Notice C

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

Digital Square supports investments in digital health global goods, which are tools that are adaptable to different countries and contexts. Mature digital health global good software is software that is (usually) Free and Open Source (FOSS), is supported by a strong community, has a clear governance structure, is funded by multiple sources, has been deployed at significant scale, is used across multiple countries, has demonstrated effectiveness, is designed to be interoperable, and is an emergent standard application.

We are using an open proposal process. Your concept notes and proposals will be publicly posted, giving you and other submitters the opportunity to find collaborators and provide and receive feedback from your peers.

Concept-Notes (48 total)

Displaying 36 - 40

Planwise - Optimizing Geospatial Network Coverage

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

Executive Summary

What is Planwise? Planwise is an open source software tool that uses geospatial modeling and optimization techniques to make it simple for an organization to understand whom they are helping, and to maximize the efficiency impact of their services.  Specifically, it shows a user what the current coverage and capacity of the network is, and then produces scenarios for how to best enhance access to care; for the least amount of funding.

Millions of people use “big data” and complex optimization algorithms every day when they look up driving directions on their smartphone. Combining good design and fast algorithms can make an otherwise daunting task intuitive, transparent, and accessible. Planwise makes optimizing the coverage of a service network (e.g., health facilities or schools) as easy as getting driving directions on your phone. It can analyze and generate coverage or catchment maps for your program & then suggest the most impactful options to improve access or capacity. Planwise does this without needing external consultants, forcing users to difficult to use or proprietary datasets or hire a data scientist.

See a brief video:     

Now, the Planwise community is seeking to mature, grow, and extend the community of implementers for increased impact. Specifically, we are seeking to:

  1. Formalize and grow the community of implementers
  2. Create and deploy a strategy for replication and scaled impact
  3. Extend Planwise functionality to fill priority community-identified gaps

Planwise Project Description

This concept note seeks to catalyze and respond to the current demand to mature the Planwise community and solution. By providing free to use, powerful planning tools, to augment the human insights to planners and managers, it is possible to achieve significant impact. The Planwise solution to date has the core components available for completing this process.  

In communities around the world, significant proportions of the population live outside the reach of critical, life-saving, health or other social services. Access to care is affected by the demand for services being greater than their capacity or that the distance an individual must travel is too far. Community and program leaders, planners, and managers are responsible for increasing access to these services but must do so without understanding the current geographic coverage area and how to optimize access to care efficiently.

Planwise solves this challenge by taking three categories of data and bringing them together in a coordinated way. The tool uses data on the current population, overlaying road and walking time calculations, and lastly locations of service networks or the health system. Each of these types of data is now available via open global services, see below for specific details. Together these data sets combined with the industry-leading best practice algorithms, and optimization techniques allow a ministry of health or NGO program manager to use Planwise to see three critical pieces of analysis:

  • The current coverage of the health system and quantified current capacity.
  • Identify areas where coverage is missing; Or with an overloaded network.
  • Receive suggested scenarios for how to best enhance the service delivery network for maximum impact.

In the future, we also plan to include other modifiers on service demand, such as disease epidemiology or the quality of services provided at a facility. This type of service is possible due to the existence of global services, including:

  1. WorldPop that provides an open-access archive of spatial demographic datasets for the developing world.
  2. Open Street Maps (OSM) that provides open road network data - while incomplete in some places, it represents the best scalable service for this data. Initiatives such as Missing Maps can also help to close these gaps for implementation partners.
  3. Google Earth Engine and the collaboration with the University of South Hampton have recently made friction surface data accessible, to allow for walking time calculations.
  4. Any geospatial dataset for a service network, including OpenHIE. Planwise allows for CSV uploads, and in the future, we plan to support common formats/standards of geospatial location data.

The application of Planwise began with maternal and child health and laboratory planning, but has expanded as more partners engage including more broadly:

  • Primary healthcare delivery, particularly for maternal and child health programs seeking to deploy new facilities, upgrade facilities, add ambulances, mobile clinics
  • Laboratory or referral networks, where facilities collect a sample or interact with a patient before further testing or treatment at a second location.
  • Staffing and training, to improve the capacity and quality of staff located within the network of locations.
  • Village or site-level interventions, disaster response where a team sets up for a period to offer emergency services or to support a public health campaign.
  • Radio tower placement and capacity for international development projects that provide educational programming and behavior change content.
  • Water well and school placement to maximize impact for investments in access and availability of critical services.

Past design and implementation partners include Concern Worldwide and the African Society of Laboratory Medicine (ALSM) - implementing in Niger, Kenya, and Ethiopia. Our partners plan to scale-up of these activities in the next 6 months. Other key partners have been identified across half a dozen other nonprofits and social impact organizations, and are working in many countries across Africa and Asia. Planwise is already operational in Afghanistan, Burkina Faso, Central Africa Republic, Ethiopia, Kenya, Nepal, Niger, Pakistan, Philippines, Tanzania, Thailand, and Uganda. Additional countries are actively being provided routinely through current program activities.

Open Source Repository: via GPLv3

Technical Approach

InSTEDD, working with existing partners, has already developed and deployed a working and stable cloud-hosted instance of Planwise that is free to use. We want to build on this success to see Planwise implementations replicated and impact scaled. The following objectives are required to achieve our impact goals:

  1. Formalize and grow the community of implementers
  2. Strategy for replication and scaled impact
  3. Extend Planwise functionality to fill priority community-identified gaps

1: Formalize and Grow the Community of Implementers

A grassroots network of Planwise implementers has emerged through InSTEDD’s leadership and partner network.  Our first objective for this project is to formalize this engagement and create an open community and governance structure that collects and shares experience, knowledge, as well as informs the future development of Planwise.  This is critical to achieving NGO-driven replication of Planwise use and to facilitate transparent collaboration among partners. Activities include:

Activity 1.1: Design and Document a Governance Model - First, we propose to design and document, with key stakeholders, a governance model for the Planwise OSS solution that makes it clear how groups can contribute or collaborate, protect intellectual property, and prioritize the future development of Planwise. Protecting the intellectual property of experts is essential, specifically for the data science associated with geospatial modeling and optimization. The license for Planwise will continue to be open-source GPLv3.

Activity 1.2: Setup Digital Community Resources and Infrastructure - We propose to set-up online community tools and establish resources for Planwise implementers and partners. It should be simple and straightforward for contributors or implementers to connect with the community and learn the basics about how to use or contribute to Planwise.

Activity 1.3: Operationalize and Run the Community - Operationalize and Run the Community - Once the foundational pieces of an online community are in place, the task of operationalizing and managing the community can begin. This process necessitates a blend of providing routine value to others, as well as fostering organic community participation. To more explicitly engage implementers, we plan to document case studies from 3 implementers and empower them to share their experiences through the community.


  1. Published governance and community model for Planwise;
  2. Operationalized community with participation from stakeholders using Planwise,
  3. With online resources and infrastructure ready. (e.g., wiki, chat-forums, and calendar of events) & Communication Tools - Simple website and onboarding materials
  4. 3 Planwise implementer case-studies.

2: Strategy for Replication and Scaled Impact

We believe the Planwise solution is ready for scale and replication to any program looking to make data-driven decisions for where investments are made to improve service. To achieve this, we are seeking to create and implement a strategy for replication and scale.  By designing such a strategy or model with scale and replication in mind, our team is seeking to find a sustainable pathway to achieve replication and increased impact; in addition to being able to maintain and extend Planwise functionality. Our experience from past open source initiatives is that quality technology alone can’t achieve the type of impact we are seeking.  That designing a strong program, engaging the right partners and executing on the model is just as critical to success. Activities include:

Activity 2.1: Bootstrap Implementation Support for Key Impact Partners - New partners may be interested in exploring the use of Planwise, but have difficulty facilitating it for existing programs. We would like to help these partners bootstrap Planwise into their organizations.  As part of the program, we propose to seed fund 3-5 organizations to explore Planwise utilization across their programs. Increasing the number of implementers are critical to many aspects of this project, but also for this program to have a direct and measurable impact.

Activity 2.2: Design and Test Models for Sustainability - Designing solutions that can have a scaled impact require a focus on developing and testing models that facilitate replication. We do not anticipate a single funder supporting Planwise directly, so instead, we plan to create a model of services and an associated program that helps partners easily replicate Planwise implementation.  While this makes it easier for partners to integrate Planwise into their programs, it also helps to make Planwise more sustainable. We would also like to explore the potential to identify other pathways for sustainability, such as private sector licensing. When our team has a first version of the model developed, we plan to test the model among partners; and using qualitative/quantitative analysis to evaluate what works and experimenting as we go.  Further, this includes seeking to formally collaborate with key actors such as WorldPop and other geospatial communities of practice.

Activity 2.3: Production of Support Materials - An organizations decision to begin using a solution like Planwise, necessitates some degree of disruption of their status-quo; as Planwise is genuinely a novel service that allows them to leapfrog several maturity steps. We would like to develop a simple set of community materials that assist in the onboarding of implementation partners and also helps them to quickly and independently begin using Planwise.  Facilitating easy use is critical, as Planwise often disrupts or is an entirely novel concept for some groups. We want to make it as easy as possible for groups to take advantage of Planwise.

Activity 2.4: Mobilize a Publication / Scientific Literature Committee that reviews best practice literature for geospatial modeling, creates a research plan with implementers/universities, develops abstracts and publications that are then submitting to journals and presented at conferences.  Participation by researchers is critical as Planwise can both contribute to, and benefit from a rapidly changing landscape of geospatial analytics and other data science techniques. By fostering a group of researchers who can grow the knowledge base, the quality of Planwise will results will improve, and we will attract more research-minded users.

  1. 3-5 organizations using Planwise
  2. A tested model to support replication and scalability
  3. User support materials, to help users independently solve their issues and use the tool.
  4. Research committee, working towards publications with partner researchers and associated implementers

3: Extend Planwise Functionality to Fill Community-identified Gaps

As is the case with most open-source software projects; there are usability, interoperability, and critical aspects of functionality where dedicated investment could help foster additional scale and grow the community of implementers by removing barriers to their use. Any investment or enhancements made to the solution will use the roadmap created by implementers.  This feedback loop is critical because we want to ensure that Planwise maps to implementers needs, and is reactive to users. Also, as we begin new collaborations, we will learn more about how Planwise should work, and being able to have the flexibility to respond to those findings will be vital to staying relevant. Activities for this objective include:

Activity 3.1: Load additional country metadata for 50 countries (e.g., roads, friction surfaces, & population). We currently have 10 countries loaded as of September 2018 and expect to have approximately 15-20 by December 2018 - all of which have been funded by current implementers. Any implementer can use loaded metadata once it has been loaded for a country, amortizing the investment.  This is key so that countries can easily begin using Planwise in their priority countries that are not currently covered.

Activity 3.2: Enable additional planning scenarios and functionality - Planwise supports two forms of planning right now; 1) Referral scenarios (e.g., lab tests or transport for services) and 2) direct service access. There are other types of planning scenarios and dimensions of planning we have already identified from partners that would be useful to provide straightforward templates for Planwise use (e.g., Outbreak preparedness/response, capacity building, malaria eradication, etc.).  We would like to work with implementers to document their needs and collaboratively create a roadmap for enhancing Planwise. This will increase participation by partners, and build in a feedback loop to respond to users critical needs.

Activity 3.3: Ensure interoperability with partner systems by implementing standards that are common in the health and geospatial data domain. Typical standards include ones such as FHIR, mCSD, or other geospatial-based standards such as those supported by the Open Geospatial Community. Interoperability with services like DHIS2 or is a priority. Planwise does support integrations with facility registry applications currently as well as providing a simple CSV import functionality as well for service location data. Making Planwise interoperable with common standards will help increase partners ability to import their service networks.

Activity 3.4: Interfaces to enable fine tuning and experiments by GIS experts. By enabling Planwise to act as a hub for research and improving geospatial optimization and planning techniques; not only with implementers and the platform be enhanced, but the state of knowledge around geospatial modeling.  Also, this functionality will target supporting the consultants and experts who often carry out these types of activities manually. Planwise can then act as a tool that enables experts to go further in their analysis and recommendations, focusing on more sophisticated issues and research questions.

  1. 50 new countries with loaded metadata; where implementation will now be possible.
  2. Community-generated roadmap of enhancements; to support user prioritized functionality and planning scenario project templates.
  3. Enhanced Planwise deployed and shared as open source software (GPLv3)
  4. Interoperability with OpenHIE / geospatial information systems.
  5. GIS expert interface in Planwise, to enable research and customization of modeling algorithms.

Consortium Team

InSTEDD is a non-profit, human-centered design, and software development organization based in California, with innovation labs (iLabs) located in Southeast Asia and Latin America. InSTEDD has been working in the health and development space for the last decade, developing high quality, scalable, open source digital solutions. InSTEDD is committed to HCD, agile development, capacity building, open source, and ensuring that partners have more significant degrees of positive impact with technology. InSTEDD was founded in 2006.  

Examples of related work include:

  • Africa Laboratory Mapping Project, with ASLM.  Seeking to map and improve laboratory networks across the continent.
  • Founding member and community lead for OpenHIE - focusing on facility registries and geospatial services and interoperability.
  • Cepheid GeneXpert remote telemetry and connectivity solution for diagnostic tests.

We plan to manage the development and community efforts centrally from the InSTEDD team. Our team will engage stakeholders with concrete implementations, who are currently, or planning to, use Planwise. Core to our team are:

  • Scott Teesdale: Program Lead and Design Researcher
  • Nico di Tada: Architect and Director of Platform Engineering
  • Backed up by the InSTEDD platform, iLab and other core team members as needed.

