[ict4chw] ClickDiagnostics experiences from Bangladesh
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Rubayat Khan
May 12, 2010, 5:45:57 AM5/12/10
to ict4chw
Greetings from Bangladesh!
This is my first post to this forum and it’s really exciting for me to
be sharing my experiences with so many people from around the globe
who are so experienced in this field.
ClickDiagnostics has been operating in Bangladesh for over a year now,
and has been working with several large NGOs, including BRAC, possibly
the largest NGO in the world. I have been leading the operations in
Bangladesh so far and have also led the BRAC project.
Possibly the most relevant to this forum would be our key insights
from close interaction and involvement with health workers over the
past one year. However, I am also including some observations from the
patient angle, which might not be as relevant but nevertheless are
very interesting:
CHW Ownership
============
• CHWs can be the strongest champions of mHealth, because it
simplifies their work and reduces redundancy (e.g. monitoring,
reporting, etc.). However, they need to be kept deeply involved in the
planning or designing of the system, without which they tend to offer
the greatest resistance because of a ‘fear of the unknown’. In our
case, initially there was a lot of resistance to change because they
feared this would increase their workload, but once we involved them
in deciding the features and functionalities of the system, they grew
ownership and eventually started lobbying for replacement of their
previous systems with ours.
• In order for CHWs to understand the value of the system, we showed
them the data coming in real time on a computer screen, and how a
doctor can see the patient data and respond with an advice. This got
them very excited about the possibilities of the system and helped
them understand the true scope of the technology.
• We made short video documentaries of their work, and also
interviewed them for their feelings about the system. These videos
were later shown to them, and they were informed that people all over
the world will be benefited by their work and see their work as
pioneering examples. We also showed top management executives of our
partner NGOs these videos to show them how much ownership the ground
level personnel had over this system. They were surprised to see it,
and it went a long way in convincing them that this was a generally
acceptable solution which would not lead to ground level discontent.
• It is important to repeatedly remind the CHWs that their mobile
phone is only a tool, and that their goal is to achieve health
outcomes (e.g. a reduction in maternal and child mortality) through
real-time interventions. This, we found, motivates them and keeps the
focus strongly towards health impact.
• In order to give CHWs ownership over the system, we remained
flexible to incorporate any feedback they brought from the ground. M-
health interventions should therefore be a looked upon as long term
iterative processes of designing solutions and testing them on the
ground, and bringing back for fine tuning.
CHW Training and usability
====================
• We trained health workers through a practice session, where they
interviewed each other, with one posing as patient.
• During implementation phases, we tried to deploy modules in phases,
starting with demo modules with a limited number of questions for CHWs
to try out and practice in the field for a few weeks. During this
period, they were asked to give extensive feedback about how the
system could be improved to make their work easier.
• Extensive localization is a crucial deciding factor for CHW and
patient comfort – simple translations often miss out important
differences in dialect and connotations which can even vary between
neighboring communities.
Value-addition, and building trust
========================
• With respect to gaining trust with patients, even the simple act of
taking a picture of the patient made them feel important and want to
be registered in the new system. The picture also helped remotely
monitor the work of CHWs, and ensure that they were indeed with the
patient while collecting their data.
• M-Health not only provided better services, but ensured patient
compliance. Generalized advice from health workers are often not
heeded by patients and their families because health workers are not
deemed to be knowledgeable enough, and because the same advice given
to everyone receives less importance. However, when a personalized
advice for a patient comes from a “city doctor”, the advice carries a
lot of weight and is often closely adhered to.
• Patients in Bangladesh seemed not to be particularly bothered about
data privacy – rather, the fact that their information was being
reviewed by a doctor and customized advice was being given to them
gave them a lot of confidence. Nevertheless, in the roll out stage, we
will voice record patient’s agreement to disclose their data to
doctors and BRAC personnel.
I think that's about all I can think of now. Sorry for the really long
message. Hope you guys will contribute to this post with your feedback
and experiences from other countries. If you have any specific
questions to ask, please feel free to ask here or at my email:
rub...@clickdiagnostics.com
Looking forward to learn from you all!
