A Framework for Case-Based Community Health Information Systems

There is increasing interest in deploying phone-based tools for community health workers (CHWs) in low-income countries. This work is motivated by numerous studies that have documented the potential for well-run community health programs to substantially improve health outcomes, especially around maternal health and neonatal mortality. However, geographically distributed workers, large volumes of data, and the need for continuous, supportive supervision mean that CHW programs are difficult to run. Community health information systems have the potential to address many of these gaps. This paper presents the CommCare framework for representing case-management tools for CHWs. This framework has been used to develop and pilot systems for over a dozen different community health programs in eight countries, including programs for HIV, TB, safe motherhood, orphans and vulnerable children, and childhood illness. The open source CommCare code base allows applications to be defined in a standard XML schema -- CaseXML -- we have developed around the framework. We show that the underlying notion of a case can be used to capture elements that are common across diverse health programs. A case can be an episode of malaria, a pregnancy, or a chronic issue, such as HIV. In our framework, different forms can be specified to open, follow, or close cases. The forms allow for decision support, data collection, and educational aids with which CHWs can engage their clients. By representing different CHW programs in a common framework, we can provide generic tools for tracking referrals and monitoring CHW activity rather than implementing a variety of point solutions that require an unnecessary duplication of effort. Being able to track the number of cases a CHW is currently assigned in real time, along with the percentage of cases overdue for follow-up, has been beneficial for the supervisors of each of the community health programs.