Other groups who are key stakeholders include the following implementers that are interested in implementing Planwise for their programs:

  • Catholic Relief Services to integrate Planwise across their programs and improve the quality of service delivery, particularly related to walking times to healthcare focusing on program work Sub-Saharan Africa.
  • Equal Access is exploring the applicability of Planwise to measure the impact of health programs transmitted via FM & AM radio and optimize their reach by calculating and optimizing locations and characteristics of transmitters. Many of these programs are located in the Sahel region of Africa and the Middle-east / Asia.
  • ASLM: Working on a funded program that is implementing Planwise in 2018 for diagnostic device placement and sample referral optimization in 12 countries - Niger, Ethiopia, Zambia, Zimbabwe, Malawi, Congo, Brazzaville, Cameroon, CAR, DRC, Gabon, Chad, & Sao Tome
  • Concern Worldwide was the first implementer of Planwise for Maternal Child Health, and their collaborators and funders (including the Xerox Foundation, and with special acknowledgment of Kelly Roberson who first pioneered with InSTEDD the work on productizing, at scale, the mathematical models validated in Kilifi, Kenya). Concern now focuses programs on the most challenging humanitarian environments.
  • Tupaia is an HMIS system being deployed in the Asia-Pacific region and are interested in using Planwise for both planning and disaster response purposes.
  • UCSF and Akros are implementing malaria control programs, and are interested in using Planwise to improve malaria eradication programs.
  • PCI-India: To improve and maximize the impact of their vaccination and infectious disease work in Bihar, India.

Technical collaborators include:

  • WorldPop, the open population and movement dataset effort that provides open access archive of spatial demographic datasets as a data commons, maintained by the University of Southampton. Additionally, Southampton researchers and grant writers are exploring further implementations of Planwise.
  • OpenStreetMap as a provider of road networks and in some cases drive time data.
  • Google Earth Engine as a source of elevation data, and as a close ally of Planwise that has worked with the University of Oxford to create unique data derivatives and friction surface maps corresponding to walking times, which Planwise can help operationalize in the field.

We plan to continue to grow the list of interested stakeholders and invite them into the community of users.

Digital Health Technologies

Planwise is its own stand-alone open source software solution, that is hosted free to use in the cloud. Partners who wish to deploy their own local version are free to do this, although we don’t recommend this unless the hosting infrastructure is proven and ready. Further, geospatial data on service location doesn’t have any of the typical limitations of medical records that have PII, so there are many financial and logistical benefits of using the cloud.

Work Plan, Project Deliverables & Timeline 

The work plan for the Planwise concept can be found here: Link to spreadsheet

Community Feedback & Ecosystem

Planwise organically attracted a living ecosystem of public and private sector data providers, algorithm experts, and country implementers, connected by common interest rather than by MOUs and competitive contracts.

Planwise commits to act as a genuinely open initiative allowing for a multitude of partners and collaborators to engage and not driven by a single consortium or set of partners. To grow the community organically, we plan to focus on empowering groups and providing value, which aligns with the community by supporting their goals. Specifically, we will:
  • Hold routine (monthly) web-based community meetings where participants can share best practices, case studies, challenges, explore collaborations, and share updates.
  • Conduct surveys and polls to gather feedback on community meetings, Planwise enhancements, guidance needs, and support material requirements, etc.
  • Create and maintain an open digital repository of guidance, likely a wiki or simple website, to share information and details.
  • Provide a simple mechanism to share and review concepts or proposals, and find collaborators.
  • Depending on community preferences, we may also create a chatroom environment (e.g., slack) or google groups for asynchronous communication.
  • Engage other communities such as OpenHIE
Planwise is a powerful example of how catalyst funds could both support current implementation and accelerate the growth of a network and technology that has the vision of being self-sustainable in the long run. Thank you for considering our concept, let us know if you have any questions.


  • Maternal and Child Health
  • Disease Surveillance and outbreak response
  • Laboratory management and referral pathways
  • Radio Towers
  • Water points
  • Schools
  • Primary Healthcare

Use Cases

Use cases for Planwise, include:
  • A program manager or planner uses Planwise to load their list of sites and review the coverage or catchment of the network, by their preferred mode of transportation (e.g., walking, driving, etc.) and the preferred amount of time.
  • A program manager or planner uses Planwise to identify areas that are outside of the current catchment area; to find locations to send mobile clinics or send community health workers.
  • A program manager or planner uses the catchment calculations in Planwise to find the best locations to enhance or grow the network of locations. These improvements may be through new locations or upgrading existing locations. The best options being the cheapest ones, that would help the most people.
  • A program manager or planner takes the findings from Planwise, and can easily customize recommendation scenarios based on his/her contextual knowledge. The tool then recalculates the findings.

User Stories

User stories for Planwise, include:
  • As a program manager, I am preparing to deploy an intervention, and I would like to know where to select my intervention site(s), to reduce walking times for those who are most vulnerable.
  • As a public health manager, I want to understand the exact catchment of who can access a service my program is providing - via both driving and walking times.
  • As a program manager, when I am designing an intervention; I want to form a strategy, with specific coverage targets, to achieve my proposed goals.
  • As a laboratory manager, I want to understand the gaps and bottlenecks in sample or patient referrals, so I can increase capacity or adapt referral patterns to maximize efficiency and decrease the time required to have a test result delivered to a patient or provider.
  • As an analyst, I want to identify communities that have limited or no access to a service, to better articulate risk for poor health outcomes, outbreaks of disease, etc.
  • As a program manager, I want to compare different scenarios for how best to increase the scope or capacity of the health system, so that I can make an informed decision about the approach we will take - such as to add more ambulances, build new facilities, increase capacity at existing facilities, send mobile clinics, etc...
  • As a GIS analyst, I want to pull the base layers of demand and capacity data into another GIS or data visualization platform, to quickly create custom reports and create compelling stories of impact and continuing need.
  • As a funder/fundraiser, I want to know how much our network or system needs to grow to support X% of the population so that I can pursue the right amount of funding or advocate for universal access to care.

Planwise Global Good Maturity Model

The self-assessment of the global good maturity model for Planwise can be found here: Link

2 Sentence Summary

What is Planwise? Planwise is an open source software tool that uses geospatial modeling and optimization techniques to make it simple for an organization to understand whom they are helping, and to maximize the efficiency impact of their services.  Specifically, it shows a user what the current coverage and capacity of the network is, and then produces scenarios for how to best enhance access to care; for the least amount of funding.

What is our proposal? Our proposal seeks to create an open community of implementers and a process to scale the use and impact of Planwise for healthcare and other social-impact related programs.  Specifically, we are seeking to:

  1. Formalize and grow the community of implementers
  2. Create and deploy a strategy for replication and scaled impact
  3. Extend Planwise functionality to fill priority community-identified gaps


Human Centered Design, Open Data, Open Source, Planning, Optimization, Catchment Analysis, Access to Care, Service Delivery Coverage, Efficiency, Cost Effectiveness, Geographic Accessibility, Demand for Services, Population Information, Census, Interoperability, Emergency Response, Facility Registry, Health Finance, Human Resources, Public Health and Disease Surveillance, Laboratory and Diagnostics Information System, Logistics Management Information System

Application Status: 
Approved – Contingent on Funding

Prototype for a generic health insurance claim management system - linked to existing OpenIMIS and OpenMRS

Primary Author: Nicolas de Borman
Notice C Opportunity: 
Announcement C1: Modular transformation of openIMIS

Consoritum Team

Bluesquare is a technology company focused on tools that will bring us towards universal healthcare coverage. Over the last five years our focus has been on developing open source tools to support Result-based Financing programs in over 20 countries. We also work towards improving how the data that is already available can be better leveraged to help ensure effective decision making.

The software products Bluesquare develops connect to technologies like DHIS2. From a technical perspective, our team of developers have a broad range of skills in Java, .NET, Python, Ruby, React, Javascript. Our team also brings broad experience within the social health insurance systems in Belgium.

Results for Development (R4D) works with change agents around the globe to create self-sustaining systems that support healthy, educated people. Their specific experience in health systems includes a focus on health financing and working towards Universal Health Care. R4D experts inform planning and policymaking through data analytics and by strengthening the technical capacity of local change agents in countries seeking cost-efficient and sustainable systems. They focus on supporting governments in the design and execution of social and national health insurance schemes. They do this by developing practical guidance that can foster dialogue on the alignment of public financial management and health financing and by exploring strategies that can help countries improve value for money and better leverage their existing resources.

In addition to this technical expertise, R4D is building global communities of practitioners and policymakers who are engaged in collaborative learning around the achievement of universal health coverage and sustainable health financing solutions. For instance, in 2010, R4D helped launch the Joint Learning Network — a thriving, member-driven community of global health policymakers and practitioners who are working together to collectively address barriers to achieving universal health coverage. R4D has served as the JLN network coordinator from 2010 to 2018 and continues to serve as technical facilitator for a number of different technical initiatives including the Primary Health Care Initiative and the Provider Payment Initiative

R4D has committed to provide an international sounding board using their rich network of actors. In the longer term, they also plan to use this project as a chance to begin the dialogue process with the JLN to broaden the network to be involved.

IntraHealth. From mobile apps to management software to multilanguage interactive voice response, Intrahealth offers health workers and managers the tools and technology they need to do their very best work. Intrahealth develops solutions that are open source, data-driven, sustainable, and collaborative. And as a pioneer in the field of health workforce informatics, Intrahealth is committed to using technology, information, and analytical approaches to support the people at the center of health systems.

AEDES, the European Agency for Development and Health, is a consulting company specialized in public health in low and middle-income countries. Experts of AEDES include specialists in public health, health economics, pharmacy, eHealth, etc.  Among others, AEDES is invested in supporting Health Information Systems with a focus on challenging operating environment. AEDES started supporting the development of CERHIS - an open source EMR - in 2014 in collaboration with the Université Libre de Bruxelles. CERHIS as a full-solution health facility tablet based package that includes hardware storage, power supply, server and in facility data exchange. Implementation include countries like DRC and Burundi. AEDES will contribute in ensuring that CERHIS is interoperable with the OpenIMIS platform, offering a ready to use point of care digital solution, and can provide eHealth and medical insurance expertise to help for the technical and content design of OpenIMIS.

Relevant Qualifications

Bluesquare’s origins are in Result-based Financing data systems. Over time, we have grown from that space and truly become a trusted data partner in international efforts toward Universal Health Coverage. We remain the lead company in the RBF data systems space and the tools we have developed have great potential for broader applications over time. Data flows for RBF programming are similar to data flows in health insurance. The main difference is that RBF programs have focused over the last years on aggregated data rather than individual data. However, RBF schemes are moving towards patient level data and the digital tools that Bluesquare provides evolve towards patient level data. Many new “tax-financed” health insurances that countries are setting up for accelerating Universal Health Coverage have a similar design as  RBF schemes. Bluesquare’s contribution will ensure that future OpenIMIS design can both create value for health insurance and RBF systems, multiplying the possible use cases.

In addition, from a pure development perspective, Bluesquare is proud of its strong team of agile developers. They have broad experience in software development both in Bluesquare’s own products and with other custom products (i.e. we have a team working on a sleeping sickness elimination data platform). All of our developers have strong experience in interoperability of global public goods software. And at the heart of it all, our products are all interoperable with DHIS2. From our tool linking ODK to DHIS2 to our Data Visualisation tool enriching DHIS2.

We would be able to collaborate closely with the developers from Intrahealth, AEDES or other groups willing to join this initiative.  

Related Work

Through its work on strategic purchasing and RBF data systems in more than twenty countries, Bluesquare has a broad experience of purchasing systems and claim management. Bluesquare has also a broad experience of interoperability with other digital square tools. For the last two years, Bluesquare develops a RBF suite of tools built on four software modules that can directly be plugged on other digital square tools, in particular DHIS2. Our experience with both the build of modular products and interoperability by design will help define a modular roadmap for OpenIMIS.       

As the developer of ORBF, Bluesquare has experience with the creation of a data tool that will address claim management and complex computations. The creation process was one that allowed us to identify needs and evolve the tool over time in close collaboration with many actors and partners.

Bluesquare has also worked on a health insurance project in Benin (CONSAMUS). This project was the implementation of a CBHI (Community Base Health Insurance) data system in Benin based on DHIS2 for the Ministry of Health. And our team of developers have health insurance data system experience with the national health insurance in Belgium.

Qualification of key members of proposed project team

Our development team

  • Martin Van Aken is a full stack software developer with 15+years experience in software development, including the health insurance sector in Europe. As the CTO of Bluesquare he leads the overall architecture of the software products Bluesquare develops. This includes data warehousing, mobile data collection, data system integration, computations and visualization. He also advises and leads the implementation of projects in the field with a focus on analyzing and enhancing IT solutions to collect, aggregate, compute, analyze and visualize health data.

In this role Martin has led the development of 30+ health data systems. Some examples include: the DRC (Integrated data system for strategic purchasing), Tanzania (tool to assess health staffing needs) and in Belgium (web-based medical records tools).

  • Stephan Mestach is a civil engineer in computer science (UCL) and a software developer with 15+ years of software development experience, including in the design and development of applications for healthcare, health insurance and banks. In particular, he developed the ORBF tool and adapted it to the needs of the strategic purchasing programs in Senegal, Cameroon, Zimbabwe, Malawi, Nigeria, Uganda  and Liberia. Its technology expertise includes the following tools: Java, J2EE, Android, Sysadmin / Linux, Puppet, Ruby, Ruby on Rails, CSS, Bootstrap, JavaScript, jQuery, web development, code quality, design, performance optimization, continuous integration and system integration.

