The objective of the project is to introduce a shelf-ready case management software with biometric identification. The solution specifically caters to local NGOs that combine health with other social services (e.g. counseling). These organizations suffer from not having customized data management systems as well as the negative effects of poor patient identification. Therefore, the open source case management software of Aam Digital will be made self-customizable and the biometric identification of Simprints will be integrated in a shelf-ready manner.
One billion people worldwide do not have an official proof of identity. For organizations working in these vulnerable settings the lack of reliable identification impedes organizations’ capacities to adequately manage their cases. This is particularly a serious challenge for health related services, where having a complete case history is necessary to provide adequate services.
Our Implementation Partner, The Leprosy Mission Netherlands (TLM), is the dutch branch of The Leprosy Mission International (TLMI), which supports more than 200 projects across 18 countries. Consultations with the organization have shown that TLM is a promising partner to pilot the combined solution of Aam Digital and Simprints. Our goal is to strengthen the case management capacity of the local implementation teams with a self-configurable and easy to use case management system that includes biometric identification. In contrast to other digital health record systems, this solution is especially shaped as a light-weight system that is easy to set up and use even for less advanced organizations.
The grant will enable the consortium to improve and integrate Simprints, a biometric identification solution, and Aam Digital, an easy to use open source case management system. Simprints' open API is currently designed for native Android applications, which will be extended to a reusable library that allows any web app like Aam Digital to easily integrate with Simprints. Building upon this we will design a biometrically derived unique patient identifier and workflows that are compatible with the OpenHIE Client Registry/Patient Identity Management module requirements and implement this in Aam Digital to be directly available for users. Additionally, Aam Digital will be extended with an intuitive configuration interface to allow users to adapt the case management system to their processes without any technical knowledge.
Aam Digital GmbH
Aam Digital GmbH is a social tech startup based in Berlin and is the prime organization in this project. The social enterprise was awarded the “Berlin Startup Scholarship” in 2021 and has evolved from an open source community-led project, initiated at Karlsruhe Institute of Technology with 31 contributors to this day (GitHub). The Aam Digital case management software is a registered Digital Public Good. The system is developed in co-creation with field-level organizations and is being scaled globally across sectors since 2020. Currently the software is actively used in India, Pakistan, Israel, Palestine, Cyprus, Tanzania, Rwanda, Germany and the US. Aam Digital’s users are small to medium-sized NGOs, where health often plays a crucial role among a broader set of activities. The project lead is Aam Digital’s Head of Product, who also initiated Aam Digital in 2015. Aam Digital GmbH has a network of over 15 field-level partners in South Asia, East Africa and the Middle East that inform our product development.
Simprints Technology Ltd.
Simprints is a tech nonprofit which builds and deploys biometric technology to radically increase transparency, effectiveness and efficiency in global development, health and humanitarian programs. Since its founding in 2014, Simprints has reached over 1.9 million people across 17 countries, across a range of sectors such as maternal health, mass drug administrations, vaccination, and HIV care. Current partners include the Federal Ministry of Health in Ethiopia, Ghana Health Service, and Gavi. Simprints brings extensive experience integrating biometric functionality into other digital health tools, such as CommCare and DHIS2. Simprints focuses on transferring capacity to local organizations through a training-of-trainers model, collaboration with program teams and local communities to ensure the program design best suits the needs of users, and partnership with local leaders and to create more awareness about the intervention being delivered. The team is globally distributed, and Country Directors in Bangladesh and Ethiopia bring a strong understanding of regional communities and stakeholders to allow for more effective capacity building.
Implementation partner
The consortium intends to work with The Leprosy Mission (TLM) and a selection of its field-level partners to understand user requirements around self-configurability and field-test the integrated biometric identification & case management solution. TLM is one of the largest leprosy-focused organizations in the world. Founded in 1874, it implements or supports about 200 projects in 18 countries. The scale and depth of the work of TLM will provide an ideal test bed. For the project, the consortium intends to work with TLM’s country offices of Bangladesh, Nepal or India. TLMs field partners have expressed a keen interest to collaborate and have shared that the integrated solution will be exactly what they need in their local context. The formal agreement with TLM and its country office will be finalized subsequent to the successful grant application.
