Notice F0: Reference implementation of the World Health Organization Antenatal Care Digital Adaption Kit

Make IeDA Maternity a reference implementation of the WHO DAK ANC

Two-sentence Overview: 

The goal of the project is to align Tdh Digital tool for Maternity (IeDA Maternity) and its ANC form developed in Burkina Faso, with the content of the WHO Digital Adaptation Kit focused on antenatal care, as well as the reference implementation guide  for HL7 FHIR data standard to make it a reference implementation of this DAK. The internal Tdh team that developed IeDA Maternity will leverage external resources known for their commitment to open source and public goods to make IeDA Maternity / ANC form a stand-alone, interoperable, open source and ultimately shelf ready reference tool.

Executive Summary: 

In 2020 and 2021, Tdh in collaboration with the Ministry of Health of Burkina Faso, digitized and deployed the antenatal care form in 34 health facilities in the Toma district. This form is part of a larger tool with a total of 5 forms, including ANC (PNC, FP, Delivery, PAC). In 2021, WHO published a DAK (Digital Adaptation Kit) for antenatal care, a technology-neutral documentation adapted to a wide audience, detailing the operational and functional constraints of the ANC Guidelines.

Tdh is seeking funding to:

  • create a reference implementation of the ANC DAK contextualized to Burkina Faso Politics and deployed in two health centers to allow for evaluation in a second phase
  • create a reference tool within the IeDA Maternity that will serve as an origin and template for the redevelopment of other existing forms (FP, PNC, Delivery, PAC), using DAKs when they exist (FP, PNC so far)
  • Carry out a pilot implementation of an OpenHIE architecture in Burkina Faso to encourage its adoption at the central level

The funds granted by Digital Square will specifically go to

  • Funding for the internal team that developed IeDA Maternity and will be in charge of this project.
  • External expertise that will be focused on 3 main areas:
    • Product Life Cycle management, to ensure adherence to a quality process throughout the design and development of a DAK ANC reference implementation.
    • Interoperability, to ensure that IeDA Maternity is part of an OpenHIE-type architecture and that its data model complies with the HL7 FHIR standard.
    • CommCare expertise in order to exploit the public good advanced functionalities, particularly in terms of data management and exploitation
Consortium team: 

To carry out this project, Tdh will seek strategic alliances with technical partners specializing in digital product lifecycle management and the implementation of interoperable health applications.

Terre des hommes Lausanne has been established in Burkina Faso for more than 30 years and has been implementing activities around digital health for about ten years. Terre des hommes has been able to scale up its digital health approach by covering today nearly 87% of the health centers (about 1750) for consultations of children under 5 years old. With IeDA Maternity, Tdh and the Ministry of Health aim to achieve the same coverage rate in an even shorter time frame.

Tdh has a multidisciplinary team composed of:

  • physicians in charge of medical and ethical aspects ;
  • system engineers and developers responsible for digitization;
  • data managers responsible for data modeling and exploitation ;
  • Field agents who accompany the health workers in the implementation of the project according to the indicated standards;
  • Monitoring and evaluation officers who design tools to monitor project activities.

To develop the IeDA maternity unit, Tdh has signed various agreements with partners, notably with Enfants du Monde (EdM) for the supply of SPN pictograms. This partnership will continue in the framework of the present project.

Within the framework of this project, Tdh will work in consortium with IT4LIFE, which has solid expertise in development. In particular, IT4LIFE will ensure quality assurance on methodological aspects and software development, especially on OpenHIE. Specifically, IT4LIFE will accompany this work through support on the following axes:

  • Best practices in product development and management

 

  • Software development process - SCRUM

A good software development methodology is important to guarantee a high level of quality and respect of delivery deadlines. IT4LIFE will support Tdh in capacity building on the SCRUM methodology which is one of the most widely used standards in the world of Agile methodologies. The fundamentals are simple to implement from the start and bring real benefits quickly. The rigorous application of the methodology follows the progress of the development team.

 

  • Test strategy - Process and tools

Development teams tend to under-invest in testing because it is a laborious activity. However, it plays a fundamental role in the quality of products delivered to users, and therefore in their adoption. IT4LIFE will support Tdh in the implementation of processes and tools that will allow the integration of the test dimension into the software development cycle. The objective will be to make this step as simple, pleasant and efficient as possible thanks to dedicated tools (Testlodge, TestRail).

 

  • Product Management

A product has its own life cycle, unlike an application designed for a specific need. It is necessary to constantly question the possible evolutions of the product with regard to the strategy of implementation and/or deployment desired by the users and the departments. IT4LIFE will support Tdh in setting up processes and tools (e.g. ProductBoard) that will allow prioritizing the demands of the various stakeholders, making documented and objective choices. This will involve, among other things, managing the product backlog, the product roadmap, deployments and the support/user feedback strategy.