  • Xavier Gillman is a full stack software developer with over 20 years experience in software development, including the health insurance sector in Europe. As a senior developer at Bluesquare he primarily focuses on D2D: a tool dedicated to exchange data across multiple DHIS2 instances. He has experience in data warehousing, mobile data collection, computation and visualization. He also advises the implementation of projects in the field with a focus on analyzing and enhancing IT solutions to synchronize data between DHIS2 instances.

Our public health team

  • Nicolas de Borman has fifteen years of experience in implementation of health financing reform and strategic purchasing, and six years of experience in implementation of health financing data system, including health insurance, Result-Based Financing, or quality of care enhancement programs. Nicolas has professional experience in around twenty countries. Nicolas is the CEO and founder of Bluesquare.

  • Antoine Legrand has over 6 years of experience in designing and implementing health data systems and leads Bluesquare’s work on health data systems strenghtening. He has lead the deployment of six DHIS2-based systems at scale and has extensive experience with data systems integration, data collection, and building M&E systems. He holds an MPH.

Number of years in operation     

Bluesquare has been in operation since its founding in 2012. We are celebrating our 6th year.

Project Description

Strengthening the governance structure for the OpenIMIS upgrade

We envision the OpenIMIS rebuild initiative as a collaborative software development effort. Different software modules would be developed by different groups in a coordinated way. The goal would be to complement and reinforce the initial efforts of GIZ and the Swiss Cooperation. To accomplish this collaboration, we propose a formal software steering committee.

The role of this steering committee group would be threefold :

  • Organize and structure the software development (tools, modules, use cases, roadmap).

  • Setup a health insurance and RBF user group that would help prioritize the software development. With the help of R4D, we would work together to seek approval from the JLN Steering Group to anchor this collaboration within the JLN network, an international network of national health insurers.

  • Identify the necessary resources for the broader and longer-term rebuild of the OpenIMIS module:  R4D, Intrahealth, AEDES and Bluesquare have established strong collaborations with several potential supporters and funders for this initiative (i.e. WHO, BMGF, USAID, KFW, GFF, EU, P4H, Belgium...).             

The first step would be a kickoff meeting where the participating organisations Bluesquare, AEDES, Intrahealth and R4D can help define the rules of the collaboration with the existing OpenIMIS stakeholders (Swiss Government, GIZ, KFW). We propose to further expand the group to others (including for example SwissTPH, HISP or SolDevelo).

Developing the first prototype - as part of this current proposal - will require ongoing and close collaboration with the steering committee and various other stakeholders. Doing so will help ensure alignment with user needs. In practice this also means working in an iterative way: we define features together, present and discuss mockups and push test versions to the advising group and other users on a regular basis.

This, of course follows the well known “agile” approach to development with a focus on a “lean” working style that is pragmatic in this specific field. By going this route we build only the key features in close collaboration with the end users.   

A. Technical approach of the OpenIMIS rebuild

OpenIMIS is a large code base and it is unrealistic to envision a comprehensive rebuild of the tool with the resources made available in this request for proposals. The rebuild of the instrument will require that other resources be raised. Rather, in this proposal Blesquare suggests to (i) setup the governance structure that will help steer the OpenIMIS project beyond this initial project, (ii) demonstrate how an open and collaborative software approach could be initiated, and (iii) trial a modular and iterative rebuild approach to determine how it could successfully take place.

The directions that Bluesquare has identified for the rebuild is to (i) modularise OpenIMIS into different software modules that would enhance the capacity of the tool to integrate itself into different country data ecosystems, (ii) build the new OpenIMIS to ensure that it does not duplicate features that are already supported by other ‘digital square’ instruments, in particular OpenMRS and DHIS2.

The claim management prototype that we propose to develop as part of this proposal will draw patient data, Health Facility Registry data and care delivery information data from existing systems. The data sources will vary by the type of data. For instance:

  • The patient level data will be imported from existing OpenIMIS deployments or existing OpenMRS instances. The prototype claim management engine would assume that the patient enrollment and data is handled in a separate patient level data base.

  • The Health Facility Registry data will come from a DHIS2 instance. Health facility accreditation will be managed in DHIS2.

  • The HR data will come from an existing HR database such as IHRIS.   

The new OpenIMIS claim management prototype would focus on defining and editing the benefit packages, the insurance products, prices and rules. It would then link these variables to patients (patient data) and health care providers (HFR data). In this vision, the software development would also parametrize the claims engine so it can support any HI scheme. In much the same way as an RBF calculation, the prototype tool would generate both the claim computations and payment orders. And aggregated service delivery data would be handled through an export to DHIS2.

Communication with any external system will be completed in adequation with the FHIR HL7 standards, notably for Patient and Organisation. The OpenIMIS resources shall themselves be available in the same format (example: Claim).

B. Use of Digital Health Technologies

For the claims management prototype, our aim is to build an insurance system on top of the best available data which is currently collected. Since integration with tools such as OpenMRS, DHIS2 and others will be key, we will look to the steering committee for insights and support to ensure alignment on those points. The integration should also respect health standards when they exist (example: FHIR) and technical best practices (for example, using REST based API with token-based authentication).

In the context of the prototype, this leads to an architecture where we would be retreiving and sending information to OpenMRS can easily be done using its REST API ( The same logic will be applied to get entity level data from DHIS2 (

In this simple model, we see a double exchange of data happening.

On one side, the claim module of OpenIMIS would capture the Health Facility Registry data from a national level DHIS2 instance, using the Web API to retrieve the whole pyramid (this is shown as a one-time data exchange here but could be used on a regular basis to keep OpenIMIS up to date).

On the other side, OpenIMIS would collect Patient data (Patient, Encounter and Observation) from OpenMRS.

From the health insurance packages defined at OpenIMIS level, the software will be able to identify which (if any) of the benefits the patient is eligible to receive. This information could if useful be sent back to OpenMRS. OpenIMIS would produce a payment order for the various providers, and send back data per facilities to DHIS2. Future iterations and improvements (not part of this first prototype) will include the integration with iHRIS as to link services and health staff IDs, CERHIS as a complement to OpenMRS and adhering to the OpenHIE standard for health facilities.    

C. Workplan and Schedule

Phase 1. Launch Steering Committee - month 1 and 2

  • Select and invite different partners to join the “OpenIMIS” rebuild workshop (to be conducted remotely).

  • The workshop will be “hosted” by Bluesquare and will help to

    • Define roles and responsibilities.

    • Identify use cases, modules and priorities.

    • Identify broader user group to grow the community.

  • Communicate a first roadmap and plan

  • Receive feedback from all parties to finalise the roadmap

Deliverable 1 - Roadmap for the Claim module

Deliverable 2 - Steering Committee members and structure established

Phase 2. Create the Claim Module Architecture - month 2

  • Finalize the analysis of OpenMRS and OpenIMIS models

  • Identify existing OpenIMIS instances and/or OpenMRS data on which the prototype could be built (OpenIMIS and OpenMRS demo offers existing material to start from)

  • Analyse the four existing OpenIMIS deployments and identify a common set of rules

Deliverable 3 - Prioritized Claim Architecture

Phase 3. Software Development - months 3 to 7 :

The software development will be completed through short iterations (sprints). These will include the following components:

  • Management of health insurance packages: the package is the main element that a person subscribe to (like an insurance product) - it will group the various benefit (for example: reimbursement of certain drugs) to possible premium (what you need to pay to have access to it).

  • Management of benefits: Benefits are the individual service that the package will reimburse, potentially partially or conditionally to some specific attribute of the patient (example: under 12 year old) or of his history (“has been vaccinated before”).

Integration 1: Collect health facilities list from DHIS2.

Integration 2: Collect patient level data from OpenMRS/CERHIS.

  • Registering patient: This allows the tool to assign an identified patient to a package of service, and will be used to compute the claims.

  • Compute Patient eligibility: When a claim is registered, the first step is to compute if the patient is eligible for a benefit - this can again be linked to the patient, the fact that he paid his premium and to the precise claim.

  • Compute Claims and payment: If the patient is eligible, the system will compute what money he’s entitled to receive.

Integration 3: Send aggregate data to DHIS2

Continuous build - In light of the flexibility we need to maintain to complete the project in the agile approach the order of these elements may vary. You will notice that the workplan includes the steps that we will follow for each of these packages on an ongoing basis.

Deliverable - Claim module of OpenIMIS

Phase 4. Building a Community - expanding awareness and use

  • Identify additional use cases

  • Presentation of the project to the JLN network steering committee

  • Engage with existing and potential OpenIMIS users

Deliverable - Launch of active network

We provide the full workplan in attacment.

D. Digital Health Atlas (registration with the Digital Health Atlas)

CERHIS (AEDES) and iHRIS (IntraHealth) are registered in the Digital Health Atlas

E. Project Deliverables

A enhanced collaborative software initiative open to several software development groups, with links to multiple health insurance implementers. The initiative is guided by transparency, trust and the mutual goal to accelerate UHC.

A platform of partners to support the raising of additional resources for the OpenIMIS initiative.      

A prototype of a generic health insurance claim management system to manage insurance packages, claims and compute payment based on a serie of policies/rules, integrated with OpenMRS for patient level data and with DHIS2 for provider based data.

2-sentence overview

  1. A description of your global good for a non-technical audience.

Many low and middle income countries have decided that a compulsory health insurance system will be one of the tools for UHC. There isn’t yet an scalable open source health insurance data system that countries could adopt for managing these schemes We propose to rebuild a first claim management module of the existing OpenIMIS code base, but in a way that does not duplicate functions and features that are best supported by other global health digital tools (i.e. patient management, health facility management).  

  1. What this investment from Digital Square will specifically go towards.

  • Software development of the claim management module

  • Development of a broader multi-stakeholder roadmap

  • Begin the process of creating a community of users and software  

Community Feedback

At the technical level, we think OpenIMIS should be run as an Open Source project where the steering committee would serve as the core advisors and help set the general direction. They would need to be complemented with a broad set of stakeholders who would focus on managing it as a product in a very transparent way (meetings with open notes, mailing list and roadmap/issues on a public platform like GitHub or Jira).

The community would be asked to contribute ideas for new features and to flag bugs. Specifically, they would have a chance to vote on what matters most to them. The result will be a healthy mix between a consistent/coherent product and representation of a large set of users.

Even when the steering committee has to discuss technical issues, they should do so in the open to allow the broader community to understand the reasoning between the choices and the direction that the tool is taking.

R4D has already agreed to support this arm of the project initiative by bringing in their rich network of health insurance practitioners as well as by fostering a link with the JLN network thus making the most of already existing infrastructures to communicate and share the result(s).

Use cases

As the maturity of the health systems in lower and middle income countries evolves, Ministries of Health begin to explore the application of health insurance platforms and approaches. Since every country finds itself in a different phase they face different challenges in the next phase. Here is a sample of the situations various Ministries and other health system players have expressed to Bluesquare and R4D over the course of the last 6-10 months.

  1. Countries like Benin or Burkina-Faso are about to launch requests for new health insurance instruments. For countries at an early stage of health insurance deployment, an open source digital instrument would be of obvious added value.

  2. Countries such as Senegal and Ivory Coast have expressed interest in cost-effective open source solutions for health insurance systems. Both countries have spent significant resources in proprietary based health insurance systems over the last years.   

  3. Countries that have existing national health insurance funds and DHIS2 platforms such as Ghana, Kenya, Morocco are spending ressources developing ad-hoc data exchange and interoperability. They could benefit from a broader and open investment in this space. Specifically, they would like to be able to share ideas and exchange with other countries implementing these kinds of initiatives.

  4. In Kenya where health insurance platforms are more developed, prominent NGO Population Services Kenya is organizing private providers in a network to more proactively engage with purchasers like the National Hospital Insurance Fund (NHIF) and several private health insurers. Doing so will contribute to the development of a well-functioning “mixed” (public and private) health system, enhance the provision of more widely accessible publicly-financed services, and reduce providers’ reliance on out-of-pocket fees and donor funds. An interoperable claims processing system to integrate, channel, and monitor payments to providers; source data for performance monitoring and planning of service delivery; and reduce inefficiencies from paper-based transactions will be critical for mitigating fragmentation in the health market and realizing the potential value of positioning ready networks of high quality PHC providers for UHC.

  5. In Nigeria, the National Health Insurance Scheme (NHIS) primarily enrolls federal civil servants and aims to expand insurance coverage for UHC by supporting the 36 states in the country in starting up social health insurance schemes to enroll public servants, vulnerable populations, and private sector employees. The NHIS is focused on developing a common ICT platform for states to use in order to transact with and monitor providers, access and warehouse data, and channel information between the state and federal levels. Such an ICT platform will help to ensure consistency and efficiency across states in starting up prepaid-pooled health financing schemes and training providers, and empower the NHIS to carry out centralized coordination and monitoring of disparate insurance schemes across the country.

  6. For some countries there is a sense that the platforms in place do not deliver. In one middle-income country in Central Africa, the national health insurance has implemented such a software instrument. However, it is not able to deliver on the expectations. The national health insurance agency has expressed an interest in exploring alternatives, in particular open source options.         


