The Principles for Digital Development and Medic Mobile

Last year, a coalition of more than 300 authoritative global health institutions and UN agencies endorsed a set of nine Principles for Digital Development. We see the growing consensus around these principles as an important step forward for our field. We also see it as validation for the distinctive approach to human centered design for global health equity that we pioneered back in 2010. As the consensus document notes, these are meant as living guidelines that should inform rather than dictate design work — they leave it up to practitioners to work out the details. Here’s a look at these principles and how Medic Mobile has put them into practice.

1. Design with the user

We believe that the only way to unlock sustained impact is to put users at the center of the whole process, solve real problems for people in health systems, and create tools that people love to use. Since 2010, Medic Mobile has embraced and advocated for a holistic approach to participatory, human-centered design of complex digital health systems. Our process begins when we sit down with community health workers, nurses, patients, and community members. We view participation in design processes as a meaningful opportunity for community health workers and other frontline staff to shape the future of their own communities.

2. Understand the existing ecosystem

Technology is a tool, not a solution. We build the right tools for health workers in hard-to-reach communities and deliver these tools where needed. For a tool to be effective, it has to be made for a specific context. We consult Ministries of Health, NGO leaders, community health workers, and patients before we ever start coding.

One of the ways that we are addressing the practical challenge of incorporating the concerns of diverse stakeholders is through the use of 50 hand-drawn design cards. Each card features a different components of the healthcare system: community members, healthcare workers, places, technology, and actions involved — such as visits to clinics. These cards are a visual and tactile way to engage people in role play to help facilitate understanding of our work and imagine new ways of doing it. They invite everyone to get involved, even where language barriers are present. Learn more about our dedication to design here.

3. Design for scale

We design for scale at the beginning of our projects. For example, as part of a 5 year, USAID- funded project, we are working in partnership with the Ministry of Health in Senegal and IntraHealth to update the way information is collected and utilized to improve health outcomes. We built an integrated disease surveillance and stock out monitoring system for 1,500 facilities across Senegal. The focus from the beginning of the project was on scale and sustainability. This year, we moved their platform from our SIM App to Medic Collect on Android phones. The intention of the project is to transfer to full ministry ownership in 2017 with many steps toward this in 2016.

4. Build for sustainability

We build for sustainability and iterate quickly to build tools that will last. During the Ebola outbreak in Liberia in 2015, ChildFund, Root Change and Medic Mobile partnered to deploy mobile tools to improve efficiencies in the registration and tracking of children in need of alternative care in Liberia. This project was designed during the Ebola outbreak and much of the workflow focused on the interim care centers to capture registration information on children. As the outbreak was contained, interim care centers were quickly closed and the partners needed to be responsive and redesign elements of the program. By focusing on providing tools directly to social workers and community welfare committees, it allowed the program to be better embedded in rebuilding efforts and plan for a sustainable community engagement post-Ebola.

5. Be data driven

Collecting data in a structured and valuable way is a core component of our products. One example is the work we’re doing with dashboards for Community Health Worker (CHW) management. The Medic Mobile team designed new tools to assist CHW supervisors to effectively monitor and manage the performance of CHWs using real-time data. We provided CHW supervisors with action-oriented information for day-to-day decision making and management of programs. Dashboards identify high and low-performing CHWs, showing activity levels in the community, outcomes compared to targets, and outcomes compared to peers. Through four deployments, we have discovered that these dashboards can help address shared challenges across contexts.

6. Use open standards, open data, open source, and open innovation

As a mission-driven, nonprofit organization, we are committed to building the right tools and developing the right use cases for our users, partners, and the communities we serve. Technology should be empowering rather than intimidating. Learnings should be shared, not held tight as differentiating business intelligence. Success and bright spots should be replicated and scaled without unnecessary constraints. We strive to make all of our tools open-sourced and accessible. Want to contribute to our open-source community? Join us.

We are also committed to making our best tools accessible to small, grassroots organizations and clinics with the least resources. We know our team has limited reach, so we created a self-service, “Do It Yourself” (DIY) version of Medic Mobile. Our free and open source platform runs entirely offline and works with any computer or phone. In the past year, we developed an entirely new version of our product, tested at initial sites, established a new team, and started testing this DIY approach.

St. Gabriel’s Hospital in Namitete, Malawi, is currently testing Medic Mobile’s DIY Toolkit

Once we have fully developed our DIY Toolkit, any clinic in the world will be able to download (or receive) our software and start their own Medic Mobile program. Each clinic using DIY could equip 10–50 health workers, each covering 25–100 families — reaching up to 5,000 people per DIY download. See it in action.

7. Reuse and improve

Over the last two years, our team started seeing more Android phones in the hands of health workers and wanted to add an Android app to the Medic Mobile toolkit. We also wanted to work with existing components to save time. We built an app that extends Open Data Kit (ODK), an open-source tool, and can be easily configured for specific projects. Health workers can register people into health programs, screen for high-risk pregnancies, submit stock reports, report disease outbreaks, and more. We built these apps faster and more sustainably because of tools built by a dedicated ODK community. A true test for “Medic Collect” surfaced after the earthquake in Nepal earlier this year. We were able to quickly deploy a disease outbreak surveillance system with the health workers’ Android phones and SMS, thanks to our work reusing and improving ODK’s tool.

8. Address privacy and security

Medic Mobile is committed to data security. We follow the data protection standards set by the Ministry of Health or our in-country implementing partner, as appropriate. We recognize the security benefits and drawbacks of different technology tools, and work with our partners to make the best choices and mitigate risk.

Discussions of privacy and security concerns are often thick with technical jargon — making these conversations inaccessible to beneficiaries and stakeholders who can be illiterate. To make equity, fairness, privacy, security and respect for different voices work in practice, we go beyond technical and text-driven means of communicating, to also engage more visual and tangible modes.

Medic Mobile and Living Goods partner to build an Android app for health workers in Uganda

9. Be collaborative

We were featured this year in Forbes article, How Successful Partnerships will Fuel Agenda 2030. Our tools are always deployed hand in hand with partners in the field. We work closely with these partners to select, deploy and sustain mHealth tools focused on improving access, adherence, and quality of health services in their communities. Working with implementing partners allows us to learn about unique contexts and improve our tools for different settings. This model is key to the long-term integration of mobile tools into health systems. By working alongside these partners, we’ve expanded to 23 countries across Africa, Asia and Latin America.

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