The Refugee CHMIS Platform

As Africa's leading, and the world's second-largest refugee host nation, Uganda shelters over 1.5 million refugees in 13 refugee settlements spread around the country, primarily from South Sudan and the Democratic Republic of Congo. Settlements are located  in hard to reach areas which are faced with disjointed healthcare systems, making it hard for refugees to find and or  receive quality and timely healthcare services. Often,  they have to walk  long distances to find a health facility; and are unlikely to receive a follow-up visit.  It is common for referrals to be undocumented, and delayed.  

UNHCR and settlement health partners have identified more than 2000 refugee volunteers who are trained and equipped in knowledge and skills on how to provide preventive healthcare to their fellow refugees. The volunteers are commonly referred to as Village Health Teams (VHTs) and may have, on average, 30 households under their coverage. This community health care model is instrumental in bridging the access and inequality gaps in health care, allowing the most vulnerable cases to be reached in time, with appropriate guided assessment, care, treatment and referral services. 

Initially, VHTs relied on cumbersome paper records and bulky logbooks which hampered their mobility and efficiency. This resulted in missing follow-ups and timely referrals due to lack of records. VHTs also experienced additional  tedious effort to conduct data analysis for timely decision-making and interventions by supervisors at all levels of the healthcare program. 

Alongside UNHCR and 5 other health implementing partner organizations, Guild Digital is spearheading the adoption of the rCHMIS - a digital health intervention that would empower refugees who volunteer as VHTs to bring health care services closer to the household - in a comprehensive community health program. This collaboration set out to increase the capability for care coordination to be supported by an innovative digital platform, adapted to the unique requirements of the settlement. 

The platform is now deployed for 1630 refugee VHTs in 7 of the 13 settlements,  and able to reach more than 94000 refugee households. We look forward to scaling up in the 4 remaining settlements, covering an additional 600 VHTs and supporting more than 10 health implementing organizations that support health care service delivery for refugees in Uganda.

rCHMIS stands for Refugee Community Health Management Information System. It's an android mobile app paired with online dashboards,  specifically designed for Village Health Teams (VHTs) working in refugee settlements. rCHMIS  is built on Community Health Toolkit (CHT), a digital public good, supported by Medic. Designed specifically for android use in offline-first and remote settings, the app ensures VHTs in the refugee settlements can continue to provide care even with limited access to the internet.  

VHTs record refugee demographics, conduct protocol guided assessments, offer in-policy treatments, and the platform provides them with in-app analytics about the community they serve. Upon having internet access, they can synchronize collected data with a secure central server, enabling data analysis and reporting for supervisors, health program managers and other local leaders. The app prioritizes a simple and intuitive design, and language localization allowing VHTs with varying levels of technical understanding to use it effectively.

Using the rCHMIS digital platform, these volunteers are empowered to provide doorstep healthcare to vulnerable children, women of child bearing ages,  pregnant, lactating mothers, and other adults in a timely manner. They can also complete longitudinal registration of refugees, organized in their households, complete household assessments of sanitation and hygiene, and even manage stock of drugs and supplies. They are able to have all their records in one accessible place for reference on assessments, treatments, health facility referrals and timely follow–up visits at the household. 

Access to the dashboards is unlimited for UNHCR and settlement partners. All the detailed data and actions carried out by VHTs are viewed here hence supporting data driven decision making for the betterment of the health in these communities. 

These solutions streamline data management, provide end-to-end support for implementing partners, and adopt a human-centered approach for frontline health workers. 

The rCHMIS platform directly serves refugees who volunteer as Village Health Teams (VHTs) in refugee settlements, their supervisors, health program managers and indirectly benefits refugee communities. 

The dedicated volunteers are the backbone of primary healthcare delivery, offering essential services directly to refugees in their homes under the guidance of supervisors. The manual system of data collection on log books hindered data collection, and analysis and ultimately was time-consuming and cumbersome for the VHTs. The rCHMIS application empowers the VHTs to overcome these challenges and significantly improves healthcare delivery within these settlements. The offline-first application ensures data capture in areas with limited access to the internet. This enables the VHTs to record information on their devices without interruption and only need data when syncing their records. The application improves data accuracy and consistency which enables better tacking of health indicators, disease prevention and facilitates informed decision making. 