Self-assessment on the global goods maturity model

See CERHIS global goods maturity model : here:

See iHRIS global goods maturity model here:


OpenIMIS,  Health insurance data system, UHC, Result Based Financing, claim management, open collaboration, prototype  

Application Status: 
Approved - partially funded

Scaling health worker capacity at the last-mile of low-resource supply chains through self-learning and community support on mobile phones

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

Technical Requirements Disclosure

Logistimo satisfies the technical requirements for C0 as noted below:

  1. Logistimo is currently deployed in >25,000 health facilities across 5 countries including India, Myanmar, Indonesia, Zambia and Uganda.
  2. Logistimo is open sourced under the GNU AGPL v3 license (code is available on Github).
  3. Software has been applied to a health domain, including immunization, reproductive health and essential medicines

Executive Summary

Logistimo is an open source supply chain management platform with a hosted service that enables optimal management of inventory and last-mile delivery in low-resource supply chains by leveraging mobile phones and cloud computing. It offers three key services: (1) inventory management (including forecasting and optimization), (2) remote temperature monitoring (of cold-chains), and (3) distribution management (including order and transportation management). Logistimo, as a hosted service, is currently deployed in 5 countries including India, Myanmar, Indonesia, Zambia and Uganda, covering over 25,000 health facilities managing vaccine cold-chains and/or reproductive health supply chains. Local partners including aid agencies (such as UN) or Ministries of health have achieved high availability (>95%) at high data reporting rates [1], and have ensured good quality of storage conditions until the last-mile of the supply chain with real-time visibility and analytics. In India, for instance, United Nations Development Program (UNDP) and the Government have leveraged the Logistimo platform effectively in the eVIN project to achieve high availability (>95%) across all vaccines in >20,000 last-mile health facilities, while also enabling data-driven policy changes leading to lowered costs [2, 3].

Logistimo services are built on the principle of bottom-up empowerment, where both health facility workers and district officials (or supervisors) are empowered with mobile applications for inventory management and supply chain monitoring, respectively. The health workers at the facility, such as a pharmacist or nurse at a village’s Primary Healthcare Center (PHC), use a store management application called Iota to manage inventory, create orders with automatic recommendations of optimal quantities (using predictive optimization), and track delivery. In immunization cold-chains, health workers are also able to monitor the temperature of the vaccine refrigerators in real-time on their phones. District officials, such as the District Health Officer or District Immunization Officer, on the other hand, are able to monitor the entire supply chain in their geographical jurisdictions through easy-to-use dashboards and alerts on supply chain risks on a mobile application called Pulse. They are also able to recognize good performance and motivate the workforce through a “social” approach of “liking” well-performing stores (as done in social networking sites). In addition, in some places both critical and good performance events are streamed on a digital monitor (such as a wall-mounted television or digital monitor), which exerts “social” pressure to act. Enabling monitoring in easy to use ways – be it mobile applications or publicly visible digital monitors – have shown to improve availability to high levels [1, 2], achieve data quality quickly with a simple training model [4], while also driving timely actions within the supply chain to mitigate risks [5].


At this time, Iota (store management) is being used in over 25,000 health facilities across the 5 countries, while the Pulse (supply chain monitoring) is being used in over 370 districts across 2 countries. The applications are available in 5 languages including English, Hindi, Bahasa, Portuguese and French. In spite of an initial training session, we find that users do not uniformly understand how to effectively use certain features of the application or follow standard operating procedures correctly. They are also not fully aware of the all the features in the application and their benefits. This is due to the fact that different users have different capacities or attention bandwidths, and there is churn of personnel in the system. A one-time, centralized training session does not effectively address these issues. It is expensive to repeatedly re-train personnel to sustain capacity at a high quality. Even if this is done, there is churn in human resources, and capacity has to be rebuilt in the new persons that arrive. All these contribute to degraded quality of service, which also leads to a less motivated workforce.

Solution approach

We intend to enable a scalable model for ongoing capacity development of last-mile workers using a combination of:

  1. Easy-to-use self-serve, e-learning service with video content that enables self-learning and capacity assessments.
  2. Community interactions with peer co-workers, supervisors or experts through an online group accessible within their mobile applications, which offers a sustained high-touch support. Such a group enables one to ask or answer questions online, as well as share of best practices.

Both of these will be made contextually accessible through the Iota and Pulse mobile applications that are already in use. The former enables deeper self-learning, while the latter enables ongoing learning through human mentorship that anyone in the community can offer online.

Content sustainability

When relying on multi-media content, there is an additional challenge of content sustainability, wherein the content has to be evolved continuously as the application features or operating procedures evolve. This will require additional resources, time and cost, and there is a need for continuous investment. Secondly, any piece of content would have to be customized to different geographies, including language and captions, if closed captioning is used

We plan to enable sustainable content in a couple of ways: 

  1. Optimize the content production process by addressing the structural design of content that maximizes learning while minimizing content maintenance. Concepts of information chunking using in e-learning design will be leveraged in this context.
  2. Provide a content production toolkit with a recommendation of self-serve production tools to produce or customize content, along with guidelines for good content design. With the evolution of video technologies, there is a proliferation of product explainer video tools, for instance, that enable self-serve video creation, thereby reducing costs and time of production.
  3. Enable a community of authors within our customer groups to collaborate and evolve content, as the application features and operating procedures evolve.

Together, we expect these to enable sustainable online learning content that will be cost-effective to create, customize and maintain.

Proposed project 

The proposed project aims to build and deploy the web services, mobile application and sustainable content required to enable cost-effective learning in a low-resource environments, with pilot in India.

In particular, it will involve the following:

  1. Software development and integration which would enable two services for self-learning and community support for ongoing capacity improvements. These include: (a) a multimedia, multilingual “self-learning content service”, integrated with the mobile applications to deliver contextual help and support to users, and (b) a “group messaging service” to enable users to interact online with their local community and experts to answer questions or share best practices.
  2. Sustainable content development including procedures and self-serve tools for content organization and rich-media content.
  3. Evaluation of capacity development using the proposed tools and methods through a pilot in India. 

The above services will have open APIs and any new code will be open sourced under the GNU AGPL v3 license for use and evolution by the developer and implementation communities. The content production toolkit will also be offered for anyone who wishes to create or customize content. The learning from this project would be shared with the global community so that others could adopt similar practices and tools to empower health worker capacity in a scalable and cost-effective manner using mobile technologies.

We believe that the outcomes of this project would deliver concepts and practical artifacts that would strongly empower and motivate the last-mile workforce to perform better, leading to a higher quality of service. Concepts and tools generated here can be used well beyond supply chain applications to any other digital health applications

Consortium team

The consortium will include the following organizations with Logistimo being the primary.


The prime organization that will develop this service is Logistimo. Logistimo is an 8-year old organization (started in 2011) that has a proven track record of building and implementing highly scalable and innovative information technology based solutions for managing low-resource supply chains, with demonstrated impacts [1, 2, 4]. Over the years, the service has scaled to work for over 25,000 facilities across over 400 districts in 5 countries, and has evolved with iterative learning from the field. Logistimo’s organization includes teams with expertise in information technology and software engineering, supply chain analysis and design, and predictive analytics using big data. The software platform adopts a scalable and reliable micro-services based architecture, with an ability to easily add new web services and mobile applications to the stack. The team is experienced in both cloud-based and in-country hosting with ability to manage large volumes of transactions and data. As of today, our services are processing over 2 million inventory transactions per day, 30 million temperature samples from remotely monitored cold-chains and terabytes of analytical data. 

Logistimo is open sourced under the GNU AGPL v3 license (code is available on Github). Logistimo is currently deployed in 5 countries including India, Myanmar, Indonesia, Zambia and Uganda.

Key members

The key members of this project will include the following.

  1. Arun Ramanujapuram (Product and Service design)
  2. Kaushal Shukla (Content management)
  3. Charan Malemarpuram (System architecture)
  4. Shailen Pandya (Engineering management)
  5. Kavya Shetty (Training consultation, deployment and support) 

United Nations Development Program (UNDP)

United Nations Development Program (UNDP) is a worldwide organization with significant experience in implementing solutions for low-resource environments. UNDP, India is the implementation partner of the Ministry of Health and Family Welfare in India and has implemented the eVIN project using Logistimo’s supply chain platform across 15 states in India over the last 3 years since September 2015. The implementation is working well at a high scale achieving strong availability (>95%) across more than 20,000 health centers.

We plan to evaluate the above services, along with UNDP, India, through pilots in the immunization supply chain in India, where we will pick 2-3 districts to evaluate the solution and get user feedback.

Key member: Dr. Manish Pant

Digital Campus

Digital Campus is a programme enabling health-specific e-learning cotent for building capacity of front-line health workers in low-resource environments in Africa and India. They have experience in creating digital content that are already being used by front-line health workers in some places in India, Ethiopia and Nigeria. They are a potential partner to help achieve good e-learning content design for health workers in supply chains, as well as capacity assessments at scale, given their good field experience in this area.

Key member: Blanco Velasco Roman 

Moodle community

Moodle, an open source Learning Management System (LMS) appears to be a strong candidate at this stage to leverage for enabling an e-learning servce. Moodle is robust, has an offline mobile application as well as a desktop application, in addition to their web interface, that is sufficient for our learning and capacity assessment needs. It is feature rich and supports a wide-range of capabilities including multi-media, collaborative content authoring, activities around capacity assessment (such as quizzes), student recognition (e.g. badges), and so on. It is used by over 100 million users worldwide. The Moodle project itself is well-supported by an active international community, a team of dedicated full-time developers and a network of Moodle certified partners. This ensures that the software is continuously evolving for the better with major new releases coming every six months. We will rely on the Moodle community for support, when needed.

NOTE: At this time, Moodle appears to be a strong choice, given its features, their new mobile application, its widespread use as well as a very active development community around it. As part of this project, we also plan to evaluate the mobile applications of OppiaMobile and Chamilo, which are other open source e-learning applications.

Project description

Logistimo’s platform is built on the principle of bottom-up empowerment, which requires that every person in the human value chain – from the last-mile to the first-mile – be empowered to effectively manage performance of their stores or the supply chain networks in their respective jurisdictions. Empowerment in this context implies at least the following:

  1. They have sufficient capacity and support to manage and perform well.
  2. They have the required data and analytics to make good decisions.
  3. They are able to justify their actions (in case it is questioned).

Empowering workers at the last-mile, below district, is challenging due to the following reasons: 

  1. Health workers at the last-mile service delivery points, such as a pharmacist/nurse at a PHC, may have limited knowledge of logistics and operating procedures. Their ability to use technology can also be limited.
  2. District officials, such as a District Health Officer, may have limited attention bandwidth due to multiple responsibilities, frequent travel, limited support staff and limited use of computers or any other form of technology.
  3. Within a given district, there can be non-standard procedures and practices around data recording and logistics, and poor coordination leading to lack of visibility and low quality of service, including stock outs and degraded storage conditions (esp. in a cold-chain).
  4. The culture of data recording and usage is low in such environments, both at the last-mile facilities and at the district headquarters (such as the district health office). Even where data exists, the ability to analyze and act on that data is limited.

Logistimo has developed and deployed a couple of mobile applications – Iota and Pulse – that can be consumed on smartphones by people managing a store or a supply chain network. Iota is used by health workers at last-mile service delivery points, to manage inventory and orders. It enables them to enter simple inventory transactions such as issues, receipts, discards and stock counts, while offering them real-time visibility of stock, alerts on low stock or expiry, optimal order quantity recommendations (based on predictive optimization), and transaction audit trails. This, in turn, empowers the health worker by enabling a relatively standard data recording mechanism, awareness of risks through timely alerts, easy-to-consume analytics for decision support and visible audit trails that are verifiable by anyone. Pulse is used by district officials, such as the District Health Officer or the District Immunization Officer, to monitor the supply chain using real-time dashboards (on inventory and storage conditions), review critical risk indicators, and recognize stores with consistently good performance using a “social” mechanism of appreciating them through “likes” (as done in Facebook, for instance). This empowers a district official, even with limited bandwidth, to relatively easily understand the current state of the supply chain, enable proactive actions through timely awareness of risks, and motivate the workforce by recognizing good performance. This, in turn, enables a higher quality of service and a more motivated workforce.

Leveraging mobile applications for supply chain monitoring, including pro-active risk management and workforce motivation has shown to achieve strong adoption, with over 250 district officials using it on a daily basis, and has enabled timely, coordinated actions in the supply chains along with new practices for workforce performance recognition (enabled using the social “likes” feature) [5].

These applications are typically deployed through a centralized training process by aggregating relevant personnel at the district and using lectures, training documents and/or offline videos as part of the training session. After the training, application usage and data entry of health workers is monitored, and district officials offer phone-based support, wherever necessary. However, there are a few challenges in ensuring sustained capacity to use the applications and following standard procedures to ensure good service. These include: 

  1. District officials tend to have low bandwidth due to multiple responsibilities or travel, then oversight and support is not available to the health workers.
  2. If there is churn of personnel in the system, be it at the health facility or at the district headquarters, then new training is required to ensure business continuity, which is expensive on a per person basis.
  3. As new features are rolled out, or operating procedures are changed, frequent re-training of personnel is expensive and not possible due to budget constraints. 

To address the above challenges, we propose a hybrid model of sustained capacity building using a combination of (a) self-learning through audio/video help and (b) an online community forum comprised of health workers, district officials and experts/technicians in the same district, both of which are accessible through their mobile applications. The self-learning content enables deep learning, while the community forum helps resolve queries and share best practices on inventory and logistics management.

Further, given the demographic spread across countries, each country or supply chain may require customizations to the content, including language of the audio, branding, or captions. The solution approach will explore a sustainable model of content creation and maintenance that will ensure faster and cost-effective customizations of the videos.