Solutions to patient identity management, such as the WHO’s recommendation to use name and date of birth, are not adequate for low-resource settings. Large and small stakeholders alike, such as donor organizations and NGOs located in the global south report that the lack of reliable beneficiary identification is an impediment for their work. Additionally, many local organisations are still taking only the first steps towards introducing digital tools to help register and monitor patients. Some of the existing solutions in the digital health space (e.g. DHIS2, CommCare) can be quite complex to set up and often require skilled staff for configuration and technical support. This project aims at solving three challenges:
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Identification of beneficiaries within and across organizations
Large unregistered populations and low educational levels pose a challenge for organizations to reliably identify and match individuals with their case history. Beneficiaries can lose ID cards and a matching through names becomes impractical at scale and challenging because of different spellings (in some geographies, >60% of males have some variation of the same name). The WHO acknowledges that unreliable identification has serious consequences for the quality of services provided.
This challenge is exacerbated in complementary programs, where multiple organizations interact with the same beneficiary. In these programs reliable identification and precise tracking of beneficiaries’ case history is often necessary to provide high-quality services.
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Identification of duplicates during Monitoring & Evaluation (M&E)
A lack of unique identifiers makes reliable M&E challenging. Firstly, engagements with patients may not be accurately recorded. A study conducted by Brown University School of Public Health found that nearly 50% of HIV visits captured in the biometric system were not otherwise recorded in the current electronic medical records system. Secondly, a lack of unique identifiers may lead to the creation of duplicate records, which are then costly and time-consuming to find and resolve. Both issues lead to inaccurate program data.
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Making Open Source easy to deploy, customize and use
The purpose of open source software is to enable collective action by permitting stakeholders to amend code to their use case and, thereby, advance the code for everyone. For many open source tools in the health sector, this is not the case, as they suffer from poor documentation and cannot be easily deployed, customized and maintained by third parties.
Objective
The objective of Simprints and Aam Digital is to address these challenges by i) integrating biometric identification (Simprints) into Aam Digital and ii) decreasing the technical knowledge needed to deploy, customize and maintain this solution.
The final result will fill a gap in the digital health ecosystem, by promoting the move towards digitisation for small to medium-sized organizations that do not have extensive technical capacity. Aam Digital has been founded particularly to provide a less complex, easier setup and use as compared to other tools. This product will be easy to deploy through complete containerization and the existing Docker Compose Files. Aam Digital platform already fulfills OpenHIE non-functional requirements (NRF1-7) and follows the architecture for Point-of-Service applications. In this project, Aam Digital and Simprints will design a Client Registry module and workflows that meet the OpenHIE architecture requirements, including a biometrically derived unique patient identifier to solve the problem of duplicates (CRF-1). The project will contribute to the broader OpenHIE community by creating a universal biometric plug-in architecture/API that can be further customised for integrating with other patient verification systems and web apps. A proposal will be made for the CR OpenHIE workflows (e.g. CRWF-1) to also include biometric data besides demographics with an updated interaction description.
Deliverables & Schedule
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Deliverable |
Schedule |
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Package 1: Biometric Identification |
Months 1 - 12 |
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A “shelf-ready” and easy-to-use integration of Simprints into Aam Digital that can be used by any organization that requires case management with biometric identification |
Months 1-3 |
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Design of a Client Registry module and workflows that include biometrics and update OpenHIE sequence diagrams |
Months 4-6 |
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User testing of integration with local partners to ensure that the integration matches the needs in the field and works in low resource contexts |
Months 7-9 |
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Extensive documentation and plugin architecture that allows other patient verification systems to be integrated into any web app with little effort |
Months 10 - 12 |
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Package 2: Self Configurability |
Months 13 - 18 |
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Requirements engineering to find out which parts of Aam Digital should be configurable by the users of the application |
Months 13 - 14 |
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Implementation of the requirements that were collected in the previous step in close collaboration with the end-users |
Months 15 - 17 |
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Field testing of the self-configurability with our existing user base to ensure exceptionally easy usability |
Month 18 |
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User documentation and tutorial videos that can be provided as self-learning material |
Month 18 |
Risk Mitigation
As Simprints has integrated their solution into other tools before, the technical risks are minimal. The largest risk concerns a mismatch with the requirements of frontline organizations and usability. This risk is mitigated by closely following the principles for digital development, especially the principle of closely designing with the user. This is ensured by requirement engineering and user testing with field-level organisations. Simprints’ technology has been designed in collaboration with frontline health workers and extensive UAT has been carried out, which further mitigates this risk. Aam Digital as well has been developed in close collaboration with local organizations from the day of its inception.
Comments
Thank you for the concept
Thank you for the concept note. For the full technical application, in addition to general recommendations per the email, please unpack the software a little more and the broader existing implementation scope. How does this tie into existing MPIs?