Ensuring healthy lives and promoting well-being at all ages is essential to sustainable development. In 2017, approximately 462 women died per 100 Thousand live births from preventable causes related to pregnancy and childcare. An estimated 3000 children out of 100 Thousand live births died majorly from avoidable causes. Most of these deaths occurred in low and lower-middle-income countries that face an acute shortage of healthcare professionals. Community Health Workers who can help improve maternal and child health are overburdened with paperwork and cannot focus on service delivery. They lack targeted identification and task tracking ability that could help them improve the quality of service. Dimagi has created a Precision Supervision Framework in CommCare. The Framework allows field workers to get much-needed help from a job-aid tool that helps them better track individual beneficiaries and daily tasks. It also enables adherence to consistent care protocols, thus improving the quality of service delivery. The application is meant to be used by two types of field workers. The first ones are the Community Health Workers , who provide services to pregnant women, mothers, and children. The others are the Supervisors, who oversee the day-to-day activities of CHWs and give guidance to CHWs to help them perform better.
The Precision Supervision applications are created as part of a reference framework in CommCare that enables CommCare users to create data-driven tasks for health workers and supervisors. These applications allow more effective performance management, optimizes time spent on the most vital life-saving tasks, and ultimately improves key health metrics and outcomes. The CHW application has been designed to feature prioritized tasks lists in the CommCare app allowing CHWs to view their list of tasks, ordered by priority. Apart from this, the system automatically sends monthly reminders to the beneficiaries about the options they can use to request a visit from CHW in case of any medical emergencies. The supervisor application includes functionality and interfaces for CHW supervisors. It allows supervisors to manage their CHWs, analogous to how the CHW app helps a CHW manage their clients. It is oriented around a list of tasks, each directing the supervisor to discuss a specific topic with one of their CHWs. The solution also offers effective performance management and capacity building workflows for the users.
The reference applications have been built on top of an existing CommCare application that involves home based care. The CommCare Tasking Reference Framework consists for the following three reference applications:
This application is created as part of a reference framework in CommCare that enables CommCare users to create data-driven tasks for both health workers and supervisors in order to drive more effective performance management, optimize time spent on the most vital life saving tasks, and ultimately improve key health metrics and outcomes. The reference application has been designed to feature prioritized tasks lists in the CommCare app where CHWs can view their list of tasks, ordered by priority. Each task will include:
Name of client
Reason for contacting client (a short phrase)
An indication of the urgency: [ offer distinction between ‘low priority’ ‘high priority’ and ‘ ‘Emergency’ follow ups
Ability to click to initiate a call to the client
Whether the visit should be ‘in person’ or remote via voice
This page outlines the workflow for the CHW Tasking reference application that is built to support CHWs in their job supporting maternal & child health initiatives. It highlights the high level components of the application to provide the reader an idea about the basic structure of the application.
Application Workflow
Location Hierarchy
App Personas
Demo
Click here for a demo of various use cases in Precision Tasking CHW Application Workflow.
Technical Design
To see the technical design of this solution, please click the section below.
Purpose of the Document
This document outlines the technical designs of the application that is built to support CHWs in their job supporting maternal & child health initiatives.
Introduction
The reference application will feature prioritized tasks lists in the CommCare app where CHWs can view their list of tasks, ordered by priority. Each task will include:
Name of client
Reason for contacting client (a short phrase)
An indication of the urgency: [ offer distinction between ‘low priority’ ‘high priority’ and ‘ ‘Emergency’ follow ups
Ability to click to initiate a call to the client
Whether the visit should be ‘in person’ or remote via voice or SMS
Per the feedback received for phase 1 of the application, the logic for creation of Tasks in the system was redesigned to have all the ANC tasks and PNC tasks created at once during registration of Pregnant women and while the delivery is recorded respectively.
The reference application will include functionality and interfaces for CHWs. The CHW app will be oriented around a list of tasks, where each task directs the CHWs to discuss a certain topic with one of their clients or to call an end client if needed (Eg emergency follow ups).