Technical approach

The approach to the problem of sustainable capacity building is three-fold:

  1. Enable a Self-learning content service that allows one to publish rich-media content, including text, audio and video consumable in HTML or other standard formats that can be rendered on a mobile application and/or a web browser. A standard, open source Learning Management System (LMS) will be leveraged for enabling this.
  2. A Group messaging service that includes peers (say, all health workers in a given district) or experts, which enables them to seek local community support through their mobile application. This would be similar to a Whatsapp group, where users can post questions and comments (along with pictures) and others can respond to it. This would enable people to clarify their understanding as well as share best practices, thereby supporting a self-learning approach with a high-touch human experience. This, we believe, could be a scalable model for sustained capacity building.
  3. A Content production toolkit that enables a sustainable content production process and tools that helps one to generate or customize quality content in a cost-effective manner. There are two aspects of content sustainability that we will consider in this phase: (a) maintainability of content, and (b) cost-effectiveness, esp. keeping in mind the need for customization across geographies and supply chains.
Self-learning content service

The self-learning content service will enable publishing and retrieval of text, audio or video content, to help the user achieve specific supply chain goals using the mobile applications and the relevant operating procedures. The content could be in the form of usage guides, FAQs, operating procedures, or troubleshooting guides. A community of geographically spread out logistics professionals already familiar with the applications can be authorized customize or publish content in localized languages, with an approval process to assure content quality. This will enable us to support deployments in multiple geographies in multiple languages in a scalable manner, while enabling local customizations. The content should be contextually accessible through the respective mobile phone applications (of Iota and Pulse), optimized in size to be downloaded or streamed on 2G mobile networks and allow offline usage in low or no network areas.

To enable this, the following services will be enabled and integrated into the mobile applications: 

  1. A backend publishing service that enables one to publish text, audio or video content along with the context of their use. Permissions on who can publish what type of content along with moderation controls will be enabled to ensure quality. This could be an existing learning management system, which offers APIs for integration.
  2. Application Programming Interfaces (APIs) within our system for accessing such content on our mobile applications.
  3. Features in the mobile application to retrieve and display such content in the context of feature usage. 

Moodle, an open source learning management system, appears to satisfy our needs in this context, and is currently the primary software candidate based on our evaluation at this time. The Moodle mobile application offers a host of features for content consumption, activities (such as quizzes) and capacity assessments of its users. It also offers applications on desktops and Surface tablets, along with a mechanism to synchronize data entered in offline (no network) mode.

At this time, Moodle appears to be a reasonable choice for the kind of requirements that we have, based on our own initial research, as well as market research of the top 10 open source learning management systems [6].
Group messaging service

The group messaging service is an ‘online group’ accessible from the mobile applications, similar to a Whatsapp group, but with topical organization of conversations. Users can post questions, answer questions or share their learning or best practices with each other. The messages can be against a topic, and content can include text, photo or audio. Users can join one or more relevant groups to interact. In the absence of supervisory bandwidth, this enables any knowledgeable person in the group to respond to questions or guide users who need help. It thereby enables a virtuous cycle of sharing and learning that further improves the capacity of individuals and the community as a whole. Posts can be “liked” (as done to Facebook posts, for instance) or “marked helpful” (as in help forums). Such signals can further be used to identify “competent” community members, and perhaps incentivize them to continue such support. In a similar vein, any abuse can be filtered out through a combination of community reporting and automated filters. This, in turn, leads to a high quality community support system that offers mentoring and sharing of best practices, thereby enabling the process of sustained capacity building.

This service will manifest in the form of a web service, and will offer relevant APIs for the mobile applications or other services to integrate this feature. This service will be built as a new web-based, micro-service with REST APIs, as part of the Logistimo platform. The source code will be made open under the GNU AGPL v3 license.

Content production toolkit

The content toolkit enables a way for authorized personnel in the user community to produce or customize content using a set of recommended tools, guidelines and existing content resources available in a repository. The content production process will be designed with sustainability of content in mind. 

In particular, the toolkit will address the following:

  1. Guidelines for effective information chunking to design content in a manner that is optimal for both e-learning and content maintenance. Chunking will also ensure that changes to features or workflows in one part of the application will not impact the others. This should minimize effort of content maintenance, while maximizing learning objectives. Guidelines for chunking will be published. Further research will be required in this project to determine the most optimal strategy for learning content chunking.
  2. An optimal content production process that leverages audio mixing to mix audio into video, thereby enabling easier customization of videos. Video and audio content will be recorded separately and mixed together later on. This would enable one, for instance, to simply replace the audio in a new language while keeping the video as is, or add captions in another language. A searchable content repository of the constituent video and audio components in different languages would be made available, say, using the LMS repository or Google docs or similar repository. Through this process, we hope enable a cost effective process of customizing content for different language contexts.
  3. Self-serve, rich-media content development tools, which will allow one to create or customize content themselves using guidelines and best practices. Explainer video creation tools will be evaluated and recommendations will be made for others to use. This will reduce production costs significantly compared to conventional, outsourced video production for such purposes.
The content toolkit will be opened to the community of users, including a the searchable content repository, guidelines for cost-effective production and customization, and a recommendation of video editing/mixing tools.

Deployment and evaluation

Once the application features are developed, it will be deployed in pilot mode in the immunization supply chain in select districts in India with support from UNDP to evaluate the effectiveness of the service. In particular, the adoption of the content/features by users and their effectiveness in building sustained capacity will be evaluated. Worker’s knowledge acquisition will be evaluated through scores on quizzes and could be correlated to improved inventory performance in the supply chain. Learning from the pilot will be published and the features/model will be fine-tuned to make them more effective. This will be shared with the broader global health community in the interest of enabling bottom-up empowerment and capacity building in similar contexts elsewhere.

Use cases and user stories

Use cases and user stories by actor are described below.


The key actors in this system include the following: 

  1. Health workers in health facilities at the last mile, as well as warehouse managers at the district or above, who use the Iota application for store management.
  2. Supervisors or officials at a district or above who are using the Pulse application for monitoring the supply chain.
  3. National Training Administrator at the National or State levels who are responsible for training and may customize content to their respective languages and terminologies.
  4. Content managers, typically from Logistimo or an organization authorized by Logistimo, create and manage the content for e-learning of features and operational procedures.

Health worker

A health worker is responsible for managing inventory in the health facility at the last-mile or at the higher level warehouse (such as a district warehouse).

Use case

A health worker is typically at the last mile health facility and is responsible for managing inventory optimally at the facility. The key use cases of health worker (or the district warehouse manager) include the following: 

  1. Health worker learns how to perform data entry: Health worker is using the mobile application to enter inventory data (such as issue, receipt, stock count or discard) in the Iota application. He/she clicks the in-context help option and is redirected to the LMS application (say, Moodle) on the mobile phone. This application shows a screen with an overview and a video is the user’s native language. The user plays the video and takes a short quiz soon after (if he/she is offline, the answers to the quiz are submitted later to the server). Subsequently, the user returns back to the Iota application and continues with data entry.
  2. Health worker asks a question on the group: Health worker does not fully understand a particular operating procedure. He/she clicks an option to ‘ask a question’ in the context of the data entry operation help content. The user can now post a simple question, which is sent to the group of their peers and supervisors in that district (or jurisdiction). Members in the group are notified, with one or more of them posting back a response, potentially leading to a solution or a sharing of a best practice.

User stories

The key user stories for the health worker include the following:

  1. Health worker clicks on a help icon in the Iota application and is able to review a course video on data entry (inline or within the LMS mobile application).
  2. Health worker comments or asks a question on the group, after reviewing others’ comments.
  3. Health worker responds to a quiz prompted by the application.
  4. Health worker reviews his/her performance on quizzes.
  5. Health worker provides feedback on learning experience.


A supervisor is responsible for monitoring the supply chain and ensuring good supply chain performance. They could be district officials or state officials or anyone else with the designated logistics management responsibility in the district or state.

Use case

The key use cases for a supervisor include the following: 

  1. Supervisor reviews how to monitor inventory performance: Supervisor accesses the help option associated with the supply chain dashboards. He/she is redirected to the LMS application say, Moodle) on the mobile phone. This application shows a screen with an overview and a video is the user’s native language. The user plays the video and takes a short quiz soon after (if he/she is offline, the answers to the quiz are submitted later to the server). Subsequently, the user returns back to the Iota application and continues with data entry.
  2. Supervisor orients everyone to a change in procedure through an announcement: Supervisor makes an announcement in the group on a change of procedure from what was originally stated in a video, and seeks feedback. Other members in the group post back in response with their feedback.

User stories

The key user stories for the supervisor include the following: 

  1. Supervisor clicks on a help icon in the Pulse application and is able to review a course video on supply chain monitoring (inline or within the LMS mobile application).
  2. Supervisor responds to a quiz prompted by the application.
  3. Supervisor answers the question or responds to a comment from a health worker on the group.
  4. Supervisor reviews the analytics on performance on quizzes of health workers in his/her jurisdiction.
  5. Supervisor reviews his/her own performance on quizzes.
  6. Supervisor provides feedback on learning or monitoring experience.

National Training Administrator

A National Training Administrator is responsible for capacity development of the human resources. In this context, they also determine the nature of the training content.

Use cases

The following is the key use case for this type of user:

  • National Training Administrator customizes e-learning content: The National Training Administrator browses the repository of training content, and customizes a video. In this context, he/she just changes the audio track to the local language, and mixes it with the video track using the recommended mixing tool. He/she publishes the updated video content back to the LMS repository with the relevant language tag and geographies of use. After a review, this video becomes accessible within the mobile applications, as well as to others who wish to reuse it.

User stories

The key user stories for the National Training Administrator (NTA) include the following: 

  1. NTA searches/browses the training content repository of the LMS for a specific learning video.
  2. NTA uses a video editing tool to mix learning video with audio in his/her country’s native language (as per the guidelines in the content production toolkit).
  3. NTA publishes the customized learning video to the LMS with the relevant metadata, including language.
  4. NTA tests the display and rendering of the video in the Iota/Pulse applications (once video is approved).

Content Manager

The Content Manager is responsible for generating training content (video or audio) and publishing it to the LMS. He/she is a person from Logistimo or authorized by Logistimo to create learning content for application features and operating procedures.

Use cases

The following is the key use case for this type of user: 

  1. Content manager creates learning video on a given topic: Content manager designs the various topics for video creation using the chunking guidelines provided (to ensure easy maintainability of the video, while maximizing learning objective). He/she may work in consultation with a training specialist. Content manager uses the recommended tool to create independent video and audio tracks. The video is created by recording actions in the product or any overlays required for better visualization. He/she then mixes these to create the final learning video for the topic, while following various guidelines to ensure the quality and usability of the video, while also taking care of ensuring it can be easily customized across geographies, if needed. The unit content files (the video and audio tracks) are uploaded to a specified repository so that is can be discovered by others who wish to reuse either of them. These units are also linked to the final video, to help identify the components of the whole.
  2. Content manager publishes training content on a given topic to LMS: Content manager creates a new topic with relevant metadata, and publishes the content video, along with the necessary language tags and geographies of use to the LMS. The LMS generates a thumbnail and enables a mobile-friendly landing page for this content, while also indexing it to make it discoverable to others browsing the LMS, as well as through the mobile application. Content manager also specifies the necessary permissions for others to access or modify the content and/or its constituent parts (for instance, a 3rd party content provider could be give access for maintaining the content).
  3. Content manager approves a customized learning video: Content manager reviews a customized learning video published by an authorized user in the authoring community. He/she approves the learning video so that it is provisioned to be accessible from the mobile application.

User stories

The key user stories for the Content manager include the following: 

  1. Content manager uses an explainer video tool to create learning videos for a set of features in the mobile applications, by mixing audio separately with video (using the content production toolkit guidelines).
  2. Content manager collaboratively helps customize a learning video along with another authorized content author.
  3. Content manager publishes a learning video to the LMS along with its constituent parts (of video and audio) and relevant metadata (including domain of use and language).
  4. Content manager reviews a request to approve a customized learning video from an authorized content author, and approves it.
  5. Content manager updates a learning video and textual overview with a modified one.
  6. Content manager discontinues a course and removes it from the LMS.

Digital technologies

The key digital technologies that will be used in the project includes the following:

  1. Logistimo supply chain management platform, where in the group message service will be built into the application.
  2. Moodle, for content publishing and mobile application access of training content. At this time, Moodle appears to meet our needs for enabling learning on a mobile application, with offline synchronization capability. In the initial phase of this project, we will more deeply evaluate Moodle for ease of integration alongside a few other open source learning management systems, such as OppiaMobile or Chamilo.
  3. Self-use, explainer video creation tools, for enabling video content creation.

System model

The model of an integrated system that enables learning and capacity building in the context of a logistics application is shown below.System model

The above figure shows the Logistimo Logistics Service, which includes a new Group Messaging Service that can be accessed by the mobile applications via REST APIs through a Mobile gateway. The Learning Management System (LMS), such as Moodle, will enable e-learning and will use a Single Sign-On (SSO) authentication to provide a seamless login experience for registered Logistimo users. 

The Iota and Pulse applications will enable contextual links (such as Android app links) to invoke the Moodle mobile or desktop application access language-specific learning content. The learning content itself will be rendered in the LMS’s mobile application.

Content production toolkit

Learning content itself will be produced in units of multi-lingual text, images, audio and video tracks, and will be stored in a document repository of the LMS or an independent document store such as Google Drive. Mixed video content (mixed with language-specific audio tracks) will be published to the LMS. The units of content in the document repository can be reused to customize learning content for other geographies. The content production process will leverage one or more explainer video creation tools that can help one customize videos in a self-serve manner, and can reduce costs of production. Guidelines for content production and tool recommendations will be published as part of the Content production toolkit. The videos will adhere to the MPEG video standard.