Rubayat
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This is my first post to this forum and it’s really exciting for me to
be sharing my experiences with so many people from around the globe
who are so experienced in this field.
ClickDiagnostics has been operating in Bangladesh for over a year now,
and has been working with several large NGOs, including BRAC, possibly
the largest NGO in the world. I have been leading the operations in
Bangladesh so far and have also led the BRAC project.
Possibly the most relevant to this forum would be our key insights
from close interaction and involvement with health workers over the
past one year. However, I am also including some observations from the
patient angle, which might not be as relevant but nevertheless are
very interesting:
CHW Ownership
============
• CHWs can be the strongest champions of mHealth, because it
simplifies their work and reduces redundancy (e.g. monitoring,
reporting, etc.). However, they need to be kept deeply involved in the
planning or designing of the system, without which they tend to offer
the greatest resistance because of a ‘fear of the unknown’. In our
case, initially there was a lot of resistance to change because they
feared this would increase their workload, but once we involved them
in deciding the features and functionalities of the system, they grew
ownership and eventually started lobbying for replacement of their
previous systems with ours.
• In order for CHWs to understand the value of the system, we showed
them the data coming in real time on a computer screen, and how a
doctor can see the patient data and respond with an advice. This got
them very excited about the possibilities of the system and helped
them understand the true scope of the technology.
• We made short video documentaries of their work, and also
interviewed them for their feelings about the system. These videos
were later shown to them, and they were informed that people all over
the world will be benefited by their work and see their work as
pioneering examples. We also showed top management executives of our
partner NGOs these videos to show them how much ownership the ground
level personnel had over this system. They were surprised to see it,
and it went a long way in convincing them that this was a generally
acceptable solution which would not lead to ground level discontent.
• It is important to repeatedly remind the CHWs that their mobile
phone is only a tool, and that their goal is to achieve health
outcomes (e.g. a reduction in maternal and child mortality) through
real-time interventions. This, we found, motivates them and keeps the
focus strongly towards health impact.
• In order to give CHWs ownership over the system, we remained
flexible to incorporate any feedback they brought from the ground. M-
health interventions should therefore be a looked upon as long term
iterative processes of designing solutions and testing them on the
ground, and bringing back for fine tuning.
CHW Training and usability
====================
• We trained health workers through a practice session, where they
interviewed each other, with one posing as patient.
• During implementation phases, we tried to deploy modules in phases,
starting with demo modules with a limited number of questions for CHWs
to try out and practice in the field for a few weeks. During this
period, they were asked to give extensive feedback about how the
system could be improved to make their work easier.
• Extensive localization is a crucial deciding factor for CHW and
patient comfort – simple translations often miss out important
differences in dialect and connotations which can even vary between
neighboring communities.
Value-addition, and building trust
========================
• With respect to gaining trust with patients, even the simple act of
taking a picture of the patient made them feel important and want to
be registered in the new system. The picture also helped remotely
monitor the work of CHWs, and ensure that they were indeed with the
patient while collecting their data.
• M-Health not only provided better services, but ensured patient
compliance. Generalized advice from health workers are often not
heeded by patients and their families because health workers are not
deemed to be knowledgeable enough, and because the same advice given
to everyone receives less importance. However, when a personalized
advice for a patient comes from a “city doctor”, the advice carries a
lot of weight and is often closely adhered to.
• Patients in Bangladesh seemed not to be particularly bothered about
data privacy – rather, the fact that their information was being
reviewed by a doctor and customized advice was being given to them
gave them a lot of confidence. Nevertheless, in the roll out stage, we
will voice record patient’s agreement to disclose their data to
doctors and BRAC personnel.
I think that's about all I can think of now. Sorry for the really long
message. Hope you guys will contribute to this post with your feedback
and experiences from other countries. If you have any specific
questions to ask, please feel free to ask here or at my email:
rub...@clickdiagnostics.com
Looking forward to learn from you all!
Rubayat
--
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neal lesh
May 17, 2010, 8:59:02 PM5/17/10
to ict...@googlegroups.com
Dear Rubayat and the ClickDiagnostics team,
Thanks for this great post! Really interesting to see your insights, and an
eloquent description of how important it is to partner with our users in
developing these systems.
