Empowering frontline services and bridging gaps A tech journey for impact

“Harnessing the power of digital technologies is essential for achieving universal health coverage. Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.” – Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO (April 2019).

As the world becomes increasingly connected and digital, the role of technology in revolutionizing crucial sectors like healthcare, education and nutrition, etc. cannot be underestimated. There is a growing recognition that technology has the potential to transform economies, create jobs, and improve livelihoods. Healthcare challenges, for example, in low- and middle-income (LMICs) have been the focus of many digital initiatives. These have aimed to ensure consistent implementation of these services. In this piece, we will highlight our ongoing efforts and initiatives towards empowering frontline workers, the potential to extend digital solutions to diverse sectors, and the inclusive, decentralized approach we adopt.

Harnessing digital technology for positive social change

Dimagi, as a social enterprise, has been working toward meaningful impact by facilitating frontline work through scalable digital solutions and services. We use the term “designing under the mango tree” to emphasize the need to involve all stakeholders, including partners and the end users, in the design process. This ensures that frontline workers’ perspectives are valued and amplified. This is a crucial step that often gets missed in the design process.

Comm Care, our flagship product tries to harness user-driven innovations. It strives to remain a scalable, sustainable and contextually relevant tool. We are a certified Benefit Corporation. In USA’s corporate law, a Benefit Corporation is a for-profit corporate entity whose objectives include positively impacting society. We have teams in the USA, India, South Africa, Senegal, and elsewhere around the world. We have supported over 3,000 digital programs in over 130+ countries. In 2021 alone, we supported over 120,000 active FLWs (frontline workers).

These all have the potential to improve outcomes and in turn, well-being. It’s worth taking risks on such technologies, even if there are no guarantees they will pan out. We believe in placing substantial bets on these technologies, while applying them thoughtfully and realistically to help drive major improvements in closing the service gaps.

While we aspire to ambitious goals, we also acknowledge the value of taking incremental steps towards realizing a grand vision. We advocate for a “crawl, walk, run” approach to digital technology in general, and data use in particular. In this approach, programs must first establish a foundation of consistent technology use before venturing into more advanced technologies.

We believe that inclusive technology is open source, is designed for low-literate users, and works in environments with limited internet connectivity. The offline capability of our software platform, CommCare, is particularly critical. This is because it serves markets where connectivity is not assured. This enables frontline workers to provide uninterrupted care in remote, disconnected areas.

Comm Care’s support for the advancement of frontline workers, many of whom engage in demanding work for minimal or no pay, is underpinned by numerous studies that highlight its positive impact on their legitimacy. Therefore, we advocate for smartphone use in the context of work, and for non-work-related utilization of these devices to support FLWs’ health, in line with our commitment to their holistic well-being.

Comm Care Connect – empowering frontline workers

Dimagi’s CommCare Connect initiative is a significant milestone in our journey. It is underpinned by a $25 million investment from Steele Foundation for Hope. This initiative aspires to empower Frontline Workers (FLWs) in low and middle income countries (LMICs). It enables them to learn, deliver, verify, and be compensated for high-impact interventions.

On top of their heavy workloads, FLWs typically have limited training and support. Comm Care Connect aims to put more money into the hands of local actors. This would allow interventions to be more efficiently delivered where they are needed. The goal is to catalyze their impact at scale, while leveraging existing health resources and contributing to local economies.

We initiated pilot interventions in collaboration with Cohesu in Kisumu, Kenya, and Live Well in Lusaka, Zambia. We are pleased to announce that these organizations have successfully delivered one round of Vitamin A supplementation and deworming to 5,000 eligible children in their respective areas.

As we progress, we are committed to moving from these smaller milestones towards large scale implementations. In partnership with C-WINS in Katsina, Nigeria, and SANMAT in Jharkhand, India, we are working to provide these essential supplements to 80,000 children by March 2024.

WellMe – a digital solution for FLWs’ well being

The crucial roles of FLWs often come with heightened levels of stress. When not managed successfully, this work-related stress can lead to burnout. This manifests as exhaustion, mental distance or negativity towards one’s job, and reduced professional efficacy. Unfortunately, burnout is prevalent among FLWs such as healthcare providers.

To address this issue, we have introduced Well Me. It is a well-being and resilience building application, specifically designed to promote resilience-building behaviors and prevent burnout among FLWs. Grounded in the evidence, it’s clear that resilience is a learned skill that can prevent burnout.

Well Me helps FLWs develop healthy routines such as self-care, stress management, and connecting to others. It uses a combination of evidence-based learning materials and practice activities. It is designed for all frontline workers across sectors including delivery partners, health workers, and drivers. All of these groups of FLWs are likely to be smartphone-equipped.