Community feedback

Logistimo’s current community is comprised of a global group of its users across health supply chains, implementation/deployment partners, Ministries of Health, aid agencies, funding organizations, software partners, University professors, and consortium partners. In particular, the following channels of feedback will be leveraged.




Implementation partners

Logistimo currently has partnerships with at least 8 implementation agencies including UNDP India, UNDP Indonesia, MoH Zambia, MoH India, JSI, VillageReach, WHO and Karuna Trust (India). Key personnel in these organizations channel early feedback on requirements, and have their own internal processes for collecting field feedback as well.

Implementation partners would provide early feedback on requirements and design.

Funding partners

Logistimo’s funding partners include Bill and Melinda Gates Foundation (BMGF), Shell Foundation (SF) and Khosla Impact Ventures. BMGF and SF in particular have significant experience and contacts in the global health and logistics context in low-resource environments, and can provide relevant insights on success/failure of similar projects.

Early feedback will be sought to them during the research phase to get insights on success or failure of similar projects.

Consortium partners

Consortium partners such as Digital Campus and UNDP India, along with PATH, can offer relevant insights on e-learning content development and what would work for health workers in low-resource contexts

Feedback during content design and post content development

User community

Logistimo’s user community comprises over 25,000 users across 5 countries of India, Myanmar, Indonesia, Zambia and Uganda. Each user has an option to provide feedback using a feedback-from in their respective mobile applications. This is one of our strong channels to get feedback from the field, and will be leveraged for this project as well. This offers a very strong bottom-up mechanism to evolve this software to drive real value back to the community.

User’s would provide feedback through the mobile application post deployment

Technical consultants

Logistimo has strong technical consultants for validating architecture and infrastructure configurations, and help in ensuring that the designs are scalable, highly available, well-performing and secure.

Feedback on technical design and infrastructure configuration, post the design phase.


Self-assessment on the Global Goods Maturity Model

The self-assessment of the Logistmo platform against the Global Goods Maturity Model is available here
(Global utility = 10, Community = 7, Software = 9).

Global good maturity

The proposed software in this project will adhere to the Global Goods Maturity Model in ways depicted below.

Core area


Global utility

The community-based e-learning service, at scale, will be deployed as part of the Logistimo platform, which will cover at least 5 countries covering over 25,000 health facilities. The source code will adhere to best practices of software development, and will be opened under the GNU AGPL v3 license. The service will also be offered in a hosted manner as part of the SaaS (Software-as-a-Service) model currently followed by Logistimo.

Community support

The developer community spaces of both Logistimo and the LMS provider (Moodle) will be leveraged to ensure that the software evolves with feedback from the community. There is a good feedback collection process in place through the application and partners. 

The Customer Support Team of Logistimo has evolved a Deployment Toolkit, and has significant experience in training the trainers to further impart training within their respective countries. The same will be followed for this new service as well, with support from new consortium partners.

Software maturity

Technical documentation will be created for the architecture/design of the service, along with source code comments, which will enable other developers to easily understand the system. 

Software itself will be packaged in a manner that it can be easily installed, along with installation instructions. Logistimo leverages Docker containers to build, ship and run the application anywhere. Logistimo follows a strong engineering and quality assurance process, involving automated unit and integration tests. APIs will follow the REST conventions and will enable anyone to integrate easily. The system can be horizontally scaled, and can be deployed to achieve high-availability, and will cluster management enabled using Kubernetes. Data will be fully secured as per industry standard practices, with sufficiently strong authentication and role-based authorization mechanisms.


Digital Health Atlas

Registration of this project on the Digital Health Atlas is available here with identifier IN1de12f82.

Work plan and schedule

The work will be divided into various phases, with a specific set of deliverables from each phase.

Phases of work

The project will be divided into four phases each with specific deliverables, as described below. 

  1. Tools and methods research: This represents an initial research to ensure that we have a strong validation of our hypothesis or assumptions. In particular, the following research areas will be covered with stated outcomes: (a) What is the best tool to use as a learning management system (LMS)? At this time of our online research, Moodle has come up as the best tool that satisfies all the requirements including robustness, scalability, large community adoption and ease of integration, with a new offline Moodle mobile application that is rich in features. We will more deeply evaluate a few other open source learning management systems, esp. on ease of integration, and publish our findings, and (b) What is the optimal method for content chunking that can optimize both learning and content maintenance objectives?What tools can be used for this process? We will publish the guidelines and tools for content creation as part of a Content production toolkit. In this context, we will perform research on the most effective e-learning content/methodology, based work already done in low-resource settings, such as [7], or that of DigitalCampus.
  2. Software development: This phase will involve the following with stated deliverables. The software will adhere to best practices of software engineering and will be available through a source code repository on Github. The deliverables in this context include: (a) Enabling learning content access within the mobile apps: Integrate the selected learning content management system with Iota and Pulse apps, and (b) Enabling group messaging access within the mobile apps: Build a group messaging service with REST APIs and integrate with the rest of Logistimo services.
  3. Content development: This phase will enable development of learning videos for Iota and Pulse applications, as per the guidelines and practices established earlier. Initially, a subset of features will be selected for content development, internally evaluated, and the feedback will be used to refine the quality of the content and the process. The content development will be achieved through a closed-knit group of individuals within Logistimo, and subsequently, opened up to one or more of our implementation partners for customization. This would help refine the content production toolkit guidelines and methods.
  4. Field evaluation: This phase will actually involve a pilot rollout of the service and the content in one district in the immunization supply chain in India, to enable real-world feedback. Field evaluation will be done and the feedback will be incorporated before any scale up begins. This will help us inform further evolution towards scale. The following areas will be evaluated. (a) Software usability, (b) Content quality, and cost/time of production, and (c) Community involvement in support.

Post the field evaluation, all conditions being correct, the content services will be scaled to all districts in India across 12 states, and possibly in Zambia and Indonesia, as well.

Expected schedule

The expected schedule and responsibilities for the project is depicted below

Roles and responsibilities

The roles and responsibilities in the project are as depicted in a RACI chart below.


Project deliverables

The project will enable the following deliverables: 




Due on (from start)

Tools and methods research complete


Logistimo (in consultation with DigitalCampus and UNDP)

Month 2

Software design

Software development

Logistimo (in consultation with UNDP and DigitalCampus)

Month 4

Software complete

Software development


Month 8

e-learning content, Content production toolkit

Content development

Logistimo (in consultation with UNDP and DigitalCampus)

Month 8

Pilot results

Field evaluation

Logistimo (in consultation with UNDP)

Month 11

Ready for scale up


Logistimo (in consultation with UNDP)

Month 12


Supply chain, Logistics Management Information System (LMIS), Knowledge management system, Community-based information system, Facility management information system, Learning and training system.

2-sentence overview

Logistimo is an open source supply chain management platform with a hosted service that enables optimal management of inventory and last-mile delivery in low-resource supply chains using mobile phones and smart technology on the cloud. The investment from Digital Square will enable development of a scalable and sustainable system for capacity building of health workers at the last mile, through a combination of self-learning (via e-learning) and ongoing community support on mobile phone applications
  1. Ramanujapuram, A. and Akkihal, A., “Improving performance of rural supply chains using mobile phones”, Proceedings of the 5th ACM symposium on Computing for Development, San Jose, CA, USA, Dec 5-6, 2014.
  2. Kumar, R., “A shot in the arm: The India Story of Electronic Vaccine Intelligence Network (eVIN)”, UNDP Asian Pacific Conference, Bankok, August 2017.
  3. Cillers, J., “How smart tech is changing the way India vaccinates 156 million people”,, August 7, 2017.
  4. Gilbert S.S., Thakare N., Ramanujapuram A., Akkihal A., “Assessing stability and performance of a digitally enabled supply chain: Retrospective of a pilot in Uttar Pradesh, India”, Vaccine – the official journal of The Edward Jener Society and the Japanese Society for Vaccinology, Volume 35, Issue 17, April 2017.
  5. Ramanujapuram, A and Shukla, K, “Driving timely actions in public health supply chains using mobile phones”, Africa Healthcare Delivery Conference, Abuja, Nigeria, June 25-26, 2018.
  6. Elabrody, M. R., “A survey of the top 10 open source Learning Management Systems”, International Journal of Scientific and Technological Research, Volume 5, Issue 09, September 2016.
  7. De Waard I., “Challenges in Developing Global Online Courses in Low Resource Settings”, The E-Learning Guild’s Online Forums, October 1-2, 2009.
Application Status: 
Approved – Contingent on Funding

Scaling the Capacity for BLIS 3.0 (Basic Laboratory Information System) Implementations across Laboratories in Africa

Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

The Problem Statement

Strathmore University requests support for the scaling of in-country technical and implementing capacity for the expanding open source BLIS 3.0 (Basic laboratory Information System) user community across selected laboratories in Africa.

As a background Laboratories in developing countries, have a high demand for test services but are under equipped, understaffed and compounded by workflow inefficiencies. Strathmore University in collaboration with other implementing partners have developed  an open source Basic Laboratory Information System (BLIS) that was configured primarily for specimen, testing and test results management supporting  functionalities such as lab test equipment  interfacing  and electronic data transmission to other systems(e.g. EMRs) to reduce manual workload, decrease turn-around times, and improve quality control, and documentation to meet internationally-recognized laboratory standards and improve quality of laboratory specimen testing.

The BLIS 3.0 Technology

The Basic Laboratory Information System (BLIS) project, is an open source Web-based system that can be installed in a local, district, or national laboratory. It is a tool that can help to standardize data, track the specimen/test workflow and improve the ability to generate useful reports and can both give a realistic picture of laboratory services and assist with staff and budget planning. With enough data, BLIS can be used to track disease surveillance and response over time. BLIS has incrementally improved based on the user feedback and now is moving to the new release of Ver. 3.0

Features of BLIS include:

  • One-time entry of each unique patient and specimen detail. 
  • Workflow specimen management including test results verification and reporting
  • Standardization of data collected (allowable entries for specimen type, test type, patient data, reagents)
  • are set at Ministry of Health (MOH) level and then entered consistently throughout a country)
    • Customization to a country’s needs
    • Ability to track lab supplies such as test kits, reagents and inventory
    • Ability to run reports as specified by a country
    • Automatic alerting of data values that may be out of range(reference ranges and panic values are set at the regional or national level

BLIS has been successfully implemented in 2 county level hospital laboratories in Kenya with ongoing implementations in 10 district/regional laboratories in Uganda. This implementation experience and proof of concept has resulted in emerging interest and requests for technical support from a number of countries including Swaziland, Mozambique and Nigeria. We have also developed a growing community of BLIS users including developers, implementing partners, lab managers and technologists and the ministries of health stakeholders.

Our Approach to long term sustainability

This proposal is a request to support the scaling and building of local in-country capacity to sustainably support BLIS 3.0(the upgrade) implementation to laboratories in Africa.

The Scaling of the BLIS project will require as part of long term objective of sustainability and retaining local ownership an Active Participatory Approach involving all the stakeholders. The key stakeholders in the Scaling are the BLIS Community comprising of the core developers, implementers, lab users and the hospital/country administration and partners.

The implementation and participation will be based on the following key objectives.

1)      Developing and strengthening of the in-country technical capacity through the establishment of the “BLIS Academy” to focus of developing both offline and online training resources targeting various categories of the BLIS user community. This means the BLIS community will have access to co-create resources for the development and scaling of BLIS.

2)      Strengthening the development of the BLIS 3.0 core modules to support a wide ranges of workflows, services, tests and specimen referral support. This will target the core development community of the technical teams in the respective countries.

3)      Support the BLIS 3.0  integration to more laboratory testing equipment and data exchange with other systems.

4)      Provide technical support to the BLIS 3.0 user community and drive the expansion of the community through a well-defined communication strategy.

  The community engagement will be based on the Agile Systems Development Methodology. Agile Development is an umbrella term for several iterative and incremental software development methodologies. Agile development methods are characterized by the short period generally 1-4 weeks in which software is developed. These periods are called iterations and can be considered sub projects that deliver something operational at the end of the period.

The full details of the proposal and  implmentation plan are provided in the supporting documentation

Tagging: LIMS, Laboratory Information Systems, Interoperability, Diagnistics and Testing, Specimen Tracking, System Intergration


Application Status: 
Approved - partially funded

Scaling up Evidence-based Digital Patient-Centered Care: WelTel’s East African Hub

Primary Author: Richard T. Lester
Notice C Opportunity: 
Announcement C0: Global Good Software Development and Support

Global Good Requirements: 1) Existing software in >3 LMIC - Kenya, Rwanda, Uganda, Ethiopia. 2) Freely accessible adherence to the Open Definition for access to data - responsible licensing and support via social enterprise, non-profit, and global access principles. 3) Software applied in the Health Domain - primary health focus.

Consortium Team

Leading this project is WelTel, a social enterprise with a registered office in Kenya. WelTel thrives within this dichotomy, exhibiting success in the development, customization, deployment, and evaluation of digital outpatient management software in African countries.

 The non-profit began operation in 2011 in Nairobi, following the success of the first WelTel study (2005 - 2009), with findings that linked care delivery via text message with medication adherence, resulting in a decrease in viral load for patients with HIV. Operations have since expanded within Kenya (Northern Kenya, 2013) to clinics in other countries: Uganda (2012), South Africa (2016), Ethiopia (2016), and Rwanda (2018). The WelTel Kenya team includes a senior computer programmer, IT support, and field officers who support programs in Kenya, Rwanda, Ethiopia, South Africa and are starting up in Uganda. Currently, WelTel only has a small office of its own in Kenya to represent the African service region and relies on partner organizations for shared overhead.