Health program managers and supervisors are responsible for the success of different health programs and making decisions regarding the healthcare of the refugee communities. Manual data entry, a slow process prone to errors hinders accurate tracking of health indicators and resource allocation. Additionally, real-time data on healthcare delivery and community health needs is unavailable making it hard to respond effectively to outbreaks or specific health concerns. Lastly, delayed data driven decision making hinders proactive healthcare measures. With the rCMIS app, supervisors and settlement partners are able to gain access to aggregated data via dashboards allowing them to identify areas of need and tailor interventions accordingly which fosters a more proactive and data-driven approach to healthcare delivery. 

The platform transcends a mere data collection tool as it fosters a more effective and efficient care coordination healthcare ecosystem within the settlements. Streamlined workflows have freed up the VHTs time enabling them to dedicate more resources to providing care to their fellow refugees. This has improved the health outcomes of the communities they serve. 

The effectiveness of rCHMIS hinges on a deep understanding of the challenges faced by both VHTs and communities they serve. It requires a collaborative approach that integrates the needs of all the key stakeholders; the VHTs, communities around them and the settlement partners. Guild Digital’s intervention is an accompaniment model that ensures end-to-end support in the design, deployment, support and maintenance of the platform; as well as skilling and empowering partner organizations to effectively integrate the platform in their program intervention design.

We actively partner with key stakeholders throughout the design and development process. This includes the UNHCR, alongside settlement partners who manage various health programs within the settlements. We recognize the value of existing knowledge within the healthcare system. Using the guidelines established by the Ministry of Health as a foundation, we identify the types of data that would be most beneficial to their specific health programs. Most importantly, we create strong relationships with the VHTs themselves. Their continuous feedback throughout the entire process ensures the app remains user-friendly, and addresses their most pressing concerns.

We conduct regular user research surveys with VHTs to understand their experience with the app. We utilize industry-standard tools like the System Usability Survey and the Client Effort Score to gauge usability and effort required for interaction. However, our approach goes beyond mere numbers. We conduct generative interviews and hold in-depth conversations with VHTs. This qualitative data provides invaluable insights into their workflow challenges and allows us to tailor the app to their specific needs. 

We understand that the needs of VHTs and the communities they serve can evolve. By actively incorporating user feedback, we ensure the app continuously adapts to address these evolving challenges. Feedback becomes the fuel for improvement, allowing us to refine functionalities and introduce new features that enhance the overall user experience.

rCHMIS is a  functional app with a consistent design and approach currently being used by VHTs in 9 of the 13 refugee settlements in Uganda. 

In 2022, we conducted pilot testing in 2 of the refugee settlements (Kiryandongo and Kyaka II refugee settlements). The testing was focused on usability, effectiveness in improving healthcare delivery and user satisfaction. We collected this data through surveys and interviews.

Currently, about 1600 VHTs are using the application in these settlements. This translates to reaching 220,000 individuals in 94000 of households performing over 220,000 care actions. We have established partnerships with UNHCR and settlement partner organizations  like IRC and MTI to facilitate app deployment and training for the VHTs. 

• Completed deployment of the rCHMIS in 3 out of 13 refugee settlements.
• Engagement Rates, of the 83% of the 702 trained VHTs - Active: 1 device based care action - together completing more than 68,600 actions on their devices.
• Collaborating with more than 25 Public Health Assistants and Supervisors, from 6 partner organisations.
• 13,309 Households registered, reaching 65,600+ clients specifically 15,730 Children under 5; and 16,800 women of reproductive age.

Guild requires additional funding to scale its operations, develop new features in the existing tool, and expand its reach to more refugee settlements. Solve can help by connecting us with potential partners who can provide monetary support, such as grants or sponsorship. 

Developing and implementing digital solutions often requires specialized technical expertise and resources. We encounter challenges in diversifying into new technological infrastructure, tools, and skilled personnel. Solve can facilitate partnerships with tech companies, software developers, and IT experts who can offer technical support and guidance

Operating in diverse geographical regions, especially refugee settlements outside Uganda, may entail navigating complex legal frameworks, regulations, and compliance requirements. Solve can connect Guild with legal experts and organizations experienced in international law, humanitarian aid, and refugee rights to address legal challenges and ensure compliance with relevant regulations.

Cultural differences and norms within refugee communities may impact the acceptance and adoption of digital solutions. We need to adapt our technologies and approaches to suit the cultural context and preferences of its target beneficiaries especially regarding language. Solve can provide access to cultural sensitivity training, anthropological insights, and community engagement strategies to help us navigate cultural barriers effectively. 

