Maintaining Preparedness: Applying pandemic platforms beyond COVID-19

Bolstering future pandemic response by developing digital applications and analytics tools to respond to today’s malaria threat

Dr. Neal Lesh, Chief Strategy Officer at Dimagi, Inc.

 PhD in Computer Science from the University of Washington

MPH from Harvard University

Digital solutions for Frontline Workers (FLWs) are an essential element of almost all efforts to respond to global health emergencies.  As developers of the two most widely used platforms for digital solutions of FLWs, Dimagi and Medic sprang into action in early 2020 to rapidly build digital apps for a wide range of containment and mitigation strategies including for contact tracing, port of entry screening, facility readiness, and vaccine delivery. 

In order to create feedback loops to support response to future health emergencies, it is imperative to establish common tools and standards for FLWs in a robust digital pandemic platform.  The COVID-response apps created by Medic and Dimagi were used by over 40,000 users in 100 programs across 40 countries, capturing data on over 30 million interactions.  But for these tools to stay relevant they must be consolidated into a comprehensive platform, used in real-world settings, and continually improved.  

We propose to address the twin problems of maintaining a robust digital pandemic platform and tackling malaria, an ongoing global emergency that rivals COVID-19 for its devastating impact.  World Health Organization’s World Malaria Report 2020 states that malaria killed 409,000 people, most of them young children and pregnant women.

Our digital pandemic platform will benefit stakeholders across all programmatic levels: patients and communities impacted by the disease, FLWs who utilize the solutions at the community level, and stakeholders who access and analyze the data to design more effective programs that respond to existing gaps.  

As experts in human-centered design (HCD), Dimagi and Medic will engage directly with communities and populations most affected by malaria. Through focus group discussions (FGDs), interviews with people living in communities most impacted, and analysis of existing data collected through current programs, we will seek to understand current gaps in malaria prevention, diagnosis, and treatment. Our efforts will target the parents of young children and pregnant women, most at risk of severe illness and death from malaria.

FLWs will also be key collaborators in our HCD activities. We will work with FLWs supporting existing malaria programs to update our suite of applications to better address key pain points in current patient-level support activities. 

Implementing partners and governments need improved access to real-time data and analytics for rapid decision-making. This is true of both malaria and pandemic responses.

CommCare and CHT are already proven public global goods. Our open source model makes our technologies more accessible at the last mile and we will implement our digital pandemic platform under the same philosophy. Digital health leaders and institutions (i.e., UNICEF, USAID, & Gates) have endorsed the global goods vision where multiple software systems embrace standards and work together as part of a healthy digital ecosystem. Ensuring that digital health implementers have access to multiple options and are encouraged to make value-based choices about which software systems are best suited to particular health system challenges is a central part of that global goods vision. 

Dimagi and Medic will also include a white paper that will explore the outcomes of this work on malaria programs who utilize our digital pandemic platform. Our research will examine how malaria programs managed their recovery from COVID-19, usability of the platform, and how weill the platform facilitated improved interventions.

From an FLW perspective, our solution makes it easier for them to use mobile applications that enable data-driven decision making at the community level. As a result, pregnant women and young children at the highest risk of severe illness and death caused by malaria will have improved information and care. For example, our partner Terre des Hommes implemented the Integrated eDiagnosis Approach (IeDA) interventions at scale in Burkina Faso, including a CommCare application that supported integrated management of childhood illnesses. A study of the intervention found that there was an improvement in danger sign identification, correct referrals/hospitalizations and management of severe malaria (further information in our evidence base). 

Our solution will also create impact at the programmatic and governmental levels. By equipping FLWs with improved applications that include a feedback loop, we enable better access to real time data analytics for programs and government stakeholders. For example, data collection at the community level can use geospatial technology to highlight service area disruptions and target prevent campaigns where they are most needed.

Both Dimagi and Medic bring extensive expertise in bringing solutions to scale. Not only have our platforms scaled to more than 80 countries, but we have had national scale programs in Burkina Faso, Ethiopia, India, Madagascar, and Mozambique (not an exhaustive list). We will leverage the lessons learned from those years of experience to scale the digital pandemic platform, as well. 

We are currently using a similar model for scale that is specific to COVID-19 vaccine distribution. Built on CommCare and in collaboration with Medic, Dimagi has developed a digital solution for vaccine distribution that is currently being deployed in multiple countries, including Burkina Faso, Guatemala, and Somalia. This tool can then be rapidly adapted to improve routine immunization, as well. Similarly, we will deploy our digital pandemic platform to multiple countries for their malaria response programs and equip them to rapidly adapt the platform for future pandemics, and other current endemic diseases in addition to malaria.   

Dimagi and Medic will ultimately achieve impact by improving access to data and building capacity for data-driven decision making at the community, program, and government levels. This access to data also enables us to collect baseline, midline, and endline data over the duration of the project implementation so that we are able to assess impact and course-correct as needed. 

Our research teams will monitor the use of the system, including the number of users at each level, the number of patients reached within specific populations (i.e. children under five, pregnant women), and how the platform is being used across the continuum of malaria programs (prevention, testing, treatment, recovery). Over time, and with enough data, we will be able to determine the impact of our solution on malaria mortality rates.

The world is still in the midst of the COVID-19 pandemic. Making significant investments in malaria while focus remains on the current pandemic and while on-the-ground efforts are restricted, poses its own challenges. Our solution will not only address malaria and prepare for future pandemics, but also will work on ways to recover in the wake of COVID-19 in the hopes of securing stakeholder buy-in. 

Amidst on-the-ground restrictions, both Dimagi and Medic have invested significant resources in determining how best to rapidly deploy our solutions while remote. We found that there is room for improvement in how FLWs are currently trained on new content, where the norm is lengthy, in-person meetings. These trainings serve an essential purpose, but are also expensive, time consuming, and do not necessarily engage FLWs as well as possible. Additionally, pandemic will also require rapid dissemination of new information. 

There is tremendous potential to leverage digital technology to improve training and establish the ability to do it with less or no in-person training. For example in low-resource settings we can use digital to enhance in-person training, use digital to follow up on and supplement in-person training, or even replace in-person training with remote only solutions. 

Dimagi and Medic has partnerships with dozens of implementing organizations, and has received funding and awards from numerous donors. We do not have formal affiliations.

The Trinity Challenge can help overcome 2 significant barriers caused by limitations at points of data entry:

1. Developing systems that support remote training of FLWs for efficient and effective multiple roll-outs. The success of the response depends on how well equipped the FLWs are to handle the crisis. Getting them ready, well-informed and motivated is a crucial part of the response lifecycle. This will require several iterations in different settings to come up with a successful workflow. 

2. Interoperability between different systems so we have a seamless mechanism to collate data accurately and quickly. 

With an initial focus on malaria, applying our existing knowledge from efforts in malaria and COVID-19 and funding from The Trinity Challenge, we can build a template solution which can be quickly customized and rolled out to meet future needs. 

Through this Challenge we can also explore ways to rapidly analyze and disseminate findings. With process and decision-logic built into the system, we can provide guidelines for more efficient use of health-systems both in terms of human resources as well as infrastructure. Proper data entry mechanisms will lay the foundation for swift recovery of financial and health-system to their former or an even better states.

Dimagi and Medic will build on the existing partnerships with organisations that have already contributed to initial development of our solution including Google.org and the Rockefeller Foundation. We will also engage with partners who have used CommCare and CHT as part of their malaria and/or COVID-19 response efforts. These may include: Terre des Hommes, Malaria Consortium, Elizabeth Glaser Pediatric AIDS Foundation, and various ministries of health.