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Looking to change the way health care is delivered in the developing world, one cell phone at a time

Cell phones have become such fixtures in our everyday lives that most of us take them for granted. Those small handsets lying inconspicuously in our bags have broken down communications and information barriers over the past decade, but now, because of their increasing accessibility and relatively low cost, cell phones are transforming a more unlikely field: health care delivery. And you thought your iPhone was revolutionary.

Dimagi was one company fortunate enough to recognize this potential early on.

Founded in 2002 as a health-software company comprised of a group of clinicians and programmers from MIT’s Media Lab, Dimagi has looked to use mobile phone technology as a tool for fixing some of the most pressing health needs of the developing world – from mobile health education, to health records keeping, to aiding the diagnosis of disease. The company has set up systems from Bangladesh to South Africa, while their current focus project, CommCare, a cell phone- based system for community health care workers, is being developed in Tanzania.

According to Jonathan Jackson, co-founder and CEO of Dimagi, CommCare is the product of collaboration among many partner groups and is built on an open source data collection platform. While Dimagi is responsible for the software programming side of the project, another company, D-Tree International, is leading the implementation on the ground.

“[The CommCare program] runs directly on your handset and it helps groups like community health workers. It will allow them to do scheduling, task management, and decision support,” Jackson said.

CommCare aims to link individuals, community health workers, and larger health organizations through a network of on-the-ground record-keeping.

The software also provides detailed symptom questionnaires, which can be followed by less-skilled health care workers in routine house-to-house check-ups. This would allow health organizations to extend their reach as health care services could be extended to a greater number of communities.

“Usually, they are going household to household and recording symptoms of people on their phone – and that’s driving them through this tree of questions in our program [on their handset]. Depending on how people answer, it directs the health care workers to refer them to the right medicines or other services.”

For Jackson, the provision of such services through mobile technology is especially important in settings where greater technological infrastructure is lacking.

“There aren’t necessarily standardized health records [in many developing countries], which is a big problem. So we’re focused on minimal data fields [and] the household, whereas you’d usually be talking about data gathered at the clinic,” he said.

“We are a ways off from an accessible clinical records sharing system going across many of these countries because of the basic lack of Internet connections. I think the small-scale, phone-based, community programs are going to work because they are such simple systems and can therefore actually be implemented.”

Dimagi and its partners are currently working on expanding the field of users on the CommCare platform. According to Jackson, the use of a uniform product across sectors would facilitate communication and health information sharing between different levels of health officials and organizations, contributing to better community health data gathering overall.

“Right now we’re just in the early stages of design for the headquarter software, and that will be used by a number of different people, like the supervisors of community medical centres, but also centres of operations, like the NGOs who are employing these workers, so that they can check trends, not just individual cases. They can then chart the overall health of the system, which is a huge missing gap today,” Jackson said.

Still, Jackson believes that technology alone is not sufficient to make a deep-seated impact on health care delivery in the developing world. Instead, the main contribution of technologies such as CommCare is their ability to facilitate better monitoring of and communication between health service providers on the whole. In this way, such systems can allow for greater innovation in the direct patient care already being provided by community health programs.