
This is not a radical idea: digital tools can make jobs better for users by reducing their effort, and worse by increasing them. And while there is growing recognition that CHWs in LMICs are overloaded, under-appreciated, and underpaid, our community lacks common standards to measure digital tools’ impact on users’ jobs. By running digital programs that increase organizational productivity but make users’ jobs worse, we are exacerbating CHWs’ challenges without recourse. Users often don’t have a choice about which tools they use, or how. And while users may help design tools, projects often aren’t structured for them to give feedback later.
We can do a lot to protect CHWs by reducing their personal efforts. In this workshop, we are excited to dive into this topic in greater detail and work together to collectively define a hypothetical 10th Principle for Digital Development: “Make the user’s job better.”
Avoiding Tragedy of the Commons: Open Source Governance Models – Mary Rocheleau, Director of Technology Solutions
Software Global Goods are by definition Free and Open Source Software (FOSS) packages, maintained by stewarding organizations, teams of volunteers or individual contributors. Ensuring that those software projects are maintained to a technically high standard is necessary to provide strong protections for the sensitive health data being collected and stored. However, keeping the software up to date, including adopting security best practices, addressing technical debt and ensuring that the code is easy to contribute to for all members of an open source community, is critical but often overlooked. One way to address these challenges is to consider a Software as a Service (SaaS) model, unlocking long term software maintenance activities while running and sustaining an open source community.
This panel will explore the governance models around both SaaS and Open Source communities, considering Global Goods at different points along this journey. We will discuss key considerations when moving from a proprietary codebase into an open source model, and how to cultivate a community of implementation organizations working with and around an open source software project. We will explore staffing models which benefit being both a sustainable business and also a responsible open source community. In addition, we will consider how to avoid common issues which may occur when open source communities aren’t incentivized to address software and operational sustainability.
The Model is the Message – Advances in AI portend a dangerous future for digital equity unless we can find our voice – Clayton Sims, Chief Technology Officer
You’re probably not surprised to hear what the cutting edge DALL-E1 image generator AI spits out to visualize “Lawyer.” Six remarkable photorealistic images of older white men.
Implicit bias in AI technologies isn’t exactly breaking news. Authors of prominent AI systems frequently share public examples of the limitations of the tool they’ve built, along with the work they are doing to improve them. In fact, based on those efforts a newer version of DALL-E2’s output includes a woman among the imaginary attorneys.
It’s great that DALL-E2’s model now knows that women can be lawyers. What it still doesn’t know, though, is what an ASHA looks like. Not just by diversity of demographics, the AI/ML model doesn’t know what an ASHA is at all.
No careful training can overcome the fundamental limitation of AI systems. What these remarkable AI’s are capable of depends on what excesses of data are produced in overwhelming magnitude by unrelated market actors. We should expect it to be as realistic to shape into a specific purpose as it would be to insist that toothbrushes be made of silver.
For the populations worldwide who are underserved by consumer technologies today, the incorporation of AI tools risks a spiraling feedback loop placing value further and further away. As AI capabilities become more integral, readily-available context relevant datasets have become a form of scarce infrastructure like power, water, or connectivity.
In this talk we will present some of the unexpected ways that the ongoing incorporation of AI systems may impact equitable access to digital technologies, whether they are adopted by digital health programs or not. We will also outline some of the ways that practitioners can prepare for these impacts, and how the industry as a whole can plan ahead to avoid getting left behind.
How Digital Solutions Can Help Scale & Support Mental Health Care in LMICs – Lauren Magoun, Senior Health Strategy Specialist
There is a staggering unmet need for mental health care and it is intertwined with almost all other global development goals. These conditions are common – and at any time nearly 1 in 8 people have one – and yet 75% of people living with depression (one of the most common conditions) in LMICs receive no treatment at all. The COVID-19 pandemic further increased rates of anxiety and depression, and even those without diagnosable conditions have felt strain in their mental well-being. Thankfully, there exist effective treatments for common conditions like anxiety and depression that don’t require specialists, who are rare in much of the world.
This session will describe why and how Dimagi is developing digital solutions to improve mental health and psychological wellbeing in Lower- and Middle-Income Countries (LMICs). It will cover how digital solutions can support improved outcomes by helping those delivering care, improving program operations, and supporting clients themselves.