 

  • CommCare Application Development
  • Software architecture

Although the DAK ANC contains a precise description of all workflows associated with the support protocol, it will be necessary to adapt them to the CommCare platform and the constraints it imposes. IT4LIFE will support Tdh in this software architecture work (the deliverable is documentation) to maximize the maintainability of the protocol implementation and thus its replicability.

 

  • Development

IT4LIFE will provide Tdh with experienced IT engineers who will assist the team in the development of the CommCare application.

Project Description: 

Background or problem statement

Maternal mortality is a major public health problem in Burkina Faso. Indeed, maternal and neonatal mortality rates remain high in Burkina Faso (330 per 100,000 live births and 23.2 per 1,000 live births EMDS 2015) despite the efforts made by the State and its partners. Taking care of pregnant women through quality prenatal consultations could help solve this problem. However, this preventive activity aimed at the target population of pregnant women remains unsatisfactory (ANC1 coverage: national 74.10% ;Toma : 60.9%[1]) and few of them manage to reach 4 ANCs (ANC4: national: 38% ;Toma: 34.8%[2]) and of variable quality. 

Also, Burkina Faso adopted the PNP/SR in 2018 taking into account the new WHO recommendations on ANC but implementation remains weak. In response, Terre des hommes and the Ministry of Health are piloting the digitization of maternal care with five forms including the ANC form in Toma district since November 2020. The Maternity REC was developed based on existing WHO guidelines for maternal and neonatal health.

Tdh adopted a pragmatic approach consisting of developing consultation workflows inspired by the field, developing forms similar to those used in health facilities, while using the advantages of digital technology to facilitate the work of health workers and improve the quality of consultations. The result is a contextualized tool that is perfectly aligned with the practices of health workers, achieving the goal of improving the quality of care.

IeDA IMCI and then IeDA maternity were precursors in Burkina Faso. In a digital context with few standards, it was necessary to create patient registers, a register of health centers, a register of HCW, a register of drugs and medicines, map business processes and digitize forms in a very short time. Terre des hommes went to the essential by bringing together these different bricks within the same tool. Interoperability with DHIS2 has been developed in a peer-to-peer manner. Furthermore, the development process chosen did not guarantee an exhaustive implementation of the recommendations related to the ANC. All this makes the ANC form of IeDA Maternity a very specific implementation in Burkina Faso, achieving its objective of improving the quality of care, but not very interoperable and above all difficult to replicate.

The project is an ongoing project within the framework of IeDA Maternity. This project aims to redevelop IeDA Maternity and more specifically its ANC form in compliance with the WHO DAK, the HL7 FHIR implementation guide while implementing the OpenHIE Framework for data. 

The work will be done by the Tdh delegation team in Burkina with the support of the health team in the region and at headquarters. Also, IT4LIFE will provide technical assistance on certain topics. The aim will be to develop a standard reference tool (a complete version of the DAKs) and to adapt it to the Burkina Faso RH NIPs for local testing.

 

Digital health technologies

The implementation of the ANC OMS DAKs will be done on the CommCare platform with FHIR services. Different methodologies will be used such as SCRUM for the development. Tools like TestRail, Testlodge will be used for testing and Productboard for user requirements management.

 

Use Cases and User Stories

The main use cases of the application to be developed are the following:

  • Authenticate yourself
  • Manage patient records
  • Provide prenatal care
  • Manage references
  • View statistics
  • Manage users

 

  1. Use case diagram

 

Figure 1: Use case diagram of the application

  1. Description of the different use cases

The detailed description of the use cases can be found in the attached table.

 

Objectives and activities

Work package 1: Adaptation of ANC according to WHO DAK

Objective 1.1 The aim is to build the capacity of Tdh teams by strengthening their technical ability to ensure a design according to international standards.

  • Activity 1.1.1 Capacity building session on the Agile SCRUM method

The training will focus on theory and practice and will equip the staff to master this method. This training will bring together staff involved in the development of applications, monitoring and evaluation, the medical team and the project management team. It will be facilitated by IT4LIFE.

  • Activity 1.1.2: Capacity building session on FHIR

The session will bring together the application development, monitoring and evaluation, medical, team and project management teams. The training aims to equip the project management staff on FHIR standards, fundamentals and good implementation practices. It will be provided by experts in this field.

Objective 1.2: Develop the ANC form in Commcarre according to the recommended standards (WHO DAK)

Activity 1.2.1: Workshops to design, develop and validate a CNA form according to WHO DAKs

Work sessions in the form of workshops will allow us to define the architecture and the development stages. The validated architecture will be implemented in CommCarre according to international standards. The ICT, medical and monitoring and evaluation teams will work on developing an ANC form according to WHO DAKs and also international standards and good practices for application development.