This application assumes that one CHW is assigned to one location.
Design
Location Hierarchy
Modules/Menu
Menu Name
Description
My Tasks
Case list contains a list of tasks assigned to the CHW based on priority (low, medium, high). Each list item contains a general description of the tasks like task-type (follow-up/home-visit), client-name, urgency , due date, expiration-date etc.
Tasks will be sorted based on the due date. Sorting would be based on urgency, followed by due date and expiration-date.
Each Task will lead to a form, submission of the form will lead to creation of new tasks or closure of the tasks (depending upon the outcome of the task).
The type of various tasks are as mentioned below:
ANC: Upto a maximum of 4 ANC tasks will get created for the pregnant woman depending on the number of days passed since LMP.
PNC: Upto a maximum of 2 PNC tasks will get created for the mother post her delivery depending on the number of days passed since the Actual Date of Delivery.
URGENT ANC: This task will be created for a pregnant woman if she is exhibiting danger symptoms.
URGENT PNC: This task will be created for a woman, once she has delivered a child and is exhibiting danger symptoms.
CHILD CARE: This task will be created for a child who is exhibiting symptoms.
List of Beneficiaries
The case list will contain the list of pregnant women registered in the app and clicking on the pregnant woman will lead to a sub menu which contains the list of children registered for the pregnant woman and the Edit Woman Details form.
Clicking on the Child sub menu will display the list of children registered for the Pregnant Women and a child can be registered using the “Register Child” option available in the case list.
My Performance
This menu will contain an option to “Click here to view performance” and upon clicking on the link, the case detail will contain graphs that will display the individual CHW performance and the graphs will be representing the list of metrics for the last three months:
Pregnancies Registered
Sick Child Follow-ups
Total Tasks
Total ANC Tasks
Total PNC Tasks
Apart from the individual graphs mentioned above, this menu will also contain a tabular representation of the above metrics.
Important Note: This menu leverages the auto case closure workflow defined here.
Case Structure
Case Type
Short Description
Parent?
Child?
Host?
Extension?
Case created in form
Case Updated in form
mother
Saves details around mother’s demographic and other health related information
NA
child
task
Register Woman
Edit/Remove Woman Details,
Pregnancy Followup Form, Delivery Follow up form, Record Delivery, Delivery followup, Pregnancy Urgent Follow up, Delivery Urgent Followup
child
Saves details of the child as a result of pregnancy . The information is mostly around overall health of a child during a set amount of time
The D2C Tasking Reference application has been built to support beneficiaries by providing a way to directly interact with CommCare in order to initiate a visit during pregnancy or post delivery of the child. This is in association with the CHW Tasking Reference Application which is build in order to track pregnancies, post-delivery follow-ups and child care. This page highlights the high level design considerations that have been used to design the application.
The D2C Tasking reference application has been built to allow the beneficiaries to perform following operations:
Initiate a Task with task type as “urgent”
General FAQs/guides for beneficiaries during pregnancy and post-delivery
The following section outlines the high level workflows for the D2C Reference Application
Assistance Workflow
Keywords
Keyword
Function
Hi
This keyword is mostly meant to ensure that the beneficiary is able to communicate with the CommCare server.
The message replies with a confirmation/greet message , followed by keyword to be used for next step
FAQ
This keyword is intended to provide the beneficiary with general health and nutrition related information
Based on the beneficiary’s choice, this keyword provides links and videos which they can use to understand about a certain topic in more details
Help
This keyword is intended to provide the beneficiary to request an immediate visit by a CHW in case someone beneficiary or her children are showing any symptoms.
The beneficiary can raise an urgent visit upon a confirmation from CHW
A beneficiary can request only one urgent visit at a time
Location Hierarchy
App Personas
Technical Design
To see the technical design of this solution, please click the section below.
