IeDA is a health approach containing digital health tools initially developed in Burkina Faso at the peripheral level of the health system, to support health workers in their work. This project aims to make IeDA "shelf ready" by improving its maturity as a Public Goods, as well as by developing its interoperability within an architecture that respects the framework defined by the OpenHIE.
IeDA is the digital health approach of Terre des hommes, developed in Burkina Faso. Initially intended for consultations for children under 5 years of age, it now includes a "Maternity" module for women, pregnant women and mothers (ANC, PNC, Delivery, FP, PAC). IeDA is implemented in more than 1700 health facilities in Burkina, about 50 in Mali, two in Niger and about 50 in India.
The core of IeDA is a job aid tool, aligned with WHO guidelines and the policies, standards and protocols of the countries where the approach is deployed. In order to function in contexts such as Burkina Faso and at the time of the creation of the approach, it was necessary to put in place the functional bricks that were essential to its implementation: the patient registry, the HCW registry, the Master Facility list, the drug/product registry, the terminology registry. In order to reduce design, development and implementation time, these bricks were implemented directly on CommCare (the platform used in Burkina Faso for IeDA) and directly in the IeDA application. In today's world, where interoperability and mutualization are sought after, the approach would be different. The result is a robust and reliable tool, but not very interoperable, and difficult to maintain because of its complexity.
IeDA has reached a stage where it is necessary to rethink its entire design and development chain. For this, Terre des hommes proposes to make IeDA evolve towards characteristics close to those of a Global Public Goods, in order to accelerate its development and replication in other West African, sub-Saharan and Asian contexts. This involves the formalization of its governance structure, its global roadmap, the creation of a developers community, the preparation of various documentations (users, implementers, developers), rethinking the global architecture of the application (core + packages), among other activities.
Given the disparity of digital health contexts around the world, it also seems necessary to make IeDA flexible to adapt to this disparity. In order to facilitate (and therefore accelerate) the deployment of IeDA, packages compatible with the OpenHIE interoperability framework and compatible with IeDA will be developed to adapt and integrate in the different digital health contexts that will be encountered.
Terre des hommes will rely on its internal regional team (Dakar), on the Burkina Faso Team as well as on external resources (consultants) based in West Africa, to train, accompany and supervise Terre des hommes in this project.
The two identified workstreams will lead to a form of containerization of IeDA in order to accelerate and facilitate its implementation in various contexts.
It is not planned to build a consortium for this project. Terre des hommes will rely on external resources (consultants), not identified at this stage, but whose expected expertise is specified later in this document.
Background or problem statement
Terre des hommes is the largest Swiss NGO for child relief. Through its health program, Terre des hommes seeks to improve the health of mothers and children by improving the quality of care provided at the primary level of health systems in its countries of intervention. The digital health tool IeDA has been developed with this aim, to offer diagnostic assistance to health workers in the health centers of Burkina Faso. The primary vocation of this tool is therefore to be a job aid tool, based on contextualized management protocols for the countries in which it is deployed.
IeDA was designed and developed in Burkina Faso, without having integrated as a constraint the replicability in other contexts. IeDA is therefore very specific to Burkina Faso, and largely dependent on the digital health context in this country. In particular, Terre des hommes has created and implemented patient databases, registers of medicines, health agents or health centers, in order to enable the Job Aid Tool to function properly. Despite this constraint, Terre des hommes has been able to replicate IeDA in Mali, Niger, and India (IeDA PCIME) and is in the process of doing the same in Guinea (IeDA Maternity).
On the other hand, Terre des hommes came to digital health through IeDA before developing an expertise in this field. The development of IeDA did not necessarily follow a particular methodology nor concepts, now widely used, to facilitate the maintenance and evolution of the code.
It is therefore necessary to rethink the architecture of IeDA as much as its design and implementation methods, and its compliance with the consensus standards in digital health.
Terre des hommes proposes to base the redesign of IeDA in Senegal in Dakar, where the Africa digital health team is based and will be in charge of the implementation. This redesign project would be an ongoing project, linked to the current development of IeDA, and the funding requested in this request would be a first step in a longer series aimed at completing the transformation of IeDA.
Digital health technologies
The technology currently used by Terre des hommes to implement IeDA is CommCare, an OpenSource technology, itself, qualified as Public Goods by the main actor implementing it, Dimagi.
