Notice C

Promoting the collaborative development of proposals for investments in digital health global goods

Zero to mHero: A Packaged Workflow for Technologists

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support
Proposal Status: 
Approved - Fully Funded

I. Executive Summary

mHero is a two-way, mobile phone-based communication system that connects ministries of health and health workers, developed by IntraHealth International and UNICEF in 2014 and now deployed in seven countries. mHero links the RapidPro communications engine with an InterLinked Registry and iHRIS, an established global good human resource solution for health systems. At present, this complicated software technology stack is difficult for technologists who want to experiment with mHero and has limited adoption.

Zero to mHero promises to make mHero much easier to launch, test, and deploy by developing a standardized and streamlined containerization, orchestration, and configuration of mHero, using Docker or a similar technology. We will also revise the configuration to use mCSD, a FHIR-compliant profile.

With these enhancements, software developers, health program staff, and policy-makers will better understand how to use mHero to support their programs, add new features, and be empowered as users, then as contributors, and eventually as maintainers of the platform.

II. Consortium Team

For 39 years in 100 countries, IntraHealth International has partnered with local communities to make sure health workers are present where they’re needed most, ready to do the job, connected to the technology they need, and safe to do their very best work.  IntraHealth has a long history of developing successful data tools for digital health applications. From mobile apps to management software to multi-language interactive voice response, we offer health workers and managers the tools and technologies they need to do their very best work.

We develop solutions that are open source, data-driven, sustainable, and collaborative. As a pioneer in the field of health workforce informatics, we’re committed to using technology, information, and analytical approaches to support the people at the center of our health systems.

This intervention will be led by the following IntraHealth staff and supported by a full range of health experts, project managers, and software developers:

  • Richard Stanley, Digital Health Product Manager, has over 20 years of experience in information and communication technologies, including directly supporting the development of RapidPro, a core mHero technology, and developing dockerized solutions.

  • Ally Shaban, Global Health Workforce Technologist, has over 7 years of experience in software analysis, design, development, and implementation in both East and West Africa, including leading implementation of mHero in Liberia and Sierra Leone.   

  • Luke Duncan, Digital Health Assistant Director, has over 20 years of experience in software development, including leading the developing of iHRIS, the flagship human resources solution for global health, and multiple data interoperability standards and reference designs to connect iHRIS, DHIS2, and OpenMRS.

  • Emily Nicholson, Technical Advisor, has over 10 years of experience leading and supporting digital health solutions including mHero, iHRIS, OpenHIE, DHIS 2, and OpenMRS. 

The United Nations Children's Fund is a United Nations program headquartered in New York City that provides humanitarian and developmental assistance to children and mothers in developing countries. UNICEF has spent 70 years working to improve the lives of children and their families in 190 countries and territories around the world.

UNICEF created the RapidSMS open source platform in 2007, and later on, RapidPro, a free and open source framework designed to send and receive data using basic mobile phones, manage complex workflows, automate analysis, and present data in real-time. 

UNICEF staff will support the design and testing of the new mHero configuration and workflow processes, including:

  • Sean Blaschke, Technology for Development Business Analyst, East and Southern African Regional Office, has over 18 years of experience supporting health and technology programs and operations in 21 countries in sub-Saharan Africa,

III. Project Description

Problem Statement

Open source technology has a reputation for requiring a high degree of technical knowledge to install and operate.mHero, a two-way, mobile phone-based communication system to connect ministries of health and health workers, is no exception.

mHero was developed by IntraHealth International and UNICEF in 2014 to support health-sector communication during the Ebola outbreak in Liberia as a USAID Grand Challenge winner. mHero linked the RapidPro communications engine with an InterLinked Registry and iHRIS, an established global good workforce solution for health systems, to support efforts to fight the Ebola epidemic. mHero helped health workers report on new cases; broadcast messages about care and prevention; share training information; and allow for real-time coordination between them and the ministry.

mHero builds on best practices in using Short Message Service (SMS) and Interactive Voice Response (IVR), which are widely and successfully used to create reminders, alerts, and surveys to engage populations, such as frontline health workers.

Launching the mHero stack requires an OpenHIM console and server (with MongoDB), a mediator (microservice), OpenInfoMan, and additional OpenInfoMan libraries, as well as iHRIS and RapidPro. Each software is open source and available at its respective website. mHero.org contains more information about its configuration and deployment in health systems.

However, as mHero hasn’t had funding directed toward software development, it is still a complicated software technology stack that is difficult for technologists to launch and test. This has limited its adoption to IntraHealth programs in Angola, Burundi, Cote d'Ivoire, Trinidad & Tobago, Malawi, and Mali, in addition to Liberia.

Technical Approach

We will work with UNICEF to develop comprehensive use cases that will guide our efforts to make mHero much easier to launch, test, and deploy. We will develop a standardized and streamlined containerization, orchestration, and configuration of the mHero stack using Docker Compose or a similar technology. We will also revise the configuration to use mCSD, a FHIR-compliant profile.

We will then test our configurations with UNICEF staff to ensure that software developers better understand how to use mHero to support their programs, add features, and be empowered as users, then as contributors, and eventually as maintainers of the platform.

mHero then can be adopted by ministries of health for disease surveillance, where there is existing demand, and government staff can expand it for other health worker communication use cases.  