(Also, for the list, we have all of this week to discuss this post, so feel
free to follow up with more questions.)
I wonder if you could provide a short summary of how your system works or
point us to a description of it. It would probably help provide some
additional context for your conclusions below. I think many of the people
on this list are aware of the model originally used by ClickDiagnostics in
which, I think, CHWs facilitated remote diagnosis to paying clients, but
this sounds different-- are you equipping CHWs to improve routine care? If
you can point us to the videos that would also be great.
It does sound like you all have retained the link to the doctor. In
particular, perhaps can you elaborate on how that works. Do they review
each case? Or only problematic cases? And am I right you are saying the
feedback from the doctor comes immediately while the CHW is visiting the
client in their home? I'm thinking this means you have dedicated doctors to
support this.
What happens with the pictures that the CHWs take? Do they get printed or
just remain on the phone? Are they shown back to the clients at later
visits?
That's an interesting point you make about localization. Do you vary the
text on your phone-based application from community to community? I'm
curious how you handle updates in that case. It all seems possible, but a
lot to take on to get it right.
And, again, it was great to see how much you involved the end-users in your
process. I'm curious if you have any stories of features you all liked but
were rejected by them.
As always, no need to answer all these questions.
Take care,
neal
-----Original Message-----
From: ict...@googlegroups.com [mailto:ict...@googlegroups.com] On Behalf
Of Rubayat Khan
Sent: Wednesday, May 12, 2010 5:46 AM
To: ict4chw
Subject: [ict4chw] ClickDiagnostics experiences from Bangladesh
Greetings from Bangladesh!
This is my first post to this forum and it's really exciting for me to
be sharing my experiences with so many people from around the globe
who are so experienced in this field.
ClickDiagnostics has been operating in Bangladesh for over a year now,
and has been working with several large NGOs, including BRAC, possibly
the largest NGO in the world. I have been leading the operations in
Bangladesh so far and have also led the BRAC project.
Possibly the most relevant to this forum would be our key insights
from close interaction and involvement with health workers over the
past one year. However, I am also including some observations from the
patient angle, which might not be as relevant but nevertheless are
very interesting:
CHW Ownership
============
. CHWs can be the strongest champions of mHealth, because it
patient comfort - simple translations often miss out important
data privacy - rather, the fact that their information was being
Thanks for this great post! Really interesting to see your insights, and an
eloquent description of how important it is to partner with our users in
developing these systems.
(Also, for the list, we have all of this week to discuss this post, so feel
free to follow up with more questions.)
I wonder if you could provide a short summary of how your system works or
point us to a description of it. It would probably help provide some
additional context for your conclusions below. I think many of the people
on this list are aware of the model originally used by ClickDiagnostics in
which, I think, CHWs facilitated remote diagnosis to paying clients, but
this sounds different-- are you equipping CHWs to improve routine care? If
you can point us to the videos that would also be great.
It does sound like you all have retained the link to the doctor. In
particular, perhaps can you elaborate on how that works. Do they review
each case? Or only problematic cases? And am I right you are saying the
feedback from the doctor comes immediately while the CHW is visiting the
client in their home? I'm thinking this means you have dedicated doctors to
support this.
What happens with the pictures that the CHWs take? Do they get printed or
just remain on the phone? Are they shown back to the clients at later
visits?
That's an interesting point you make about localization. Do you vary the
text on your phone-based application from community to community? I'm
curious how you handle updates in that case. It all seems possible, but a
lot to take on to get it right.
And, again, it was great to see how much you involved the end-users in your
process. I'm curious if you have any stories of features you all liked but
were rejected by them.
As always, no need to answer all these questions.
Take care,
neal
-----Original Message-----
From: ict...@googlegroups.com [mailto:ict...@googlegroups.com] On Behalf
Of Rubayat Khan
Sent: Wednesday, May 12, 2010 5:46 AM
To: ict4chw
Subject: [ict4chw] ClickDiagnostics experiences from Bangladesh
Greetings from Bangladesh!
This is my first post to this forum and it's really exciting for me to
be sharing my experiences with so many people from around the globe
who are so experienced in this field.