Terre des hommes believes that CommCare remains the most suitable technology for tools like IeDA. Its key features, such as its ability to operate in disconnected mode, remain decisive advantages. Nevertheless, Dimagi will be called upon to develop interoperability functionalities in order to allow full integration of the platform and IeDA in an architecture that meets the OpenHIE interoperability framework. In this field, Terre des hommes will choose, with the help of an expert consultant, the best modules / packages to implement the interoperability conceptualized by OpenHIE.
Use cases and user stories
Containerizing IeDA will improve the replicability of the tool in other contexts: national health teams implementing IeDA in countries, assisted by regional teams (Africa, Asia and MENA) will be equipped to ensure replicability and contextualization of IeDA.
Containerizing IeDA will facilitate the work of Data Managers and M&E teams for the production of internal indicators as well as for the provision of individual or aggregated data to Ministries and government agencies in charge of health data management.
Containerizing IeDA will also make it easier for the developer community to maintain IeDA and evolve it to keep pace with changing guidelines and national policies, standards and protocols.
Objectives and activities
Work package 1: Promote the replicability of IeDA by improving its maturity as a public good
Objective 1.1: Development of "community support
Activity 1.1.1: Creation of a community platform for IeDA developers and contributors
Developers and contributors to IeDA will be engaged on a community platform dedicated to the development of IeDA. The community will include representatives from countries where IeDA is implemented (Burkina Faso, Mali, India, Guinea, Niger) and representatives from observer countries, interested in deploying IeDA in their countries.
Duties related to this activity will include:
- Registration of IeDA in the different forums and community platforms related to digital health: Digital Square, OpenHIE, FHIR,
- Creation of a community platform "IeDA" to centralize existing and future contributions and federate a community of developers around the development project.
- Animation of a community through the organization of remote events, connectathons, etc.
Activity 1.1.2: Creation of IeDA governance structures
Formal community structures (e.g., leadership, technical advisory group, community representatives) will be created and instantiated with transparently documented roles and responsibilities and will be used to direct the ongoing development of IeDA.
Digital health actors, within the Ministries of Health of IeDA beneficiary countries, and international NGOs will be identified and solicited to constitute the strategic and technical governance structures of IeDA.
The strategic group will meet once to define the rules of operation of the various structures, their constitution, their mode of renewal.
Activity 1.13: Implementation of a global software roadmap for IeDA
New features and functionality in IeDA will be documented in a software roadmap and release cycle. Forums will be opened for community members to discuss requests for new features. A clear prioritization process will be documented, and used for the development of new features as part of a product backlog.
Activity 1.14: Creating user documentation
A full suite of user documentation will be developed, including training manuals, online courses, tutorials, and implementation guides for most common features. The documentation will be published under a Creative Commons license.
Activity 1.15: Implementation of multilingual support
IeDA will be translated into at least English and will meet internationalization requirements. A tool to easily add new translations to IeDA will be developed. Important parts of the documentation for users and implementers will be translated into at least English.
Objective 12: Development of software maturity
Activity 12.1: Improving accessibility to source code
The source code will be made publicly available in a repository under a license approved by the Open Source Initiative. IeDA will be structured to allow local customizations and the addition of new modules and features without the need to fork the main code.
Activity 12.2: Formalization of technical documentation
Source code will be documented: new adopters will be able to customize and add new features without relying on extensive help from one of the core developers. Online courses or tutorials will be available to cover common development and deployment tasks. Core workflows and functional requirements will be fully documented using use cases, user stories or other equivalent methodology.
Activity 12.3: Strengthening software productivity
Full documentation will be made available for deployment and configuration. A new implementation will no longer require the intervention of the core development team.
Activity 12.4: Development of IeDA interoperability and accessibility to its data
A robust API will be created to address key data and metadata exchange needs in the core business area, with functional requirements for the API developed in collaboration with appropriate national, regional, and global stakeholders. API access points will be created for core data and metadata elements that meet international health data standards.
Activity 12.5: Strengthening data security
Authentication/authorization based on duties and responsibilities will be created where appropriate. All remote access (web interface, API) will be encrypted by default according to current best practices. An independent software security audit will be scheduled during 2022.
Work package 2: Creation of a digital, lightweight and modular environment, compliant with the OpenHIE interoperability framework and compatible with IeDA
Objective: 2.1Develop a modular OpenHIE compliant digital environment to facilitate the deployment of IeDA
Activity2 .1.1: Implementation of an environment based on the Instant OpenHIE project https://openhie.github.io/instant/
Instant OpenHIE provides several sets of scripts to configure and install OpenHIE components for particular OpenHIE use cases and workflows. These scripts and configurations are organized into self-contained packages. Each of these packages can depend on other packages, making it possible to instantly configure a very complex infrastructure by deploying a number of packages.