For this application WelTel will partner with a number of relevant implementing partners who will share the resourced of the East African Hub and 2Paths will lead the data integration component.

2Paths ( to enhance data analytics for integration into open electronic medical records (e.g. OpenMRS) and health management information systems (HMIS, e.g. DHIS2). 2Paths has over 15-years experience in this field automating data flows, implementing open source health information systems and building tools to visualize and analyze complex datasets. 2Paths has executed on official contracts with PEPFAR, WHO and the Bill & Melinda Gates Foundation among other local and international clients, such as government departments and ministries, universities, international NGOs and other aid organizations and have also been subcontracted to round out technical expertise for specific projects. Project sizes have ranged from $25,000 to $1,500,000 and include:

-         Built data dashboards for PEPFAR to help showcase its track record of impressive outcomes to change the trajectory of the global HIV/AIDS pandemic. (2014-17)

-         Developed an application for the Institute for International Programs - Johns Hopkins University to address existing challenges with program evaluation of large-scale MNCH and nutrition programs in Mali, Malawi, Mozambique and Tanzania. (2015-17)

-         Built an application that automates the flow of project-level data into DHIS 2  for the International Rescue Committee. (2016)

-         Grameen Foundation and Bill & Melinda Gates Foundation sponsored project to develop a highly scalable open source mobile platform (MoTeCH) available to community health organizations serving remote and vulnerable populations who wish to implement a national scale mobile health system. (2011)

-         Consulted directly to the Bill & Melinda Gates Foundation on the technical architecture of the IATI standard in its nascent days. (2010)

-         Contracted by the Bill & Melinda Gates Foundation to work with the Organization for Economic Cooperation and Development (OECD) to deliver an application that provides users with one-button access to rich data about aid-flows between the reporting countries. (2008)

-         Developed for WHO a functional prototype of a health information mapping platform which helped to inform the direction of DHIS 2. (2007)

Amref Enterprise (Kenya), the Rwanda Biomedical Centre (Rwanda), the University of Gondar and eHealth Labs (Ethiopia), academic and implementing partners to assist in developing pathways and policies for scale, including integration into the public and private health sectors in the East African region.

Project Description

 WelTel is a frontline digital health service designed to connect outpatients with their care providers in regular, reliable, low-cost ways using their mobile phones. It was founded, developed, and researched in East Africa since 2005. It’s a mobile health (mHealth) solution linking patients and providers, utilizing text messaging via short-message service (SMS), with voice calling (and now video where appropriate) support, to communicate health related issues from the patient’s perspective. It provides regular check-ins with outpatients and offers real-time, needs-based sorting of responses, and is a secure housing for patient-level data. Moreover, WelTel helps care providers better understand and respond to the needs of their patients while in the community. This interactive outpatient care approach distinguishes WelTel from simple texting platforms since its unique approach enables enhanced holistic care of patients, rather than a simple messaging service add on.

Since its inception, the development and refinement of WelTel has followed the directives of enhancing access, building equity, and saving lives. It offers greater applicability across disease-categories, populations, and geographies by utilizing more ubiquitous infrastructure (mobile penetration, accessibility of mobile units, & low-cost SMS) to enable clinics to “reach the unreachable”; it was one of the first mHealth initiatives proven to improve patient health outcomes in clinical trials (increased adherence to antiretroviral therapy (ART), higher quality of life scores, increased antenatal clinic attendance (ANC), and greater number of skilled birth attended deliveries in northern Kenya).The evidence generated from WelTel’s proof-of-concept studies has informed many other programs and international guidelines. Importantly, the WelTel technical service internalizes the learnings from the extensive research by its partners and others into its own product features, ensuring it leads with evidence-based best practices. Much of the research conducted on WelTel and its services has been published in top tier and open access journals. Program level health system data captured by the WelTel system belongs to the health service providers and authorities responsible to their populations, with appropriate data sharing agreements for research and quality improvement initiatives.  The global relevance of WelTel has amplified, as a viable solution for low-resource health delivery systems that also offers an ability to integrate with emerging health system technologies (i.e. EMRs, HIMS) as they are increasingly available in lower and middle income countries (LMIC).

With a focus on reciprocal learning and continual software refinement across continents, WelTel maintains versatility to meet unique health system needs. WelTel’s application in managing infectious disease in developing countries (e.g. HIV, TB) is paralleled with its emerging use in chronic disease self-management (e.g. asthma, diabetes mellitus). Within East Africa, countries like Ethiopia and Kenya are dominant leaders in mHealth integration into their health service delivery. While the willingness to adopt mHealth solutions as complementary strategies for health service delivery is high, the scale-up and wider adoption, especially in countries with less experience and fewer resources, has been low. Necessary next steps for mHealth in East Africa includes knowledge exchange, coordination, and strategic regional collaboration within and across countries to improve scalability (Lee, Cho, & Kim, 2017).


Originating in Kenya, WelTel has a growing global presence with demand for projects now expanding in Canada, the USA, Belgium, and South Africa which is facilitating the core technology feature development and base for a sustainable business model. However, as WelTel continues to grow in East Africa, with new projects launched in Rwanda, Ethiopia and Uganda, there are multiple challenges we face that hinder our ability for sustainably and timely growth, including:

  • The lack of strategic regional collaboration. Many of the mHealth services offered in this region are still in pilot phase and struggle with scale-up over the long-term (known informally as pilotitis) (Huang, Blaschke, & Lucas, 2017). Although WelTel preceded the influx of pilots, WelTel’s expansion has also faced small level deployments. However, WelTel is considerably well-positioned for expansion, given its continued use, institutional knowledge from a history of iteratively overcoming challenges, and cross-cutting competitive advantages to alternate approaches that remain today - (see Community Feedback for developments around WelTel’s sustainability). Unfortunately, many organizations repeat facing the same challenges and may waste valuable time relearning lessons already learned by others. Only with strong intraorganizational and interorganizational collaboration, including exchange of best practices and knowledge between existing mHealth services in East Africa, will there be an efficient environment for scaling.
  • The lack of integration with other health system infrastructure, including electronic medical records(EMR) or HMIS. Many facilities currently using WelTel to assist in care delivery in East Africa still rely on paper charting, while others have an EMR where patient data is input either real-time or from charts after clinical visits. Since WelTel is primarily used for improving the front-line patient care experience and improving health indicators (ANC visit attendance, facility births, immunization uptake, reduced HIV/TB defaulter rates etc) and can be used as a standalone digital service, it can be used in adjunct with both paper and EMR charting, and the key indicators are captured by the existing systems. However, the WelTel platform also offers an opportunity to strengthen data capture quality, and capture data that is missed or unavailable by traditional medical records that exist only at the health facility level. For example, if a pregnant woman has a complication and dies in the community without reaching hospital, this information may not be captured in the facility level EMR, leading to under-reporting. In addition, because many individual patients access several different health service providers for various aspects of their care, due to mobility or differential value seeking, patients registered in WelTel remain their with their unique identifiers and contacts which can be used to harmonize different facility level data sources. For those facilities that have adopted EMRs, ensuring quick integration could offer time and cost savings in data exchange at the facility and national levels. Because WelTel is easy to adopt, it can also act as a bridge to more comprehensive EMR and HMIS adoption, sensitizing remote communities and facilities to digital services.


Despite its extensive evidence-base and development of a viable digital health outreach platform service, implementation at scale remains too slow to ensure global best practices are attained. Our own research determined the extensive potential for current implementation of SMS-based mHealth programs for MNCH in remote communities (REF) which directly aligned with a government sponsored assessment of the digital health landscape in Kenya. In a recent USAID program officer visit to northern Kenya’s Afyaplus program, the officer called it a ‘game changer’ since no other digital health technologies were able to work in the area. For this application, theDigital Square financial resources and partnerships will be used to strengthenWelTel’s ability to enhance, expand, and sustain mHealth services in East Africa in alignment with health system and population health priorities.

Core Activities

We will enhance the regional scale up of WelTel through activities that foster sustainability by breaking down silos (knowledge exchange, collaboration), that capitalize on existing infrastructure (enhancements to software), lobby for investments by the telecommunication sector, government, and non-governmental organizations (collaboration, global relevance), and integrate health system technologies (interoperability, open sharing). In summary, activities will contribute to Building Regional Collaboration & Exchange and/or Technology & Integration Enhancements within a 2-year timeframe (2019 - 2021).

A. Regional Collaboration & Exchange

  1. Creation of a Physical Hub/Headquarters (HQ):A regional headquarters will be developed in Kenya to serve as the administrative host for regional implementation. Core staff will be hired as well as a Regional Coordinator to liaise with country level programs and programs outside of Africa.

Core Activities (30%):

  • Expand WelTel Kenya Office (HQ Nanyuki which is strategically located with access to Nairobi’s tech hub and the remote northern communities currently using the service)
  • Hire East African Regional Coordinator & Administrator (admin assistance)
  • Expand office infrastructure (e.g. hardware)
  • Country site visits by Regional Coordinator (Y1: Kenya to Ethiopia, Rwanda | Y2: Kenya to Uganda, South Africa plus any new implementing countries)
  • Executive team visits (International, e.g. WelTel, 2Paths) for needs assessments, strategy, and administrative support.

Key Outputs:

  • In 2020, improved to administrative capacity and opportunities for collaboration for WelTel's sites with physical office space, hardware, and Regional Coordinator
  • Generated interest in WelTel for expansion within countries and beyond, including adoption or preludes to the adoption of eHealth strategies in these countries
  • Increase accountability and transparency to staff, stakeholders (e.g. health delivery systems) via visitations and timely reporting
  • Furthering investments internationally with recognition and physical point of contact - at least one new funder recruited
  1. Creation of a Regional Virtual Hub: In addition to creation of a physical office space with staffing to improve collaboration and exchange, a virtual hub offers a space for digital health organizations and key personnel in the health sector to communicate. It also extends the abilities of the Regional Coordinator and staff to troubleshoot and provide assistance in Kenya and other neighbouring countries where WelTel is used. There is flexibility in the design of a virtual hub based on stakeholder need, but its use to store and share documentation, and bring together knowledge holders (point of care) that really can assist one another in both implementation and delivery.

Core Activities (20%):

  • Establish an online communication platform for knowledge exchange
  • Identify each country representative(s). Includes standing country representatives as well as guest participants (such as key stakeholders or partners offering new ideas and contributions).
  • Hold monthly within-organization virtual meetings (discuss challenges, strategies, etc.) and quarterly meetings which can involve users & external stakeholders
  • Offer operational assistance (technical and limited administrative support to country programs)

Key Outputs:

  • By 2020, have an online communication platform that is used by all countries (4) using WelTel in East Africa for general communication and exchange
  • By 2020, the Virtual Hub houses documentation and virtual meeting space for all countries (4+) and representatives using WelTel in Africa
  • Administrative processes (i.e. reporting templates, auto-fill forms) on Virtual Hub complete and adopted by all countries (4+) using WelTel in Africa
  • Approx. 2-3 digital health organizations in Africa invited into shared space, with pertinent documentation made available for capacity building and collaboration
  • By 2021, active engagement with a collaborative virtual hub including WelTel sites and collaborators to build capacity, troubleshoot, streamline admin duties, and create open data exchange.
  1. Marketing & Business Development: Although WelTel’s customer base is increasing in North America and Europe, development of a sustainable revenue stream for expansion, ongoing support, and future development in LMIC remains a challenge. As country economies improve in the region, there is an increasing shift toward donor independence. For example, in Kenya, County governments have devolved health funding to select health investments most appropriate for their setting and population. Affordable interventions that can improve health outcomes are being sought. In some of the poorest areas, however, donor investments an essential component of health system strengthening and are secured as part of local and national government collaborations and guidance. To date, WelTel has relied largely on individual level partnerships through demand and convenience rather than a broad marketing strategy. Opportunities include adoption by public and private health providers. In part of its transition from research into global implementation, WelTel requires additional resources to market itself as a premier service provider in the region.

Core Activities:

  • Development of a regional scale-up strategy
  • Seek new opportunities for scale-up (customers, funding, integration, sustainability) within East Africa
  • Develop and deploy marketing materials (For conferences, trade shows, direct stakeholder and customer engagement, and online and social media presence.)
  • Seek opportunities for expansion beyond East Africa (e.g. Southern and West Africa)
  • Provide reports and analytics on scaling process within East Africa (and share within hubs)

Key Outputs:

  • By 2020, a written strategic plan for regional scale up (4+ countries, 20%+ entities metrics). This will be a living document that updates over the course of the 2 years.
  • An inventory of partners and customers existing and in the pipeline. Developed by 6 months and updated quarterly with Hub meetings. 
  • Coordinated marketing materials targeted to the region. E.g. Posters, banners, newsletters, collections of published articles and evidence, and an active online presence including social media.
  • Analytics and annual reports for funders, investors, and use in further marketing. 
  • By end of 2021, have at least 1-2 expansion projects within existing WelTel countries and 1-2 scale-up projects in new countries

B. Technology & Integration Enhancements

  1. Data & Health Systems Integration: We seek to understand and coordinate shared needs in health informatics integration at a regional level (e.g. integration into clinical settings with and without EMRs and into national and regional HMIS). The WelTel clinical service platform is already developed to include the various clinical settings including for multiple health conditions and will continue to have its development and support funded elsewhere. Ideas for clinical feature development, however, will continue to be captured during the Hub interactions. The core technology development that will be supported by this Digital Square application is to determine and develop the optimal data capture and integration strategies for the local health facility users (e.g. EMRs) as well as the higher level HMIS (e.g. DHIS2). WelTel has currently developed several data sharing agreements with implementing partners; however, additional resources will be required to ensure a clear pathway to Open Data sharing from its applications in LMIC. A clear strategy and documentation of data sharing processes and procedures will be essential to the broader adoption of WelTel’s services into the health informatics ecosystem.

