1. Deploying CommCare as an mHealth Tool

2. Key Steps 1.Planning a Project 2.Identifying Key People 3.Setting up a Workspace and Application 4.Building an Application 5.Procuring Equipment For Deployment 6.Training the Mobile Users 7.Developing Custom Reports and Validating Data 8.Ongoing Monitoring

3. 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): ACTIVITIESTIME FRAMEKEY PEOPLE Step 1: Plan the project requirements2-4 weeksGovernment*; Field Engineer, mHealth Specialist, Health Experts*** Step 2: Identify key team for implementation2-3 weeksGovernment*; Field Engineer Step 3: Set up a workspace and application1 dayField Engineer; mHealth Specialist Step 4: Build and review the application2 weeksField Engineer; mHealth Specialist; Health Experts*** Step 5: Procure and configure equipment2-4 weeksGovernment*; Field Engineer Step 6: Train mobile users and supervisors3-5 days per district** Field Engineer; mHealth Specialist; CHW Manager Step 7: Validate data and develop custom reports4 weeksField Engineer; mHealth Specialist; Health Experts*** Step 8: Monitor program and conduct continuous quality improvement (including validation of reports) OngoingmHeath 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

4. Planning a Project Step 1

5. 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+Assessmenthttps://confluence.dimagi.com/display/commcarepublic/Project+Needs+Assessment STEP 1

6. 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/

7. 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

8. Identifying Key People Step 2

9. 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

10. 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

11. 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

12. 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

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

14. 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 needshttps://www.commcarehq.org/exchange/  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/. http://www.dimagi.com/ STEP 3 For more info: https://confluence.dimagi.com/display/commcarepublic/Building+A+Blank+App+or+Starting+From+The+Exchange

15. 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 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/ae5f99ea661d4534b81462c9f fff1365/info/

16. 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.

17. 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

18. 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

19. 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+Suggestionshttps://confluence.dimagi.com/display/commcarepublic/General+Workflow+Suggestions

20. 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+Suggestionshttps://confluence.dimagi.com/display/commcarepublic/General+Workflow+Suggestions

21. Building an Application Step 4

22. 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_checklis t.xlsx?version=1&modificationDate=1323198581000&api=v2 https://confluence.dimagi.com/download/attachments/5899647/commcare_definiton_template_pregnancy_checklis t.xlsx?version=1&modificationDate=1323198581000&api=v2 STEP 4 For more info: https://confluence.dimagi.com/display/commcarepublic/Beginner+Tutorial

23. 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

24. 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

25. Example Application Design from MVP STEP 4 Modules Forms Application

26. 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+Tutoria l+Part+2+-+Navigating+and+Preparing+the+Application+Builder for application building tips and tutorials https://confluence.dimagi.com/display/commcarepublic/Beginner+Tutoria l+Part+2+-+Navigating+and+Preparing+the+Application+Builder STEP 4

27. 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

28. 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 https://confluence.dimagi.com/display/commcarepublic/Install+ CommCareODK+for+Android+Smartphones  Refer to https://confluence.dimagi.com/pages/viewpage.action?pageId=5 636127 for installation guidelines for other types of phones, including Java and Nokia phones https://confluence.dimagi.com/pages/viewpage.action?pageId=5 636127 STEP 4

29. Using the Application on the Mobile Device  Touch screen  Decision algorithm  Multimedia  Validation rules STEP 4

30. 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

31. Equipment for Deployment Step 5

32. 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

33. 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

34. Training the Mobile Users Step 6

35. Training Components: For Mobile Users STEP 6 For more info: https://confluence.dimagi.com/display/commcarepublic/Traininghttps://confluence.dimagi.com/display/commcarepublic/Training TopicExample Lessons Roles and ResponsibilitiesResponsibilities of a CHW Using mHealth as a CHW Basic Phone UsageManipulating the Touchscreen How to Recharge Data Connecting to the Network Application UsageLogging into the Application Navigating the Modules Case List and Details Validation and Display Conditions Playing Multimedia TroubleshootingForms Not Sending Losing Data Application Crashing

36. Training Components: For Supervisors STEP 6 TopicExample Modules Roles and ResponsibilitiesResponsibilities of a Supervisor Basic Phone UsageManipulating the Touchscreen How to Recharge Data Connecting to the Network Application UsageLogging into the Application Navigating the Modules Case List and Details Validation and Display Conditions Playing Multimedia TroubleshootingForms Not Sending Losing Data Application Crashes Interpreting and Analyzing the DataUsing CommCare HQ How to Download Data How to View Reports

37. Developing Custom Reports and Validating Data Step 7

38. 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

39. 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 generation 2.Identify user errors preventing accurate data capture in the reports 3.Validate CommCare data against other data collection tools – i.e. community vital statistic records STEP 7

40. 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

41. Ongoing Monitoring Step 8

42. Program Monitoring: Ongoing Activities Technical FunctionalityHealth 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