Purpose of the Document
This document outlines the technical designs of the application that is built to support beneficiaries by providing a way to directly interact with CommCare in order to register themselves in CommCare or initiate a visit during pregnancy or post delivery of the child. This is in association with the Precision Tasking CHW app which is build in order to track pregnancies and post-delivery follow-ups
Introduction
This document will outline the technical design considerations that would be applicable for a D2C application which would be available for the beneficiaries to perform following operation
Initiate a Task (Urgent ANC/PNC or Child Care)
General FAQs/guides for beneficiaries during pregnancy and post-delivery
Design/Workflows
App Personas
Location Hierarchy
Technical Implementation
Keyword
Function
SMS Content
Case Created
Case Update
Hi
This keyword is mostly meant to ensure that the beneficiary is able to communicate with the CC server.
This Keyword helps the user to get to know the available options which she can use as part of this project
Hello!! Welcome to Goldsmith SMS Chatbot .
Reply with :
'Help' to request a visit
'FAQ' to access the FAQ section.
NA
NA
FAQ
This keyword is intended to provide the beneficiary with general health and nutrition related information
Based on the beneficiary’s choice, this keyword provides links and videos which they can use to understand about a certain topic in more details
Please type the number
corresponding to category in
which you are seeking
Exclusive Breastfeeding
Child Activity Levels
Lactating Mother Nutrition
Family Planning
SAM/MAM Child Counselling
Kangaroo Mother Care
Complementary Feeding
NA
NA
Help
This keyword is intended to provide the beneficiary to request an immediate visit by a CHW in case someone beneficiary or her children are showing any symptoms.
The beneficiary can raise an urgent visit upon a confirmation from CHW
A beneficiary can request only one urgent visit at a time
If no tasks pre-exists for beneficiary:
Thank you **<Mother Name>** your request for **Urgent Visit** is noted and a CHW will follow-up with you before **<Follow Up Expiry date>**
If a task pre-exists for beneficiary
An Urgent Visit exist for you and a CHW will conduct a follow-up before <Follow Up Expiry Date>
The Supervisor Tasking Reference Application includes functionality and interfaces for the CHW Supervisors. The CommCare app is designed help Supervisors manage their CHWs, analogous to and linked directly to how the CHW Tasking Reference Application help a CHW manage their clients. The supervisor app is oriented around a list of tasks, where each task directs the supervisor to discuss a certain topic with one of their CHWs or to call an end client if needed (Eg emergency follow ups). Each supervisor task will include:
Name of CHW / Name of the Task
Reason for contacting CHW (a short phrase)
An indication of the urgency
Suggest ‘in person’ or call for the task
This page outlines the workflow designs of the application that is built to support Supervisors in monitoring CHWs in their job supporting maternal & child health initiatives. The following sections highlight the high level components of the application to provide the reader an idea about the basic structure of the application.
Supervisor Tasks Escalation Workflow
Location Hierarchy
App Personas
Demo
Click here for a demo of various use cases in Precision Tasking Supervisor Application Workflow.
Technical Design
Purpose of the Document
This document outlines the technical designs of the application that is built to support CHWs in their job supporting maternal & child health initiatives
Introduction
Per the feedback received for phase 1 of the application, the supervisor application was redesigned to have 4 menus as described in the following table, to address the problem statement given below:
The reference application will include functionality and interfaces for CHW Supervisors. The CommCare app will help Supervisors manage their CHWs, analogous to and linked directly to how our CHW apps help a CHW manage their clients. The supervisor app will be oriented around a list of tasks, where each task directs the supervisor to discuss a certain topic with one of their CHWs or to call an end client if needed (Eg emergency follow ups).
This application assumes that one CHW is assigned to one location.