ClickDiagnostics has been operating in Bangladesh for over a year now,
and has been working with several large NGOs, including BRAC, possibly
the largest NGO in the world. I have been leading the operations in
Bangladesh so far and have also led the BRAC project.
Possibly the most relevant to this forum would be our key insights
from close interaction and involvement with health workers over the
past one year. However, I am also including some observations from the
patient angle, which might not be as relevant but nevertheless are
very interesting:
CHW Ownership
============
simplifies their work and reduces redundancy (e.g. monitoring,
reporting, etc.). However, they need to be kept deeply involved in the
planning or designing of the system, without which they tend to offer
the greatest resistance because of a 'fear of the unknown'. In our
case, initially there was a lot of resistance to change because they
feared this would increase their workload, but once we involved them
in deciding the features and functionalities of the system, they grew
ownership and eventually started lobbying for replacement of their
previous systems with ours.
. In order for CHWs to understand the value of the system, we showed
reporting, etc.). However, they need to be kept deeply involved in the
planning or designing of the system, without which they tend to offer
the greatest resistance because of a 'fear of the unknown'. In our
case, initially there was a lot of resistance to change because they
feared this would increase their workload, but once we involved them
in deciding the features and functionalities of the system, they grew
ownership and eventually started lobbying for replacement of their
previous systems with ours.
them the data coming in real time on a computer screen, and how a
doctor can see the patient data and respond with an advice. This got
them very excited about the possibilities of the system and helped
them understand the true scope of the technology.
. We made short video documentaries of their work, and also
doctor can see the patient data and respond with an advice. This got
them very excited about the possibilities of the system and helped
them understand the true scope of the technology.
interviewed them for their feelings about the system. These videos
were later shown to them, and they were informed that people all over
the world will be benefited by their work and see their work as
pioneering examples. We also showed top management executives of our
partner NGOs these videos to show them how much ownership the ground
level personnel had over this system. They were surprised to see it,
and it went a long way in convincing them that this was a generally
acceptable solution which would not lead to ground level discontent.
. It is important to repeatedly remind the CHWs that their mobile
were later shown to them, and they were informed that people all over
the world will be benefited by their work and see their work as
pioneering examples. We also showed top management executives of our
partner NGOs these videos to show them how much ownership the ground
level personnel had over this system. They were surprised to see it,
and it went a long way in convincing them that this was a generally
acceptable solution which would not lead to ground level discontent.
phone is only a tool, and that their goal is to achieve health
outcomes (e.g. a reduction in maternal and child mortality) through
real-time interventions. This, we found, motivates them and keeps the
focus strongly towards health impact.
. In order to give CHWs ownership over the system, we remained
outcomes (e.g. a reduction in maternal and child mortality) through
real-time interventions. This, we found, motivates them and keeps the
focus strongly towards health impact.
flexible to incorporate any feedback they brought from the ground. M-
health interventions should therefore be a looked upon as long term
iterative processes of designing solutions and testing them on the
ground, and bringing back for fine tuning.
CHW Training and usability
====================
. We trained health workers through a practice session, where they
health interventions should therefore be a looked upon as long term
iterative processes of designing solutions and testing them on the
ground, and bringing back for fine tuning.
CHW Training and usability
====================
interviewed each other, with one posing as patient.
. During implementation phases, we tried to deploy modules in phases,
starting with demo modules with a limited number of questions for CHWs
to try out and practice in the field for a few weeks. During this
period, they were asked to give extensive feedback about how the
system could be improved to make their work easier.
. Extensive localization is a crucial deciding factor for CHW and
to try out and practice in the field for a few weeks. During this
period, they were asked to give extensive feedback about how the
system could be improved to make their work easier.
patient comfort - simple translations often miss out important
differences in dialect and connotations which can even vary between
neighboring communities.
Value-addition, and building trust
========================
. With respect to gaining trust with patients, even the simple act of
neighboring communities.
Value-addition, and building trust
========================
taking a picture of the patient made them feel important and want to
be registered in the new system. The picture also helped remotely
monitor the work of CHWs, and ensure that they were indeed with the
patient while collecting their data.
