For the last 20 years, Dimagi has been digitally enabling Frontline Workers (FLWs) in LMICs, primarily through our open-source CommCare platform. In 2022, Dimagi took the first steps in launching CommCare Connect, supported by a $25 million investment by the Steele Foundation for Hope. The CommCare Connect platform is built on four pillars, namely Learn, Deliver, Verify and Pay. More details about the CommCare Connect platform are detailed in an earlier blog, highlighting its achievements in the first year.
Retrospective on CommCare Connect in 2023
One of the key pathways for the field implementation of CommCare Connect was working with locally-led organizations (called the Direct-to-Frontline-Organization pathway) across programmatic areas to deliver key services to vulnerable populations. As part of the D2Org pathway, one of the most widespread programs so far has been Dimagi’s CommCare Connect Child Health Campaign (CHC) under which we have provided Vitamin A and Deworming(VAS+D) supplementation, MUAC screening and referrals, and basic infant vaccine checks. In our recent pilots in Nigeria, we have also included dropping off ORS and zinc sachets for all children under 5 years of age. After the initial pilot in Rajasthan, India, Dimagi conducted three small pilots of 5000 children each in Kenya, Tanzania and Zambia. Our partners in these countries were Cohesu, Sujukwa and LiveWell respectively. After this, Dimagi launched a Request for Proposal (RFP) and selected two partners, the Center for Wellbeing and Integrated Nutrition Solutions (C-WINS), in Nigeria and Sanmat in Jharkhand, India. Both organizations conducted a major campaign to deliver the Child Health campaign to 40,000 children each in Katsina in Nigeria and in the Dumka district of Jharkhand in India. Dimagi was supported by Vitamin Angels, India with doses of VAS+D for our campaigns in India and Zambia.
Key Achievements and Findings
Both Cohesu (Kenya) and Livewell (Zambia) have presented their findings to the governments of their countries. LiveWell will also be utilizing the CHC app to deliver VAS+D in the upcoming child health weeks of the Government of Zambia in May and November 2024.
In March 2024, Dimagi furthered this initiative by launching a program to deliver ORS+Zinc treatment in addition to VAS+D to 5000 children in Nigeria. Two co-packs of 2 ORS sachets and 1 strip of 10 Zinc sulphate tablets were handed over to children between the ages of 0-59 months. Dimagi achieved a milestone of reaching 1,00,000+ children across seven countries; Kenya, Tanzania, Zambia, Nigeria and India for the child health campaign and Uganda and Ethiopia for the mental health and kangaroo mother care pilots respectively.
In the earlier pilots, Dimagi’s main aim was to show that delivering VAS+D through trained FLWs was a feasible proposition in rural areas of the regions we implemented in. Most of our pilots found that the implementations were highly successful, frontline workers were provided technical training by local experts to deliver VAS+D with good quality and fulfill a critical need at the community level. In multiple countries, local officials mentioned that the campaigns helped to supplement their efforts to provide VAS+D.
Challenges and Areas for Improvement
It was noted through various conversations and field experience, that the County and Local Governments in many regions appreciated support from Development Organizations to saturate their areas for reasons related to supply shortages, overburdened staff and a lack of verification mechanisms. In the larger pilots in Nigeria and India, Dimagi made efforts to improve verification measures and check if service deliveries were ‘real’ and done with good quality. Our pilots showed that while most FLWs conducted quality service deliveries, there was still a need to improve verification processes and standards. These implementations have provided us with the necessary foundation to develop the technology for CommCare Connect and also build new verification processes and mechanisms that can be utilized for large-scale implementations along with exploring the idea of digital learning.
Dimagi’s vision for CommCare Connect
One of the key focus areas of 2024 for Dimagi is identifying pathways to scale these interventions, and rapidly testing new platform improvements for strengthening the pillars of digital learning, verification and payments to FLWs. For the past few months, Dimagi has been engaging with GiveWell through a planning grant, to examine our approach to delivering cost-effective critical interventions and improving counterfactual coverage of services in vulnerable communities across Nigeria. We have also been focused on building and testing the CommCare Connect Tech platform through a pilot with the Solina group in Nigeria.
Scaling up the Child Health Campaign
To further the Child Health Campaign scale-up, Dimagi aims to work with more locally-led organizations for focused interventions in Nigeria, potentially targeting a million verified service deliveries this year, while also taking strides to reach our planned scale of 10 million verified visits each year in the upcoming years. For many years, service delivery campaigns across LMICs have faced the challenge of being unable to estimate and verify coverage and track beneficiaries in hard-to-reach areas. CommCare Connect aims to alleviate this problem while simultaneously strengthening local ecosystems by utilizing the skills of local frontline workers who are trained for the cause, but who lack the opportunities to do so. CommCare Connect will enable governments and ecosystem partners to maximize the utility of FLWs for high-impact service delivery along with digital verification of data to ensure quality services.
