CommCare is used by over 50 organizations across the globe.
Currently operating in over 30 countries across four continents.
Organizations Using CommCare
Supporters of CommCare
Projects in Africa
Pathfinder Int’l, Family Health Int’l
Started November 2008
Home-based support for HIV+ and other chronically ill patients.
Millennium Villages project / UNF
Started March 2009
Safe pregnancy promotion.
BRAC / Microsoft Research
Started April 2009
General health promotion and detection and referral for illness, promoting safe pregnancies.
Catholic Relief Services
Started June 2009
Support for Orphans and Vulnerable Children.
Started February 2010
Community-based tuberculosis case detection and follow up.
Started April 2010
Promotion of safer pregnancy and newborn care.
Projects in Asia
A pregnancy checklist application for Accredited Social Health Activists (ASHAs).
CommCare as a training and home visit support application for ASHAs.
Catholic Relief Services
A pregnancy application for ASHAs, planning to scale to approximately 285 ASHAs.
Save the Children, Hewlett Packard
Maternal and newborn health application to scale and evaluate with 70 ASHAs.
Maternal and newborn health application with potential for government uptake.
Real Medicine Foundation
Child malnutrion identification and counseling, with referral pathways.
Projects in North America
CRS & Caritas
Encouraging supportive behavior and attitude changes in new fathers.
CommCare on Android for a directly observed therapy (DOT) adherence intervention.
Boucan Carre, Haiti
Cholera surveillance with approximately 100 community health workers.
CommCare Accredited Social Health Activist (ASHA)
In 2010, we launched the CommCare-ASHA project to deploy CommCare widely within the Accredited Social Health Activist (ASHA) program in India. The National Rural Health Mission in India is training over 750,000 ASHAs, who have demonstrated the potential to substantially improve health outcomes in areas of extreme poverty, notably in maternal health. However, ASHA programs are difficult to run effectively because ASHAs have minimal training and operate independently. CommCare is especially well suited to meet the needs of the ASHA program due to its accessibility to low-literate users, and ability to scale nationally with high a degree of local customization.
Low-literate interface: Given varied literacy rates among ASHAs and their clients, we use audio clips and images to reinforce each prompt, creating a simple interface accessible to low-literate users.
Improved quality and consistency of care: CommCare-ASHA contains registration forms, prioritized checklists, danger sign monitoring, and educational prompts. We have found that included multimedia provides the ASHA with powerful tools to engage and educate clients.
Scale: CommCareHQ allows groups to deploy CommCare without engaging expert computer engineers. CommCareHQ will improve monitoring and health surveillance by collecting data from each household visit to provide real-time monitoring of ASHA activity and population health.
CommCare is expanding rapidly in India. We currently have 30 partners operating CommCare in India. CommCare is being used as the electronic job aid for frontline health workers in the large health intervention in Bihar funded by the Bill and Melinda Gates Foundation. We are integrating CommCare with MOTECH in order to create an open source mHealth platform that includes job aids for health workers, outreach to end clients via voice and SMS, and an electronic medical record system.
CommCare Tanzania Case Study
Our first CommCare projects began in Tanzania. These projects include work on TB, routine care, maternal care, family planning, and HIV. We highlight two projects here, both of which are ongoing and growing.
Home-based Care Providers: The first deployment of CommCare was by D-tree International with Pathfinder International to support their large network of home-based care providers (HBCPs). Each HBCP has a roster of clients that they visit at least once a month to provide social support and screen for clinical symptoms associated with adverse drug events or other problems requiring immediate clinical care. D-tree and Dimagi developed a module for CommCare that prompts the HBCPs through the key points of the visit and collects data that can produce the monthly reports required by Pathfinder and the government.
In June 2010, CommCare 1.0 was released and the project began to scale steadily. There are currently over 150 HBPCs using CommCare regularly, trained and monitored by D-tree staff in Tanzania. The computer science department of the University of Washington conducted a trial study on the use of SMS reminders to HBPCs to encourage them to visit their clients on schedule. The reminder system improved timeliness of visits by 85%, as reported in a paper to appear in ICTD 2012.
