Commcare

Commcare

CommCare is an open-source digital data collection and service delivery platform designed to improve data collection and the quality of frontline services in low-resource settings. CommCare is one of the most widely adopted and technically advanced digital platforms. Users in 130+ countries used CommCare applications in 2021, and more than 400 million people have been registered in a CommCare application. CommCare is also one of the most researched mobile data collection platform, and supports an evidence base of more than nearly 100 peer-reviewed studies, including eight randomized controlled trials. Together, these studies have demonstrated CommCare’s positive impact on strengthening frontline healthcare systems, frontline worker capabilities, and client outcomes.

In addition to CommCare's evidence base that speaks to its impact on frontline programs, users, and clients, there are also a number of third-party technology evaluations of CommCare. Many of these include comparisons of CommCare against other digital systems in terms of features, pricing, reach, maturity, security, etc. CommCare has been recognized with numerous awards - including a Global Digital Good by the World Health Organization (WHO) and Digital Square as well as the 53rd most valuable open-source repository out of 96 million repositories by GitHub.

CommCare is used across multiple sectors, including healthcare, education, financial services, government, supply chain, gender equality, agriculture, and sanitation.

Approach

Dimagi’s most significant contribution to date is the development of its flagship platform, CommCare - an award-winning, open source digital data collection and service delivery platform designed to improve data collection and the quality of frontline services in low-resource settings. As a no-code platform, CommCare provides a turn-key system that enables non-developers to quickly build mobile applications, web applications, and SMS interactions and workflows. This enables CommCare to meet aggressive timelines and provides the benefit of allowing very fast iteration on the user experience by allowing multiple rounds of user testing. The end-result is a product that is well matched to the expectations of the users. Furthermore, the fact that this system does not require software development expertise to make changes also means that an application built on CommCare can be easily handed off to a local team for maintenance without requiring staff with extensive technical skills. The long-term sustainability of these applications is high as program staff can make changes to the system over time and can pass on responsibility over multiple staff changes without requiring external training.

Health content in CommCare: A core area of Dimagi’s domain expertise is the design and development of mobile technology platforms on CommCare that strengthen frontline programs and health systems. Dimagi designs technology with the intention that it will ultimately be supported by local capacity. Dimagi has relevant expertise in mobile systems, health information system (HIS) strengthening, technical training, behavior change communication, logistics and supply chain management, application of healthcare data standards, decision support, requirements and feasibility analysis, and usability design. Dimagi applies the above skills in an advisory function to in-country technical groups. It also performs full software development on a broad range of relevant technologies spanning from the prototype phase to an enterprise national deployment.

Over 60 studies have demonstrated CommCare’s positive impact on strengthening frontline healthcare systems, frontline worker capabilities (FLWS), and client results. Several rigorous studies have been published showing CommCare’s impact on child health, including the largest mobile health RCT to date and a study that shows CommCare’s impact on reducing child mortality.

In what, to CommCare’s knowledge, is the largest, most rigorous evaluation of mobile health to date, Mathematica Policy Research conducted an RCT to evaluate the impact of equipping FLWs with CommCare in Bihar. Both control and intervention groups received extensive health interventions implemented by CARE International. The intervention group FLWs were additionally given an ICT solution built on CommCare. Relative to the control end line results, CommCare increased the rate of women having three ANC visits by 73%, consuming 90 IFA tablets by 58%, using modern contraceptives by 34%, and immediate breastfeeding by 22%. All statistically significant results showed higher performance in the CommCare group. The improvements from CommCare more than doubled most of the improvements achieved by the core intervention as measured in a separate study.

The evidence base for CommCare includes many other studies showing CommCare can help improve behaviors that can avert maternal and newborn deaths. CRS found that 18 months after introducing CommCare the average number of FLW visits to pregnant women increased by 26%, 62% more women reported knowing at least two delivery danger signs, and on average had 41% more ANC check-ups [CRS 2014]. In Guatemala, a rural population of 233,000 served by an ICT intervention including CommCare was shown to reduce the IMR to 13 compared to a comparable control group with an IMR of 20 (p=0.054). In Zanzibar, D-tree International used CommCare to improve institutional delivery to 68% compared to control groups that remained at 40% [Mitchell, 2014]. In Afghanistan, World Vision found that after introducing CommCare, the percentage of women who developed a birth plan increased from 63% to 76%, the percentage of women who had at least one ANC visit increased from 53% to 73%, beneficiary knowledge of at least two danger signs increased from 58% to 71%, and facility delivery rates rose from 47% to 58% [World Vision 2012]. World Vision found similar results in Mozambique [World Vision, 2013].

CommCare has also been shown to improve FLW performance in providing better access to and quality of care. An RCT in Tanzania showed that SMS alerts to FLWs and their supervisors using real-time CommCare data increased timely FLW home visits by 85% [DeRenzi, 2012]. In South Africa, CDIA conducted an RCT to compare cardiovascular disease screening on paper vs. using CommCare. Training with CommCare was 3 hours compared to 12.3 hours using the paper tool; screening time was 41% faster with CommCare (p = <0.0001), and the paper tool had 3.8% error in calculating the risk score, while the CommCare algorithm had no calculation error [Surka, 2014]. In Mexico and Guatemala, Harvard Medical School conducted a study of 17 FLWs that found the use of CommCare consistently resulted in a higher medicine dosing accuracy compared to a paper-based tool [Palazuelos 2013]. In Nigeria, Pathfinder International found that CommCare increased the quality score for ANC visits from 13.3 at baseline to 17.2 at the end line (p<0.0001), out of a possible score of 25 [Pathfinder 2014].

Implementations

CommCare has wide reach and use in many countries worldwide. Please note the information below:

• 3000+ project are affiliated with CommCare
• 130+ countries with CommCare users
• 700,000+ frontline workers supported through CommCare
• 400 million+ people supported with CommCare

It has been used at a national scale in the following countries: India, Burkina Faso, Senegal, Benin, Ethiopia, Malawi, Mozambique, South Africa. A global map with national scale projects can be accessed here.

The primary users of the CommCare solution are community health workers (also known as frontline workers or outreach workers) directly working with communities in low- and middle-income countries. Depending on the solution architecture, the CommCare solution can also be used by nurses, Auxiliary nurse midwives, Anganwadi workers, and lab technicians.

Resources

• Website: https://dimagi.com/commcare/
• Source Code:https://github.com/dimagi/commcare-hq 
• Articles
  • The CommCare Evidence Base includes dozens of studies that explore CommCare’s impact on frontline programs. This resource lives as an online, up-to-date repository, with new studies being shared and published frequently. Dimagi maintains the CommCare Evidence Base and adds new studies as they are discovered. In addition to maintaining the CommCare Evidence Base, Dimagi has also published The CommCare Evidence Base Overview. This resource sheds light on our key learnings from the studies included in the CommCare Evidence Base. To read our analysis of how CommCare and mobile tools in general can impact frontline programs at the last mile, please download the CommCare Evidence Base Overview. The CommCare evidence can be found here
• Some other links for articles that describe the impact of the tool are:
  • https://news.mit.edu/2020/dimagi-commcare-health-0309, https://www.ipeglobal.com/upload/covid-19/content/201126Img_2ba83f_covid-19vriddhiworkreport-final.pdf
  • https://www.ipas.org/news/got-an-abortion-question-ask-nurse-nisa/