 

Activity 1.2.2: Conducting tests

Two peripheral health centers will be identified for field testing with patients. Health workers will be identified in these centers to use and test the application. A total of four agents will be used as investigators to test the tool during the design phase over a 40-day period. Supervision will be carried out by the project team (ICT, medical and M&E) to strengthen the capacity of the interviewers and to correct residual problems. Feedback will be provided by the interviewers and integrated into the application.

 

Activity: 1.2.3Presentation and validation of the final CNA form

A workshop will be organized for the validation of the designed application.

 

Activity 1.2.4: Adaptation of the data dictionary to DAKs

The aim will be to develop a data dictionary according to the DAK recommendations. This development and adaptation will bring together the monitoring-evaluation, ICT and medical teams during working sessions and workshops.

 

Activity: 1.2.5Development of monitoring tools

The team will develop a dashboard to track statistics and indicators on prenatal care. This development will be done through work sessions/workshops.

 
Activity 1.2.6: Workshop to develop and validate the implementation guide

This workshop will allow the development of a user guide/manual for the application. This document will be validated and used by different actors for a better understanding

 

Schedule

Activity

Team

Location

Month/Quarter

[Month/Term

 

 

 

 

 

 

[M]

[M]

[M]

[M]

[M]

[M]

[M]

[M]

[M]

[M]

[M]

[M]

1

2

3

4

5

6

7

8

9

10

11

12

Capacity building of teams on good development practices and product management

 

 

 

 

 

 

 

 

 

 

 

 

 

Capacity building session on the Agile SCRUM method in 1 week

Tdh, BFA

X

 

 

 

 

 

 

 

 

 

 

 

Capacity building session on FHIR 10 days

Tdh, BFA

X

 

 

 

 

 

 

 

 

 

 

 

Design, development of the CNA form according to the standards

 

 

 

 

 

 

 

 

 

 

 

 

 

Workshops for the design, development and validation of a CNA form according to WHO DAKs including field feedback on the amendments

Tdh, BFA

 

X

X

X

X

X

X

X

 

 

 

 

Testing (health workers for application testing)

Tdh, BFA

 

 

 

 

 

 

X

X

 

 

 

 

Presentation and validation of the application

Tdh, BFA

 

 

 

 

 

 

 

 

X

 

 

 

Adaptation of the data dictionary according to the DAK

Tdh, BFA

 

 

 

 

 

 

 

 

 

X

 

 

Development of monitoring tools

Tdh, BFA

 

 

 

 

 

 

 

 

 

 

X

 

Elaboration and validation of the implementation guide

 

 

 

 

 

 

 

 

 

 

 

X

 

 

 

The duration of this project will be 12 months divided into 3 main concomitant or successive stages:

  • Design of the tool architecture and the OpenHIE integration environment
  • Development of the tool and integration in its environment.
  • Test of the application in 2 health centers

 

 

 

Deliverables

 

Deliverable

Month/Quarter Due Date

 

[Work package 1, Objective 1.1, Activity 1, Output 1 "Capacity Building Report"]

[M3]

[Work package 1, Objective 1.1, Activity 2, Output 2 "Capacity Building Report"]

[M3]

 

[Work package1 , Objective1 .2 , Activity 1,2,3, Output 3 " ANC form"]

[M9]

[Work package1 , Objective1 . 2, Activity4 , Output "Adapted data 4dictionary"]

[M12]

 

[Work package1 , Objective1 .3, Activity5 , Output "5Dashboard ANC"]

[M12]

[Work package 1, Output 6 "ANC form user manual"]

[M12]

 

Global Good Maturity Model Assessment

https://docs.google.com/spreadsheets/d/1kFXaJGaN87ecsu_nybagI5hvOw-k2V9CCc63N8TA_NI/edit#gid=249752520

 

 

[1] « Annuaire statistique 2020 » from the Ministry of Health in Burkina Faso : http://cns.bf/IMG/pdf/annuaire_statistique_ms_2020_signe.pdf

[2] « Annuaire statistique 2020 » from the Ministry of Health in Burkina Faso : http://cns.bf/IMG/pdf/annuaire_statistique_ms_2020_signe.pdf

Application Status: 
Pending Review & Investment

Comments

Thank you for the concept note. For the full technical application, in addition to general recommendations per the email, please also ensure that your technical application describes the underlying software and particularly how it adheres to the definitions of global goods. The tool is portrayed as being in early stage of use; please ensure the application outlines it scope of current implementation and future plans.

Noting that funding is in part intended to fund "CommCare expertise in order to exploit the public good advanced functionalities, particularly in terms of data management and exploitation", and noting that the CommCare team has also submitted a proposal to this notice ("Reference implementation of WHO Antenatal care Digital Adaptation Kit through CommCare"), it might be worthwhile to collaborate. 

Dear Digital Square team,

Please find our Technical Application with all required documents.

We remain at your disposal should you have any question regarding our submission.

Regards

Florian Triclin - Tdh