Each of these packages contains scripts that configure the containerized applications. The scripts configure and preload the necessary data into the containers. Docker will be used to containerize the applications, which makes it easy to deploy them.
Activity2 .1.2 : Containerization of Instant OpenHIE modules for IeDA
Within the framework of this activity, it will be a question of creating a modular environment instant OpenHIE, by packaging the various modules necessary to the complete deployment of an OpenHIE architecture in an environment which would be completely deprived of it.
Objective: 2.2Make IeDA / CommCare compatible with Instant OpenHIE packages developed
Activity2 .2.1: Using the OpenFn module https://docs.openfn.org to integrate IeDA into an OpenHIE environment.
OpenFn is a suite of data integration, interoperability and business process (i.e. workflow) automation tools used by governments, NGOs and social enterprises, primarily in the health and humanitarian sectors. The opportunity to use OpenFn as an interoperability module for CommCare will be explored. The objective will be to overcome the difficulties of CommCare to integrate in an environment that follows the OpenHIE concepts.
Comments from the community
The creation of a community platform for the development of IeDA will aim to federate the digital health community around the project and to involve it in the choices that will be made on the architecture, design and software roadmap. Specific forums will be created in which the community will be consulted. Users will be able to ask for help from the community to overcome problems encountered in the development or implementation of IeDA in their context.
The establishment of strategic and technical governance structures will facilitate the implementation of events around IeDA to foster the expansion of the community.
The technical group will engage IeDA in the OpenHIE community, through a dedicated channel that will specify the architecture needed to integrate IeDA into a fully compliant OpenHIE environment.
Schedule
Here is a high level work plan.
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Activity |
Team Location Month/Quarter |
[Month/Term |
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M |
M |
M |
M |
M |
M |
M |
M |
M |
M |
M |
M |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
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Creation of a community platform for IeDA developers and contributors |
SN
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X |
X |
X |
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Launch of the community platform |
SN |
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X |
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Creation of the IeDA governance structures |
SN |
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X |
X |
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IeDA Governance" workshop |
SN |
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X |
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Implementation of a global software roadmap for IeDA |
SN |
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X |
X |
X |
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Creation of user documentation |
SN |
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X |
X |
X |
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Implementation of multilingual support |
SN |
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X |
X |
X |
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Improved accessibility to the source code |
SN |
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X |
X |
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Formalization of the provisional technical documentation |
SN |
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X |
X |
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Finalization of the technical documentation |
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X |
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Strengthening software productivity |
BFA |
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X |
X |
X |
X |
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Development of IeDA interoperability and accessibility to its data |
BFA |
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X |
X |
X |
X |
X |
X |
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Strengthening data security |
BFA |
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X |
X |
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Instant OpenHIE |
BFA |
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X |
X |
X |
X |
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Containerization of Instant OpenHIE modules for IeDA |
BFA |
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X |
X |
X |
X |
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OpenFn |
BFA |
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X |
X |
X |
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Deliverables
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Deliverables |
Month of maturity |
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[Work Package1 , Objective1 , Activity result 1] Functional and live community platform |
M3 |
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[Work Package1 , Objective1 , Activity result 2] Status and composition of IeDA's governance structures |
M3 |
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[Work Package1 , Objective1 , Activity result 3] IeDA software roadmap |
M5 |
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[Work Package1 , Objective1 , Activity result 4] User documentation for IeDA |
M7 |
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[Work Package1 , Objective1 , Activity result 5] Availability of the multilingual module |
M10 |
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[Work Package1 , Objective2 , Activity result 1] Availability of IeDA source code |
M4 |
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[Work Package1 , Objective2 , Activity result 2] Final technical documentation |
M12 |
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[Work Package1 , Objective2 , Activity result 3] Documentation for deployment and configuration |
M12 |
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[Work Package1 , Objective2 , Activity result 4] Data exchange API |
M12 |
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[Work Package2 , Objective1 , Activity result 1] Instant OpenHIE test environment (Sandbox) |
M7 |
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[Work Package2 , Objective1 , Activity result 2] OpenHIE modular environment |
M10 |
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[Work Package2 , Objective2 , Activity result 1] IeDA application fully compliant with OpenHIE environment |
M12 |
Global Good Maturity Model Assessment
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 explain why the deployment footprint is different in this application compared to what is included in F0.
Technical application
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