. M-Health not only provided better services, but ensured patient
be registered in the new system. The picture also helped remotely
monitor the work of CHWs, and ensure that they were indeed with the
patient while collecting their data.
compliance. Generalized advice from health workers are often not
heeded by patients and their families because health workers are not
deemed to be knowledgeable enough, and because the same advice given
to everyone receives less importance. However, when a personalized
advice for a patient comes from a "city doctor", the advice carries a
lot of weight and is often closely adhered to.
. Patients in Bangladesh seemed not to be particularly bothered about
heeded by patients and their families because health workers are not
deemed to be knowledgeable enough, and because the same advice given
to everyone receives less importance. However, when a personalized
advice for a patient comes from a "city doctor", the advice carries a
lot of weight and is often closely adhered to.
data privacy - rather, the fact that their information was being
Rubayat Khan
May 23, 2010, 3:05:17 AM5/23/10
to ict4chw
Hey Neal and others,
Thanks for the encouraging words, and sorry for responding late. It’s
been a busy week.
Our system basically consists of health workers empowered with Click
mobile phones visiting households and collecting health data. The data
is sent immediately to our servers where the data is analyzed to
categorize patients into risk profiles. The highest risk patients’
data are then reviewed by doctors who return customized advice to the
HW’s mobile phone. The advice is relayed to the patients, immediately
or the next day depending on the situation. Currently, we are
basically integrating mHealth into existing health organizations to
empower them and make them more effective and efficient; hence, these
organizations are paying for these routine visits and care. However,
we are also in the process of developing a model based on small
payments from beneficiaries.
As I mentioned in the last mail, we have tried to keep the
questionnaires localized as much as possible. So far we have done this
and kept them up-to-date (admittedly with some trouble!) by separating
the questionnaire from the software engine (that’s as far as I
understand – not a techie you see! :) ). If any of you have better
success stories or methodologies to share, we would love to learn from
you.
The pictures of patients are retained within the system largely for
monitoring purposes. The patients can view their pictures if they
want, and our experience is that people (and especially women) in
Bangladesh feel empowered to have their pictures taken and sent to a
doctor.
The videos we made of all of these are not yet transcribed with
English subtitles, so it wouldn’t really be of any help as is. We’ll
be sure to upload and share it with the community after subtitling
them.
Last of all, I can’t think of any instances where any of our features
were rejected by the ground users.
Hope I’ve attended to all your questions. Looking forward to getting
more feedback and suggestions from the group.
Best!
Rubayat
> ruba...@clickdiagnostics.com
Thanks for the encouraging words, and sorry for responding late. It’s
been a busy week.
Our system basically consists of health workers empowered with Click
mobile phones visiting households and collecting health data. The data
is sent immediately to our servers where the data is analyzed to
categorize patients into risk profiles. The highest risk patients’
data are then reviewed by doctors who return customized advice to the
HW’s mobile phone. The advice is relayed to the patients, immediately
or the next day depending on the situation. Currently, we are
basically integrating mHealth into existing health organizations to
empower them and make them more effective and efficient; hence, these
organizations are paying for these routine visits and care. However,
we are also in the process of developing a model based on small
payments from beneficiaries.
As I mentioned in the last mail, we have tried to keep the
questionnaires localized as much as possible. So far we have done this
and kept them up-to-date (admittedly with some trouble!) by separating
the questionnaire from the software engine (that’s as far as I
understand – not a techie you see! :) ). If any of you have better
success stories or methodologies to share, we would love to learn from
you.
The pictures of patients are retained within the system largely for
monitoring purposes. The patients can view their pictures if they
want, and our experience is that people (and especially women) in
Bangladesh feel empowered to have their pictures taken and sent to a
doctor.
The videos we made of all of these are not yet transcribed with
English subtitles, so it wouldn’t really be of any help as is. We’ll
be sure to upload and share it with the community after subtitling
them.
Last of all, I can’t think of any instances where any of our features
were rejected by the ground users.
Hope I’ve attended to all your questions. Looking forward to getting
more feedback and suggestions from the group.
Best!
Rubayat
>
> Looking forward to learn from you all!
>
> Rubayat
>
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> You received this message because you are subscribed to the Google Groups
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> Looking forward to learn from you all!
>
> Rubayat
>
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