Modules/Menu
Menu Name
Description
Tasks
This menu will contain a consolidated list of tasks assigned to the supervisor, which may include the following:
missed priority visits, e.g. if a CHW did not complete a task and the task expired
underperforming CHW (missed target), e.g., a CHW that has been inactive for 30 days, or late on tasks, missed target for number pregnant women registered in last 30 days
suspected over prescription or similar: we will create an example from our CHW workflow, such as registering more than 20 pregnancies in one month.
severe performance warning, e.g., a CHW that has no activity for 30+ days, or task completion rate below 20%. CHW has failed to meet the minimum performance standard.
Business Rules:
To view the most updated list of tasks, refresh task list button will need to be pressed, from the bottom of the task list
The CHW missed priority visits are due/ not completed high priority tasks flagged from the chw app in the supervisor app through case sharing.
Once a CHW missed priority visit is followed up on, it will stop showing in the supervisors case list for the next 5 days. If the task is completed within 5 days it will not appear in supervisors task list, else after 5 days it will reappear in the task list for the supervisor to follow up on the task again
The sorting logic is as follows:
Primary sort is based on task type. The decreasing priority is CHW Inactivity, CHW Late visits, CHW Low Task Completion Rate, CHW Registration Limit Exceeded, CHW Performance Monitoring and followed by Missed Priority Visits by CHW . Within Missed Priority Tasks the priority decreased as Urgent Tasks, Urgent ANC, Urgent PNC, Child Care, ANC and PNC.
Secondary sort is based on due date. Sort order is descending based on the number of days since the task had been due.
Tertiary sort is based on priority of the task. High priority tasks are above Medium priority task, followed by low priority task
All tasks will lead to a task follow up form which can be used to record the basic reason for following up with the CHW, outcome of the task.
If the outcome of the task is positive, Once the form is submitted , the task will be completed and will no longer appear in the task list for the supervisor.
If the outcome of the task is incomplete, the task will remain open and the due and expired date will be incremented by 5 days.
The CHW Performance monitoring task is a task which is always open until it expires, and this task directs the supervisor to visit the chw performance module in the app.
Once the task is accessed and the form is submitted, the task due and expiry date are incremented by 5
If the task expires, on form submission, the task will get closed and the user is prompted to click on the refresh task list button to create a new monitoring task.
CHW Performance
This menu will contain a list of CHW’s, with a comparative view of their performances.
On selecting individual CHWs the supervisors will be able to view a graphical representation of indicators over a 3-month timeline.
The indicators included are :
Pregnancies Registered
Sick Children followed up
Tasks completed
ANC (including urgent ANC visits) Tasks Completed
PNC (including urgent PNC visits) Tasks Completed
The comparative performance indicators are as follows:
Fraction - Number of tasks completed (in last month)/ Number of tasks due in last month
Percentage - Calculated based on the above fraction.
Performance Indicative arrow
Business Rules
To view the most updated graphs, the refresh CHW data button will need to be clicked.
The sorting logic is as follows:
Primary sort in ascending order based on completion %. The low performing CHWs appear on top.
The number of tasks completed (numerator) can be > the number of tasks due, since tasks may be completed after the due date because of which they can fall in successive months and be counted in that month's count.
Performance arrows calculations are:
Red - task completion % <= 20
Yellow - 20 < task completion % <= 60
Green - 60 < task completion %
Important Note: This menu leverages the auto case closure workflow defined here.
Having this Menu will allow the supervisor to view performance reports even without completing a task.
Overall Performance
The overall performance menu will provide a similar view with graphical and tabular representations of the indicators listed below at an aggregate level. Aggregate of all CHWs
The indicators included are :
Pregnancies Registered
Sick Children followed up
Tasks completed
ANC (including urgent ANC visits) Tasks Completed
PNC (including urgent PNC visits) Tasks Completed
Business Rules
There will only always be one overall performance case in the list to select for the supervisor
Important Note: This menu leverages the auto case closure workflow defined here.
Training Video Library
This menu contains a list of videos on different topics for the supervisor to refer to and use for training, counselling and upskilling purposes.
Note: For demo purposes the same video has been used as part of the list of three different topics.