Re: New JHU Global mHealth Initiative report: Digital Health Solutions for COVID-19 Response

Isaac Holeman <isaac@...>

Hi Alain,

Thanks for sharing the report on this list. The high level headline of this report is really encouraging. Remarkably, there are multiple stable, open-source platforms that can support what’s needed for covid-19 response, at scale.

In the spirit of transparent feedback, I feel obliged to say that there are several inaccuracies in the analysis of the Community Health Toolkit (CHT). People at Medic were asked a range of questions for this report, but much of our feedback wasn’t incorporated. If this report is to be relied on by governments and funders around the world, I think they would benefit from seeing these corrections addressed. If you're open to that, I'd be happy to follow up off-list. So the rest of the list has some context, I'll summarize a few of the issues below my signature.

It also seems important to acknowledge an aspect of the report’s methodological approach to drawing high-level conclusions:
“Unlike prior sections, where the results are based on a more objective and binary assessment of whether a specific function is available, the summary below brings in a subjective dimension based on the authors’ engagement with the platforms.”

The problem with this approach is that the authors have engaged with some of these platforms as implementers and major contributors (Alain, the OpenSRP community has benefited so much from your long term engagement that you're pictured on their "About Us" page). I don’t mean to suggest anything nefarious here, but it should be obvious that implementation experience leads to a great deal of background knowledge, and that will tend to produce a more thorough and perhaps generous assessment. The study team couldn’t possibly learn as much about the CHT developer community and technical capabilities via a few time-sensitive communications focused on completing this report.

Given the hectic pace of COVID-19 response, that’s probably a reasonable constraint. Authors who aren’t involved in developing/implementing any of these platforms might have suffered even more inaccuracies. The long term solution may be more researcher engagement with all of the platforms, rather than a “hands off” approach. Nevertheless, I hope it’s fair to encourage readers of this report to carefully consider the subjective nature of the high-level conclusions, to consider how this global analysis relates to what they’ve seen work in their own countries and regions, and to reach out to all of these platforms/open source communities directly if they have doubts or questions.

The ICT4D community often shows great interest in this kind of 'competitive landscape' report, but there's also a remarkable story in how the organizations behind these platforms have been cooperating to address the unprecedented demands of this pandemic. It's an alternative narrative that I hope we get to hear and share much more about on this list and at the forum this year.


Isaac Holeman, PhD
Chief Research Officer, Medic Mobile
Clinical Assistant Professor, The University of Washington
Twitter @isaacholeman

Check out my latest paper on human-centered design for global health equity.

Notes on the CHT and the JHU Digital Solutions for COVID-19 Response report
Active developer community and forum
The CHT community has a recently updated docs site and an active public forum. Here’s a link to our COVID-19 forum channel. The CHT's top source code repository has 337 stars and 121 forks. Stats on OpenHub show 85 code contributors and we’re proud of the fact that this community is more international, more LMIC-based, and employed by a larger range of organizations than is typical in ICT4D. The report rated CHT “some functionality available”.

Adherence to standards
The CHT supports the XForms standard, which is based on a web standard and the version we support is collaboratively maintained with ODK, Dimagi, Ona, and the Enketo community. We also support CHT integration with DHIS2, OpenMRS, and RapidPro. Our support for the Kenya COVID-19 tracker app includes integration with KenyaEMR (OpenMRS based) and has scaled up nationally. And last year we released a major refactor of how the CHT handles tasks, after consulting with the Ona/OpenSRP team to check that our spec aligns with their understanding of the task states in the FHIR tasking resource. The reported rated CHT “not available” for adherence to standards.

Built-in analytics
The CHT community supports some basic built-in data visualizations for use by health workers who are offline, and well-established approaches for getting data into third-party analytics tools (Klipfolio, Superset, Tableau, DHIS2) for more extended analytics. There’s a screenshot of a data dashboard on the CHT page of this report. This technical approach is, intentionally, very similar to the analytics approaches employed by CommCare, RapidPro, and OpenSRP. The report rated CHT as “some functionality available”.

Integration for Lab Testing
The national-scale Kenya COVID-19 Tracker app includes integration with KenyaEMR (OpenMRS) and the national lab system. CHT was rated “some functionality available”.

Several COVID-19 use cases developed and tested
The CHT framework of priority COVID-19 response use cases was posted on our forum on April 1st. By the time the report was being finalized in June, the CHT was supporting multiple national-scale covid response projects for use cases that are not included in this report’s analysis of the CHT. CHT was rated “some functionality available”.

On Thu, Jul 23, 2020 at 6:25 AM Alain Labrique <alabriqu@...> wrote:
Dear GDHN Colleagues,

     In response to COVID-19, government officials across several countries are planning for large-scale contact tracing programs to notify and track the contacts of suspected and confirmed cases to contain the onward transmission of the disease. Digital platforms can introduce significant efficiencies in case management and the process of listing, notifying, and monitoring contacts of confirmed cases. However, with a rapid influx of complex digital technologies, each with specific strengths, governments and implementing agencies are faced with a difficult choice of making a critical decision with insufficient and confusing information. 
      In an effort to facilitate the process of decision-making, the Bill & Melinda Gates Foundation commissioned the Johns Hopkins University Global mHealth Initiative (JHU-GmI) to conduct a rapid assessment of digital platforms that have an established presence in several low- and middle-income countries (LMIC), and either have been or could be rapidly reconfigured to address COVID-19 related case management and contact tracing needs.

        Nine core digital platforms were identified for this assessment: CommCare, Community Health Toolkit (CHT), DHIS2 Tracker, Go.Data, ODK, OpenSRP, RapidPro, SORMAS, and WelTel. The report called “Digital Solutions for COVID-19 Response: An assessment of digital tools for rapid scale-up for case management and contact tracing” was written in close collaboration with the stewards of these platforms. 

Download a copy here: 

A webinar, hosted by the JHU Center for Global Health, is scheduled for tomorrow, Thursday July 23, at 9:30AM EST

Alain B. Labrique, PhD, MHS, MS
Director, Johns Hopkins University Global mHealth Initiative
Professor, Program in Global Disease Epidemiology and Control
Department of International Health & Department of Epidemiology (jt.), Bloomberg School of Public Health
Division of Health Sciences Informatics, School of Medicine (jt.)    
Department of Community-Public Health, School of Nursing (jt.)

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