In this session, we will outline digital solutions we have developed, or are in the process of developing, that support the scaling and effectiveness of mental health interventions, in particular those led by non-specialist providers such as CHWs, ASHAs or peers. We will review how the open source CommCare platform can support such programs, explain an innovative tool for peer-supervision we developed using CommCare for EMPOWER – a Harvard Medical School initiative to scale the mental health workforce, where we are a technical partner. We will also discuss a client-facing chatbot, PracticePal, to help clients practice CBT-based and other well-being and self-care techniques as part of their care between sessions with their providers.
Overcoming critical digital transformation challenges in community health programs; Lessons from Ethiopia’s eCHIS implementation – Jonathan Jackson, CEO and co-founder
This Pre-formed Panel will be moderated by Leona Rosenblum, Deputy Director of the Center for Digital Health at JSI, who has been providing backstopping support on eCHIS development and implementation for multiple JSI projects in Ethiopia. She will introduce the session by presenting the eCHIS journey from its inception to the current stage of implementation. A panel of four diverse contributors mainly from the MOH, donors, and implementing partners will give 5 minutes presentations summarizing ongoing interventions and results in each of the following topics:
- Digitizing the community health information system: MOHʼs vision, programmatic goals, current challenges, and way forward (Dr. Ruth Nigatu, Chief of Staff – Office of the Minister of Health
- Addressing scale induced platform and technology complexities: Dimagiʼs approach to eCHIS technology support (Jonathan L. Jackson, Dimagi CEO)
- Learnings from the implementation of Electronic Community Health Information System at Scale (Dr. Loko Abraham, Chief of Party of the USAID Digital Health Activity in Ethiopia implemented by JSI Inc)
- Aligning donor investment for digital systems based on programmatic goals: CIFFʼs approach (Dr. Mihretab Salasibew, Director, Evidence, Measurement & Evaluation, CIFF)
The Digital Leapfrog: Using a suite of open-source tools to influence a national digital health strategy – Namrata Tomar, Project Manager
Digital transformation in Tajikistan and Central Asia is an under-explored field, as the region has not historically received significant investments in health information systems or digitization. This pre-formed panel explores what it takes to deliver a comprehensive, user-driven and data-driven digital strategy for a project in an area where digital literacy and investments are limited. It also gives an overview to the audience of the multi-platform approach taken in the USAID-funded Healthy Mother Healthy Baby (HMHB) Activity wherein the DHIS2 <> CommCare integration has been leveraged.
The USAID-funded Healthy Mother Healthy Baby (HMHB) Activity makes sustainable improvements for the Government of Tajikistan to deliver quality maternal and child health and nutrition services, and improves health outcomes in Tajikistan through digital transformation. The Activity also builds technical capacity, leadership, and management while creating a path towards country-wide digitalization and policy reform.
HMHB uses a suite of open-source in CommCare to strengthen capacity and program delivery and uses DHIS2 to make data-informed decisions at all levels (facility, community and household). It also uses data to guide implementation plans and strengthen health worker capacity by ensuring the right tools, information, and resources are readily available. USAID’s DHIS2-CommCare solution aims to eventually connect communities with their data to increase utilization. There are 1,049 users of the applications, 4,895 Healthcare worker beneficiaries, and 1.96 million indirect beneficiaries in the implementation area.
The session will dig into how Dimagi collaborated with Abt Associates to apply Principles of Digital Development to design a suite of digital tools responding to the Ministry of Health and user needs. Abt will share about the impact of deploying CommCare and DHIS2 and how this formed part of a broader digital strategy. The Ministry of Health representative in Tajikistan will share how HMHB’s efforts inspired a broader review of the country’s national digital health priorities.
When there is no word for _____ – Lilianna Bagnoli, Associate Director of Delivery
By 2030, we predict a shortage of 18 million health workers. And in some countries, there’s a risk that 20% of today’s health workers will drop out of the workforce in the next two years. A large contributor to this problem is burnout, and it is rampant among health workers. Of course, burnout is bad for health workers themselves, but it is also detrimental to patient care and workforce turnover. We have a real problem: we need more health workers, but we aren’t confident that we can retain the ones we have today. In general, we need to focus more on the problem of burnout. There is a need to try out different approaches, and share what we learn. In this lightning talk, the speaker shares Dimagi’s work on resilience, one promising and evidence-based approach to counteracting burnout.
