Creating Scalable mHealth Solutions

Our team just had a great experience with the CommCareHQ deployment management reports. We just introduced them to the organization’s administration and they clearly showed which users were awesome and which were not-so-awesome. As I said in my last post, we deployed formhub for our pilot and CommCareHQ.org for our production system. This got me thinking about data collection vs. enterprise systems and creating a scalable solution.

##Defining your Needs## Recent discussions have focused on the inability of mHealth pilot projects to scale because they weren’t designed to scale. We just started proving that these technologies work. Now is the time to think about scaling. With that aside, we need to think about clearly defining the needs of the organization up front. Are we building a data collection system or a mobile enterprise system?

What’s the difference?

Data Collection Systems are solely built to get the data in as efficiently as possible with analysis happening in a separate system. These systems often utilize a single software system or capability and have simple reporting that provides a live snapshot of the data at any given time. For example, formhub was originally built for mobile data collection.

Mobile Enterprise Systems are systems that collect data as a core activity, but also provide mobile deployment management. These systems often utilize multiple avenues for collecting (mobile application, desktop data entry or SMS integration) as well as advanced reporting that shows how the deployment is operating over time. Most importantly, these systems collect metadata on the status of your deployment including how your users in the field are using the system. Examples of these systems include CommCareHQ and Magpi

Confusion arises when a project calls for a mobile data collection system without clearly understanding what’s really needed. The M&E officer just wants the data, but the program manager may need to make sure the team is fully functional at any time.

Here are some questions to ask yourself:

  1. Will this project be for fixed time period or will it continue indefinitely?
  2. Am I creating a sustainable business capability at the organization? If so, how long will my budget last and who will pick it up after that finishes?
  3. Do I own all the devices and employ all the people who will use them? Are those employees temporary or permanent?
  4. Do I have enough money to hire someone to actively manage the deployment or am I doing it myself?

We were tried to use a data collection system (formhub) to manage a mobile enterprise deployment for our pilot. We realized this mistake and made the switch. Now, we’re evaluating if we should include another SMS or IVR component for data collection so we can better reach areas with poor 3G connectivity.

##Making Assumptions Known##
We need to clearly define our assumptions about our data collection system up front. For example, if our idea scales, will we have the budget to buy 100 more smartphones? What are the alternative methods to collect information if we can’t scale quick enough? Furthermore, these mobile devices have about a 2 year lifecycle. Will we have funds to replace all devices every two years?

We need to think about our customer and consider their needs in 3 or 5 years. A few key questions can be answered now:

  1. What do our customers need?
  2. What technology do they have access to?
  3. Can we leverage that technology today?
  4. What are the market trends that are going to impact device ownership among our target population? (i.e. cheaper smartphones, reduced data costs, infrastructure investments)

The Nepal Telecom Authority releases a MIS report every month that describes the number of voice and internet subscribers across the country. As of this writing (report number 92), there is an 86% mobile penetration rate for voice services and 34% mobile data penetration (GPRS, EDGE, WCDMA). This suggests that 34% of the Nepali population is actively using mobile data. Therefore, we expect that we can reliable reach the majority of the population through voice or SMS. However, this doesn’t tell us anything about population or regional demographic information. Our target group may be the 14% who don’t have access to a mobile phone.

##Who owns the device?
How can we get the data?##
If we own the device, we can control the system. However, this may not be the most scalable, long-term solution for our program. What would our solution look like if we tried to use customer devices?

We are often told to race to the lowest common denominator when deploying systems to customer devices. This is to ensure our message reaches the most broad audience. SMS and Interactive Voice Response (IVR) systems have met this need. UNICEF has done excellent work in this field for years with RapidSMS and just released RapidPro which became the open source version of TextIt made by the awesome team at Nyaruka. IVR systems allow users to call a number and interact with a number of voice recordings. These completely remove the barrier of mobile technology. Anyone with a touch tone phone can interact with an IVR system.

There is an interesting use case made available by emerging technology that allows for offline data collection through the web browser. Online data collection has been done for years with tools like Survey Monkey or Google Forms. However, these systems aren’t available offline. I’ve written about offline-enabled SAAS systems and identified that Enketo has been the only solution that I’ve seen so far. Enketo allows you to collect information from a desktop or smartphone through a browser and the input is stored on the phone until the user has an internet connection. Most importantly, the user doesn’t have to download an application. They just visit a URL, optionally bookmark it, and enter the data. This capability is incredibly powerful. We can now interact with customers on their own smartphone with no application installation. Furthermore, we may be able to send an SMS that points to an Enketo form for the second step of engagement. If a data connection is available, customers can directly collect robust information using the XForm standard including images and voice. If a data connection isn’t available we could continue the engagement over SMS as is currently done. I’m super excited about this technology and the ability to overcome the lowest common denominator when deploying scalable solutions to customer devices.

Fortunately, we see these systems merging together in a module like fashion. The MOTECH Suite by the Grameen Foundation brings popular mHealth systems together to communicate with patients in multiple ways (SMS, IVR & email), collect data about patients, alter caregivers and schedule work. From what I can tell, Enketo hasn’t yet been incorporated, but I’m sure it soon will be.

Note: Why do I call stakeholders customers? Take a look here.


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