Core Activities:

  • Landscape analysis of EMR and HMIS in each country

○       Identify major EMR deployments and alignment with WelTel services.  Consultation with government and collaboration partners.  A few key EMRs have been identified (e.g. OpenMRS [Kenya, Rwanda]) are examples but multiple individual facility and implementing organization level EMRs are also in use.

○       Investigate and document potential information flows between WelTel and EMRs, with alignment to national DHIS 2 flows through consultation with government, collaboration partners and technical staff.

  • Develop coordinated strategic plan for WelTel and EMR/HMIS integration

○       Depending on country context and working with collaboration partners and technical staff, develop an integration plan to implement the information flows form WelTel to facility EMR and/or national DHIS 2 implementations.  As an example Rwanda will likely require integration of several services using the Rwandan HIE, whereas Uganda and Ethiopia are earlier in their adoption of reference architectures such as OpenHIE and may benefit from more direct integration with facility EMRs.

  • Begin development of Open Data and Data sharing standards

○       WelTel currently supports access to it’s datastores via API and through simple to use full or select data exports.  However as part of the strategic plan, country requirements and integration with the broader HIE community we will evaluate which standards WelTel will implement, following the core tenets and recommendations from Principles for Digital Development.

○       Begin development of WelTel data interoperability development workstreams:

■       We anticipate at least two initial WelTel modules adhering to IHE standards - a FHIR module for communication with OpenMRS and an ADX module for direct aggregate data exchange to DHIS 2.

■       Development will be done using agile methodologies and with a user-centered design process.

○       Development of documentation

■       There is opportunity to provide a public website that indicates how WelTel plays in the broader ecosystem, and more specifically with OpenMRS/DHIS2/OpenHIE. The configuration and mapping between each of these entities, so as to line up and share data, can be disseminated in an open format.

Key Outputs:

  • By month 3 a landscape of existing and priority EMRs for developing data integration, to be updated at quarterly meetings.
  • By month 6 have a draft coordinated strategic plan for EMR/HMIS integration, finalized by end of Y1.
  • By the end of the first year, have Open Data and Data sharing standards documented and publicly posted
  • By end of Y2, have fully developed data interoperability works streams for WelTel and each country partners top EMR and HMIS (DHIS2).

Given the critical time point for investment in this sector in collaboration and interoperability initiatives, as a social enterprise existing in multiple countries, WelTel will be positioned as a use-case leader in East African mHealth reform, where considerable efforts must be made to advance targeted evidence-based services into practice while recognizing the need to meet data sharing and informatics requirements in the region.

2.  Digital Health Technologies

There are a number of mature digital health technologies involved which will be used in 3 deployment scenarios.  No changes outside of configuration will be made to OpenMRS, DHIS 2 and corresponding OpenHIE-related Components and Interoperability layer.  WelTel will include new modules for FHIR and ADX, with the specific domains and mappings aligned to the OpenMRS implementation.  Partner and government requirements will dictate which resources and actions are ultimately implemented, but will likely include certain events related to person, patient, provider, location, encounter and observation with the possibility for diagnostic report (laboratory).

  1. WelTel bi-directional with OpenMRS, federating to DHIS 2 via existing aggregation pipelines:



  1. WelTel to DHIS 2 directly via ADX:



  1. WelTel via OpenHIM to OpenMRS, DHIS 2 and corresponding OpenHIE Component Layer infrastructure:



Digital Health Atlas:

Registration with the Digital Health Atlas is in

Work Plan, Project Deliverables, & Schedule

For our full work plan and schedule of proposed activities, alongside key outputs and the associated Global Goods Maturity Model (GGMM) indicators, please see the Gantt chart here.

We assessed WelTel using the GGMM as per its present state and deployment in East Africa (Global Utility, 4/10; Community, 5/10; Software, 7/10).

WelTel ranked high for the Software core indicator, while Global Utility and Community indicators ranked lower. WelTel was designed and refined with interoperability, privacy and security principles in mind; the software is in version 3 and significant strides have been made in its usability across geographies and populations. However, strategies, documentation, and engagement with the user community requires strengthening. Digital Square offers funding for more targeted action within the Global Utility and Community core indicators, while still improving upon the software and it’s interoperability in these countries.

We assessed WelTel using the GGMM at the end of 2 years of funding, assuming completion of core activities listed in the work plan (Global Utility, 7/10; Community, 7/10; Software, 9/10). For each core indicator, the following sub indicators are directly addressed by one or more activities:

  • Global Utility: Country Strategy (Low to Medium), Country Utilization (Low to Medium), Funding & Revenue (Medium to High) 
  • Community: Developer, Contributor, & Implementor Community Engagement (Medium to High), User Documentation (Medium to High)
  • Software: Scalability (Medium to High), Interoperability & Data Accessibility (Medium to High)

We will request two years of funding to end by January 30th, 2021. Setting up of the regional hub office and hiring of key staff will occur in the first 3 months. Agreements with relevant partners will occur in the first 3-6 months. Key additional software feature development will initiate in the first 6 months and continue throughout the project period. Completion of the MNCH and TB specific modules as minimum viable products will occur in the first year and be tested and refined until the end of the project period. Business development and marketing will begin in the first 6 months and continue throughout the project period. Development of the Open Data procedures, including WelTel data linkage with the local EMRs and DHIS2 will be completed by the end of the first year, with refinements in the second year.

Project milestones will be tracked according to a Gantt chart developed with the full proposal and we will utilize a results-based accountability and management framework (RBMF). Country specific enrolment goals in terms of: a) numbers of health facilities/clinics adopting WelTel services; b) numbers of patients (direct beneficiaries) enrolled; c) numbers of frontline personnel trained; d) numbers and amounts of revenue sources for sustainability; and e) adoption of new features and services (e.g. video for TB, key indicator reporting modules linked to the DHIS2) will be monitored. We will also conduct budget impact assessments and model outcomes in terms of lives improved and lives saved.

2-Sentence Overview:

Global Good Description

WelTel is already a leading evidence-based digital health tool to support outpatient management, patient-centered care, and improve key health indicators including among vulnerable populations in in lower and middle income countries (LMIC). Our global good involves developing an affordable quality digital health service that can be scaled to the furthest reach into the population to maximize the numbers of beneficiaries and to create data flow processes that help improve critical health information exchange.

Digital Health Funded Activities

Digital Square will fund activities that WelTel have previously found difficult to secure from other sources, but that will greatly improve WelTel’s ability to scale-up and strengthen health systems in East Africa and beyond. These include creation of an East African headquarters and hiring of a regional coordinator; 2) establishment of a regional virtual communication hub to share experiences, strategies, and documentation; 3) to enhance our regional marketing and sustainable business development for scale up; and 4) develop critical health data sharing processes and standards for integration into the broader health information system in each country setting.

Community Feedback

Feedback from the Community will not be summative in nature, but rather formative.

In alignment with the Principles for Digital Development, we will be partnering with users & stakeholders throughout the process of development (Design with the User) and we will be conducting ongoing assessments of the existing ecosystems of each country and health service delivery system (Understand Existing Ecosystems). The context in which WelTel is used varies even within countries and is fluid in nature. The local complexities and nuances, and the positioning of WelTel as a tool and the organization as a leader in regional collaboration, will need to be assessed and redefined over time.

The emphasis on building community through collaborative core activities ensures integrations of users and stakeholders in process evaluation. Establishing an online communication platform for knowledge exchange, for example, involves stakeholders in determining which platform is best to use based on local preference and ease-of-use for users that may be included in virtual hub activities & collaboration. Creating strategic documents and sharing with the Community outlining processes for WelTel’s scalability and interoperability in Africa are examples of how the core activities will engage a local and broader audience.

We are mindful of the feedback that has already began during the co-creation phase of this application. Several helpful comments were made during this phase that we hope we’ve addressed in our application. We’ve reconsidered approaches and made sure to clearly define concepts that were seemingly elusive in our concept note, taking the opportunity to incorporate feedback at the onset, much like we would with feedback during the course of implementation. For answers to feedback from co-creation phase, see the Appendix.

Cases & User Stories

User type

Case Examples (Stories)


(e.g. Pregnant women, children & caregivers, HIV patients, TB patients, chronic diseases)

Clinical: A pregnant pastoralist woman (real story) registered in WelTel gets a weekly text checkin asking how she is doing. She responds “shida” and a nurse calls her and finds the patient has a new headache. The nurse is concerned and instructs her to come to the clinic and helps arrange transport. On arrival she is found to have high blood pressure and is diagnosed with preeclampsia. She is treated and delivers a healthy baby. Both mother and baby survive (who might otherwise have died if delays in therapy).

Informatics: Most government data collection systems exist at a facility level and may miss community events including complications and deaths. If this woman and baby died in the community they may not even be counted in the local or national statistics. WelTel provides a mechanism for knowing about and recording community level data that is essential for accurate data and statistics and to prevent underreporting.

Tips: Even patients with poor literacy or with the most basic phones and intermittent cellular connections can participate by keeping the service simple (easy to use) and allowing shared usage (e.g. family and community members can represent others) ensuring the furthest reach and health equity.

Digital Square Impact: 1) Through regional scaling larger numbers of pregnant women and patients enrolled in WelTel saves lives, improves key indicators, and makes community reporting of health events more accurate.

Frontline health workers

(E.g. nurses, clinical officers, counselors, community health workers)

Clinical: A busy nurse or community health worker is supporting over 1000 patients. By registering patients in WelTel the patients receive automated weekly text message checkins and other automated messaging (e.g. ANC and Immunization visit reminders, or chronic disease information) to ensure they can be supported should they have any complications or questions related to their care between visits. This has shown to improve both the quality and efficiency of HIV and MNCH care provided, since patients issues are addressed when they are needed rather than through more inefficient traditional clinic scheduled visits (supports differentiated care models). 

Informatics: Because all SMS communications and notes are captured by the WelTel platform, patient histories can be stored and referred back to for clinical care and continuity, even if the health worker changes. Information such as Expected Dates of Delivery (EDD) in pregnancy can also flag which patients (e.g. expectant mothers) should be called for follow-up. Also, any laboratory or other test results (e.g. CD4 count or HIV load) or information can be provided to patients in context at any time. This occurs routinely in practice has been prefered to providing bare lab results which can be difficult for many patients to interpret.

Tips: In rural and remote clinical and outreach settings where wifi or cellular data services are slow or nonexistent, the registering and following patients can be done completely by SMS commands. This method is fully integrated into the platform so that if a healthcare provider wishes to view the online platform for full functionality, they can do so anytime an adequate data connection exists. WelTel has run reliably in both busy urban and very remote settings with this method, which is unique and also supports health equity at the facility level since remote and smaller clinical settings can use the service.

Digital Square Impact: Through scaling, regionally harmonized training, frontline health workers work becomes more streamlined for frontline providers and extends capacity for quality care and easier capture of community level health data.

Health service providers

(e.g. Government and private health facilities, health NGOs)

Clinical: Patient defaulters are a key problem to providing optimal care. WelTel is an evidence-based tool to improve treatment adherence, retention in care, and quality of life indicators. WelTel may assist health service provider organizations in achieving health indicator targets.

Informatics: WelTel collects data and provides a connection to patients who are registered even while in the community and between visits. In addition to helping improve key indicators as above, the WelTel data can be viewed or exported to supplement data in the facility based health information systems. Because it has an open API, data can be shared regardless of which health information system (e.g. EMR) is being used, if any.

Tips: In some settings, where performance based financing is in place, the WelTel service may assist programs in reaching key indicator targets and access additional funds.

Digital Square Impact: Improved sharing of regional experiences makes implementation and scaling more efficient.

Health system administration

(e.g. Governments, Funders)

Clinical: Governments and funders are responsible for services that improve the health of the population. WelTel has been shown to be cost-effective and may therefore improve the return on investment (ROI). Modeling with PEPFAR funding has even demonstrated dramatic cost-saving due to incremental improvements in treatment adherence as offered by the users of thel service.

Informatics: In addition to improving health indicators, the WelTel service provides a unique opportunity to collect data on patients in the community which may be missed by traditional health facility level data collection mechanisms. Tips: Additional advances in analyzing text data collected by WelTel includes natural language processing (NLP) and other innovative ways to collect patient-centered data and understand patient-oriented priorities in new ways.

Digital Square Impact: Funds and activities form this grant will provide appropriate data linkages and sharing between the various levels of the health system (e.g. paper files, EMRs, DHIS2) for improved regional health informatics.


 1. Digital Healt

2. mHealth

3.     Patient care, patient-centered care

4.     Adherence, retention, engagement

5.     HIV, TB, MNCH, primary care

6.     Health outcomes

7.     Cost-effectiveness

8.     Health system strengthening

9.     Interoperability

10.   DHIS2

11.   OpenMRS

12.   OpenHIE

13.   FHIR

14.   ADX


RT Lester, … -Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet (Editor’s choice), 2010

Lester, R. T. (2013). Ask, Don’t Tell—Mobile Phones to Improve HIV Care. New England Journal of Medicine, 369(19), 1867-1868.

Kazi, AM.. Lester, R.T. (2017). Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study. JMIR Public Health Surveill, 30(3).

Patel, .. Lester, R.T., Marra, C.A. (2017). Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya. Medicine, 96(7).


Application Status: 
Approved - partially funded