Use of Digital Health Technologies

Work Plan, Schedule, and Deliverables

Month 1-2: Phase 1 - Functionality Research. We will start this project by reviewing the existing mHero software stack and documenting the multiple steps required to launch the platform. We will validate our RapidPro steps and use cases with UNICEF. We will create a plan to optimize the current process, developing the most streamlined configuration protocol that still allows for system customizations. We will also revise the mHero workflow to use mCSD, a FHIR profile, and test the results to ensure compliance with the FHIR standard. Deliverables:

  • Documented workflows with a mCSD profile.

Month 3-4: Phase 2 - Workflow Development. We will develop the containerization and orchestration workflow using open source tools, like Docker Compose, with the goal of making the process and documentation easy to follow for a competent software developer who is familiar with containerization. We will test this workflow with UNICEF staff. Deliverables:

  • A beta version of the software solution and documentation.

Month 5-6: Phase 3 - Beta Testing. Next, we will test the process and documentation with interested developers and UNICEF staff to make sure that they can truly go from zero to mHero. This testing process will also include debugging and feature development to increase the usability of the launch process. Deliverables:

  • A release candidate version of the software and documentation.

Month 7-8: Phase 4 - Release and Promotion. Finally, we will upload a release candidate version of the software and related documentation to GitHub. We will develop a marketing campaign to make sure that the software developers, program implementers, and policy-makers that make up the global health community are aware of mHero’s new ease-of-use. Deliverables:

  • A published release candidate and executed marketing campaign.

A GANTT chart of the project can be found at https://docs.google.com/spreadsheets/d/1cWBUaN8D6yZlZZ_WQD4gyz_Un9p3GQG87lcg5VXslm8/edit?usp=sharing

Digital Health Atlas

mHero Registration: https://digitalhealthatlas.org/public/142/assessment

Monitoring and Evaluation

IntraHealth International has robust monitoring and evaluation processes to ensure project compliance and success.

We will start this engagement with a deep discussion with representative software developers and policy-makers to confirm our initial needs assessment and create a clear future vision, with documented success criteria.

As we proceed through the software development process, we will monitor our progress to make sure that we are still building toward our future vision. We will bring in other global health community members to ensure our work has the greatest overall utility.

Once the software is developed and we begin publicizing its utility, we'll evaluate our overall efforts to measure how well we've met our initial objectives and the extent to which the new software is changing the way software developers approach mHero deployments.

IV. Two-Sentence Overview

Zero to mHero will make mHero much easier to launch, test, and deploy, and allow software developers, health program staff, and policy-makers to incorporate interoperable SMS and interactive voice response systems into their country health programs.

Digital Square will be supporting a standardized and streamlined containerization, orchestration, and configuration of mHero, using Docker or a similar technology, and revising the configuration to use mCSD, a FHIR-compliant profile.

V. Community Feedback

Our key engagement point with the broader digital health community will be through our advisory group, made up of representative software developers and policy-makers. This group will be initially populated by existing mHero users and UNICEF staff, and we’ll aim to quickly expand this group by bringing in health experts and technology practitioners from their respective communities and the Global Digital Health Network, and similar technology and policy communities.

We expect this advisory group to give regular input and guidance on the technology solution design and the context in which it will work, including:

  • Use cases to inform software development and testing
  • Software architecture to ensure interoperability with existing systems
  • Software documentation and code that’s usable by a wide variety of stakeholders.

As we proceed through the development process, we’ll engage with the advisory group with regular check-ins at the start and end of each phase, to make sure that we are still building toward our future vision. We will also bring in stakeholders from across the greater digital health community at the end of each phase to ensure our solution has the greatest overall utility across multiple countries.

VI. Use Cases, User Stories

HMIS Software Developer

A software developer in a ministry of health can gain greater familiarity with RapidPro, and quickly connect it to their existing health systems using the zero to mHero solution. The software developer can also use the mHero FHIR interface to extend its functionality to any other system that also uses FHIR. For example, the developer could connect mHero to their laboratory testing and reporting systems to generate automatic SMS alerts of test results for health workers and update DHIS 2 Tracker.

UNICEF Country Office Staff

An experienced RapidPro user in a UNICEF country office, many of which have heavily invested in RapidPro, can use the zero to mHero solution to better understand the health ecosystem, and connect their existing programming to national health information systems. For example, their U Report system, which is based on RapidPro, could be configured to automatically alert the relevant health workers when a high-importance response is received in U Report. 

Disease Surveillance Software Developer

Software developers who are supporting ministries of health can use the zero to mHero solution to quickly establish robust electronic Integrated Disease Surveillance and Response (eIDSR) frameworks, and other alerting systems, and connect them to existing health services. This builds on the original mHero use case with a lower technical barrier to entry for country system managers.

Health System Support Software Developer

Software developers who are supporting health system strengthening activities can use zero to mHero to quickly develop educational content for health worker pre-service and in-service training and learning objectives, remind health workers about their expected duty stations and shifts, and collect data from them on their working conditions and patient health outcomes—connecting all of these activities to existing government systems for better tracking and analysis.

VII. Self-Assessment on the Global Goods Maturity Model

The self-assessment for mHero can be found at https://docs.google.com/spreadsheets/d/19SFm2IPbdRhkUXpIzGKtQUaFXEJqhScSOZuuUOzNCbY/edit#gid=249752520

VIII. Tagging

  • mHero
  • Docker
  • FHIR
  • Containerization
  • Orchestration
  • Software configuration
  • Deployment workflows
  • Human resource management
  • Data coding
  • Data exchange