The development of Well Me has been a journey spanning nearly three years. It has been characterized by formative work conducted in close collaboration with FLWs and partners. Johnson & Johnson Foundation has been a key supporter of our formative work on FLWs’ resilience since 2020.

As part of this consortium of organizations, Dimagi has helped develop and test the Resilience Message Program. This is an evidence-based, free and adaptable set of messages designed to increase health worker resilience.

Dimagi is conducting pilot studies to test two hypotheses. The first one is that substantial use of Well Me will enhance FLWs’ well-being. The second one is about our ability to foster the use of the Well Me platform.

The pilot projects are ongoing in India and Nigeria. We have also introduced a Well Me Beta Testing Program toward collecting feedback from FLWs. This will lay the groundwork for making Well Me available to FLWs at scale across LMICs.

It has been gathered that customized videos, especially custom-animated ones, are preferred over public domain content. The cost of mobile data was a significant obstacle for users in Nigeria and Uganda. This highlighted for us the importance of offline access.

FLWs desire improved two-way communication within the app. This feedback has prompted us to start exploring ways to leverage large language model (LLM)- powered chatbots to provide this two-way communication channel at scale

The vision for Well Me extends to making a positive impact on millions of FLWs in healthcare and other sectors, such as last mile delivery, facility management, and gig workers, over the next decade. Our journey toward Well Me reflects our commitment to address the well-being of those who tirelessly serve their communities.

Extending solutions to other sectors like education

While our journey was initially centered on healthcare and nutrition, we realized the potential in extending similar solutions to various other sectors. Dimagi has acted as a technical lead and has partnered with in-country implementation leads across numerous sectors with a clear aim to enhance efficiency, efficacy, and our ability to make a meaningful impact on the communities we serve. In the domain of education, empowering educators and education systems through technology holds the potential for positive transformation. Through effective data utilization, optimized resource allocation, and enabling personalized learning experiences, we envisage a future where education becomes more accessible, equitable and efficient.

Mobile tools can help to improve quality of services, inform decision-making, and strengthen accountability. Within this landscape, Dimagi has an array of Comm Care based products. These have been developed involving continuous assessment of needs and the feedback of users who have helped us shape the solutions .

Comm Care offers features to strengthen teacher professional development programs. It does this by equipping instructional coaches with mobile tools. These can monitor teacher performance and provide individualized support by monitoring schools’ performance and attendance. These can also help in tracking progress, standardized assessments and learning outcomes, and instructional coaching.

Partnering for educational change

Banyan Global has partnered with Dimagi to create an SMS-based system. This is a journey that was initiated by a need for better program engagement and linkage to employment and education resources for youth. The development process involved building automated, personalized messaging based on registration and course data from the Moodle platform. The project begins as a pilot aiming to enhance course completion rates, employment outcomes, and program retention while reducing attrition and migration among the 2,500 participants.

Dimagi has partnered with Plan Canada for the Primary (School) Access through Speed Schools + (PASS+) Project. The goal of this collaborative intervention has been to extend the reach of education to 180,000 out-of-school boys and girls, aged 6-14, across 15 regions in Burkina Faso, Mali and Niger. The PASS+ Comm Care application tracked out-of-school children by identifying, registering and tracking them at Speed Schools and Primary Schools based on the tools developed and tested by Plan Canada. The app identifies and maps out of school children (OOSC). It creates child profiles to track attendance, progress, transfers and registration into a primary school the following year.

Save the Children Thailand, has used Comm Care to track student attendance in schools along the Thai-Burmese border, making a difference for over 100 users. In Sierra Leone, the International Rescue Committee (IRC) adopted a Comm Care app to monitor school performance and track student attendance across 450 schools, impacting 15,000 students. Field workers could enter data in real time for supervisors to assess schools’ performance on relevant indicators. Dimagi is also venturing into Large Language Model (LLM) based chatbots that have sector-agnostic use cases. Early applications have shown these to be helpful in training and development and client servicing. LLM-based chatbots can be extremely useful in the education sector use cases as well.

Closing thoughts

In this tech-driven era, Dimagi is on a mission to empower FLWs and bridge critical gaps in sectors crucial to human well-being, from healthcare and education to nutrition and mental health through technology. However, we won’t achieve the desired impact if we build apps that lead to radical improvement but cannot scale or be sustained. And as we scale, we must continue to put in the groundwork to ensure that we are continuing to improve well-being.

Looking ahead, we eagerly anticipate the continuous evolution of technology. We will explore AI applications and other technologies for our tools. We firmly believe in embracing emerging technologies while ensuring thoughtful integration, to drive improvements and bridge service gaps. Dimagi’s journey is a testament to our commitment to inclusivity. We will continue to advocate for open-source, low-literate user friendly, and connectivity-flexible technology, which can make a lasting impact in a rapidly advancing digital landscape.