This lightning talk features learnings from adapting a resilience message program for health workers in India, Brazil, Rwanda, Nigeria, Uganda, and Mexico. Across these countries, most health workers speak a language where there is no direct translation for complex topics like “resilience,” “stress,” and “mindfulness”. When there is no word for these concepts in a target language, how can we communicate critical resilience building skills? And how do we design resilience-building content that really resonates with health workers? In this session you will learn more about how Dimagi and its partners are adapting resilience building programs for health workers in low- and middle-income countries.
What if we stopped using digital tools to give people information? – Gayatri Jayal, Director of Consumer Innovations
When it comes to digital health solutions such as mobile applications or chatbots for LMICs, our focus as a sector seems to rely heavily on the goal of “giving people information”. Yet evidence from JPAL and other literature shows that information is not sufficient to motivate people into action, for example adopting a specific health behavior. In this lightning talk, I will use the example of family planning as a health area to illustrate the challenge, and use 3 techniques Dimagi has developed to shift from “giving information” to people in LMICs to “mobilizing action”. Using Guttmacher data for East and West Africa and the latest National Health Family Survey from India, the talk will highlight how people in LMICs often have good knowledge about family planning options but don’t adopt contraception for reasons other than a lack of knowledge.
The talk will then show the lack of digital health tools that seek to address social, economic and cultural barriers to FP adoption. Next, the talk will highlight 3 techniques Dimagi has implemented and evaluated in 2022 to drive positive health behaviors.
- Using a persona or avatar to help engage target clients (Dimagi’s work with Pathfinder India 2022)
- Using a topic like personal financial planning to get people engaged with family planning (Dimagi’s RCT results proving people’s increased interest in family planning when using this method)
- Using formats like quizzes and channels such as Facebook and others to achieve cost-effective scalability (Dimagi’s results in India).
- The talk will end with a call to action to organizations in our sector to move beyond “giving people information”- and to consider what our digital tools would look like if we as a sector focused instead on breaking down barriers to adopting health behaviors.
Expanding the gender-equitable use of chatbots in LMICs – Gayatri Jayal, Director of Consumer Innovations
There is lots of enthusiasm in our sector today about chatbots for women in LMICs, for example for maternal and child health, antenatal and postnatal care, family planning and a variety of other health areas. However there is little evidence to show the efficacy of these chatbots in driving positive health behaviours, and even less evidence to show these chatbots are reaching their intended audience- i.e. women in LMICs. This talk will seek to improve our sector’s collective understanding of who we can easily reach via chatbots in LMICs, who is left out and why, and how we can extend the reach to such audiences. I will illustrate the problem using the latest GSMA 2022 Mobile Gender Report, which highlights that the benefits of owning a mobile phone are not equally felt by men and women. As per this Report, a significant proportion of smartphone owners do not use mobile internet, particularly women. Awareness about mobile internet remains a significant initial barrier to mobile internet adoption. I will make the argument that any work on chatbots must address substantial gender gaps in access to technology.
The talk will highlight 3 different categories of target chatbot users:
- Women who have a smartphone but aren’t skilled in using it.
- Women who have some access every day to a household phone (i.e. a shared phone).
- Women who have no access to a phone. For each category, the talk will highlight examples of Dimagi’s chatbot work in India, East Africa and West Africa, with partners such as USAID, BMGF and others, to demonstrate proven techniques to improve equitable access to chatbots across these three groups.
- I will end with a call to action to the creators and funders of chatbots to design, launch and evaluate chatbots in a gender-equitable manner.
Digital Health for All – Welcome & Keynote – Rowena Luk (panelist), Chief Connector
To kick off GDHF this year, there will be a panel discussion with digital innovators who have successfully led the deployment of digital health systems at large scale. Panelists will reflect on what was learnt on the journey to scale and what comes next. Some of the other questions they will speak to will be – How can digital health programs that have achieved national adoption ensure that they are improving care even to the most remote and marginalized communities? How do we know whether we are making progress towards health equity for all, rather than exacerbating the digital divide? This panel will be an interactive one, and you are encouraged to bring any questions along for discussion.
We look forward to seeing you there!
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