Action Research Center, Dodoma:
Impact and research in health and technology
Dimagi partnered with ITIDO and the computer science department of the University of Washington to support a small action-oriented research program in Dodoma, Tanzania. Our mission was to study and improve the health of the population we serve as well as study and improve the use of mobile technology for strengthening community health programs. We worked closely with nearly 35 community health workers (CHWs), each serving an average of 100 households. A staff of six Tanzanian project managers, supervisors, and nurses operated from our project office in Dodoma and developed close connections to the local government officials.
Case Study: neonatal module
Tanzania has one of the highest neonatal mortality rates in the world. With that in mind, we trained CHWs to use a new CommCare module aimed at addressing the top causes of neonatal death. The module builds off of work with World Vision in Afghanistan with USAID funding, and is based on WHO’s essential newborn care, the American College of Nurse-Midwives Home Based Life Saving Skills, and content from Hesperian foundation.
The module quickly brings a CHW through key points of identifying and responding to emergency signs, including difficult breathing, low birth weight, and hypothermia. It also provides guidelines and educational aids that promote simple but effective hygiene and preventive care to reduce infections such as infected cord stumps, pneumonia, and tetanus. Because the first 24-48 hours of an infant’s life are the most dangerous, we are focused on getting the CHWs into the houses immediately after a birth. We provide a small gift package of essentials like soap and diapers, both to incentivize new mothers to report births and to encourage good health practices.
CommCare Zambia Case Study
BHOMA (Better Health Outcomes through Mentoring and Assessments) is a large research project tasked with improving maternal and child mortality rates in rural Zambia through standardized interventions in clinic care and community health. This requires building a distributed health data capture system, designed and implemented by Dimagi and CIDRZ. This initiative faces many of the same technology challenges encountered in low-resource Africa: limited computer resources, intermittent power, and above all, extremely unreliable internet.
The BHOMA system allows a clinic to have a fully functional patient data-entry system, with local records and reports available from a simple touchscreen interface all while remaining completely offline.
Each clinic is also able to connect to the internet via a modem and the local cellular network to securely sync the records to a central server. Meanwhile, community health workers (CHWs) in the villages running CommCare on their phones can pull patient follow-ups from the server and make sure that the clinic outcomes are resolved or handled in a timely manner. CHWs also conduct household visits and make referrals that can be tracked at the clinic using CommCare.
BHOMA is part of a 5 year study aimed at improving maternal and child health through standardized protocols and follow-ups. It is being incrementally rolled out to 55 clinics in rural Zambia.
CommCare United States Case Study
Dimagi collaborated with Prevention and Access to Care and Treatment (PACT) to implement CommCareODK, CommCare for Android devices. CommCareODK currently supports PACT’s directly observed therapy (DOT) adherence intervention. The system is end-to-end HIPAA compliant and securely hosted in the cloud for easy access anywhere. CommCareODK provides in-field encounter data collection, patient information sharing, and easy access to data for care management, supervision, and quality improvement purposes.
PACT and Dimagi worked together to create a CommCareODK implementation with the following goals:
- Customize the platform for PACT’s unique forms, workflow processes and care models
- Reduce data burden on CHWs and programmatic staff
- Increase the speed and ease with which the care team can access clinical and programmatic data in the field
- Increase the “patient-centeredness” of the care team’s care coordination efforts
PACT was started by the Division of Global Health Equity at Brigham and Women’s Hospital together with Partners in Health. For the last 10 years, PACT has committed to improving health outcomes for under-served individuals by augmenting the work of clinic-based providers with Community Health Workers (CHWs). Using well-tested and standardized health promotion education, skills-building, and motivational techniques, PACT CHWs improve the health outcomes and utilization patterns among the most complex HIV/AIDS patients in Boston, most of whom are Medicaid and Medicare beneficiaries.
- Chaiyachati KH, Loveday M, Lorenz S, Lesh N, Larkan L-M, et al. (2013) A Pilot Study of an mHealth Application for Healthcare Workers: Poor Uptake Despite High Reported Acceptability at a Rural South African Community-Based MDR-TB Treatment Program. PLoS ONE 8(5): e64662.doi:10.1371/journal.pone.0064662. Website
- Palazuelos D., Diallo A., Palazuelos L., Carlile N., Payne J., & Franke M. (2013). User Perception of an mHealth Medicine Dosing Tool for Community Health Workers. JMIR MHealth and UHealth. 1(1):e2. PDF
- Treatman D., & Lesh N. (2012). Strengthening Community Health Systems with Localized Multimedia. Mobile for Development. PDF
- Chittamuru, D. (2012). CommCare: Evaluation of a mobile application for maternal health. International Association of Media and Communications Research, 2012 Conference: South-North Conversations. Durban, South Africa. PDF
- Treatman D., Bhavsar M., Kumar V., & Lesh N. (2012). Mobile phones for community health workers of Bihar empower adolescent girls. WHO South-East Asia Journal of Public Health, 1(2), 224-226. PDF
- Medhi I., Jain M., Tewari A., Bhavsar M., Matheke-Fischer M., & Cutrell E. (2012). Combating rural child malnutrition through inexpensive mobile phones. Nordic Conference on Human-Computer Interaction. PDF
- Birnbaum B.E., DeRenzi B., Flaxman A.D., & Lesh N. (2012). Automated quality control for mobile data collection. ACM DEV, 1-1. PDF
- DeRenzi B., Findlater L., Borriello G., Jackson J., Payne J., Birnbaum B., Parikh T., & Lesh N. (2012). Improving community health worker performance through automated SMS. The Fifth International Conference on Information and Communication Technologies and Development, 25-34. Website
- DeRenzi B., Sims C., Jackson J., Borriello G., & Lesh N. (2011). A framework for case-based community health information systems. Global Humanitarian Conference. Website
- Schuttner L., Zijdel W., Manda H., Shearer K., Siyingwa R., Theis M., Mwaba L., Zue C., Musatwe D., Roos D., Mwansa N., Mwalukanga M., Nyakubaya L., Stringer J.S.A., Chi B.H., & Chintu N. (2011, July). Use of mobile phone-guided community outreach for integrated primary health care and HIV services in Zambia. Poster TUPE444, Sixth IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome, Italy. Website
- DeRenzi B., Borriello G., Jackson J., Kumar V.S., Parikh T.S., Virk P., & Lesh N. (2011, May). Mobile phone tools for field-based health care workers in low-income countries. The Mount Sinai Journal of Medicine, 78(3), 406-418. Website
- Braa J., Kanter A.S., Lesh N., Crichton R., Jolliffe B., Saebø J., Kossi E., & Seebregts C.J., (2010). Comprehensive yet scalable health information systems for low resource settings: a collaborative effort in Sierra Leone. AMIA Annu Symp Proc, 2010: 372-376. PDF
- Mangilma J., DeRenzi B., Lyons J., Mrema B., Ollis S., Schaefer W., Sims C., & Lesh N. (2010, November). CommCare: a phone-based tool for home based care in Tanzania. Second International Conference on Mobiles for Development, Kampala, Uganda.
- Routen T., Silas L.F., Mitchell M., Van Esch J., Lesh N., Lyons J., & Badiani R. (2010, March). Using mobile technology to support family planning counseling in the community – case study. Third International Conference on ICT for Africa, Cameroon. PDF
- Mhila G., DeRenzi B., Mushi C., Wakabi T., Steele M., Roos D., Jackson J., Dhadialla P., Sims C., & Lesh N. (2009, April). Using mobile applications for community-based social support for chronic patients. HELINA. PDF
- Bogan M., van Esch J., Mhila G., DeRenzi B., Lesh N., & Mitchell M. (2009, April). Improving standards of care with mobile applications in Tanzania. W3C Workshop in Africa to Explore the Role of Mobile Technologies for Development, Maputo, Mozambique. PDF
- DeRenzi B., Lesh N., Parikh T.S., Sims C., Maokola W., Chemba M., Hamisi Y., Schellenberg D., & Borriello G. (2008, April). E-IMCI: improving pediatric health care in low-income countries. ACM Conference on Computer-Human Interaction (CHI). PDF