We also face challenges in identifying and accessing markets for its digital solutions, as well as in competing with other organizations offering similar products or services, convincing development partners on adoption of the digital tools. Solve can assist Guild in market research, strategic planning, and partnership development to enhance adoption and market visibility, reach, and competitiveness.

Our solution stands out for its innovation because it's tailored to the specific needs of Village Health Teams (VHTs) in resource-limited settings, unlike many digital health tools that target doctors or a broader audience. rCHMIS goes beyond merely gathering data; it enables its analysis. This functionality is crucial because it empowers healthcare managers and supervisors to make informed decisions based on the data collected. They can allocate resources more efficiently, strategize interventions effectively, and enhance overall healthcare delivery within refugee settlements. By focusing on the unique workflows and challenges faced by VHTs, rCHMIS innovatively addresses gaps in existing digital health solutions and ensures that healthcare reaches those who need it most in underserved communities.

Our solution, the Refugee Community Health Management Information System (rCHMIS), is like a digital toolkit designed to help people who don't have easy access to healthcare, like refugees living in settlements. Imagine if you had a special app on your phone that helped you keep track of your health, like when you need to see a doctor or get important vaccinations. That's kind of what rCHMIS does for these refugees.

Now, the reason we think this will make a big difference is that it helps the people who are helping the refugees, like the Village Health Teams (VHTs). These are the people who go door-to-door in the settlements to provide healthcare. With our system, they can do their jobs better because they have all the information they need right on their phones. This means they can make sure everyone gets the care they need, especially during emergencies or outbreaks of diseases.

So, by making it easier for the VHTs to do their job well, we're helping more refugees get the healthcare they need, when they need it. And when more people have access to good healthcare, it can make a big difference in keeping everyone healthy and safe in the refugee settlements.

Impact Goals for rCHMIS Solution:

1. Improved Access to Healthcare: Our primary goal is to enhance access to healthcare services for refugees and underserved communities through the deployment of the Refugee Community Health Management Information System (rCHMIS). This will be measured by tracking the increase in the number of individuals receiving healthcare services within the settlements where rCHMIS is implemented.

2. Enhanced Quality of Care: We aim to improve the quality of healthcare services provided to refugees by equipping Village Health Teams (VHTs) with digital tools and resources. Progress toward this goal will be assessed through regular assessments of the accuracy and completeness of health data collected and the adherence of VHTs to established healthcare protocols.

3. Empowerment of Frontline Health Workers: Another key objective is to empower frontline health workers, such as VHTs, by providing them with the necessary training, support, and technology to effectively carry out their roles. Progress will be measured by tracking the increase in the confidence levels and skill proficiency of VHTs through feedback surveys and performance evaluations.

4. Reduction of Health Disparities: We seek to mitigate health disparities among refugee populations by addressing barriers to accessing healthcare services and providing targeted interventions for vulnerable groups. Progress toward this goal will be monitored by assessing changes in health outcomes and disparities among different demographic groups within the refugee settlements.

Measurement of Progress:

1. Quantitative Data: We will collect quantitative data on various metrics, including the number of healthcare consultations conducted, immunization rates, maternal and child health indicators, and disease prevalence rates. These metrics will be tracked over time to measure improvements in access to and quality of healthcare services.

2. Qualitative Feedback: Qualitative feedback from VHTs, healthcare providers, and community members will be gathered through interviews, focus group discussions, and surveys. This feedback will provide insights into the effectiveness of the rCHMIS solution, user satisfaction, and areas for improvement.

3. Health Outcome Indicators: Changes in health outcome indicators, such as morbidity and mortality rates, prevalence of communicable diseases, and maternal and child health outcomes, will be monitored to assess the impact of the rCHMIS solution on overall health outcomes within the refugee settlements.

By regularly tracking progress against these impact goals and utilizing a combination of quantitative data, qualitative feedback, and health outcome indicators, we will ensure that the rCHMIS solution effectively contributes to improving healthcare access, quality, and outcomes for refugee populations.

CHT(Community Health ToolkIt). This technology is used to build a CHT android Application. 

The CHT Android application is a thin wrapper to load the CHT Core Framework web application in a WebView. The CHT Android is a native Android container for the Community Health Toolkit (CHT). The repository contains “flavored” configurations, where each “flavor” or “brand” is an app. All apps share the same code and features, but can be customized, hard-coding a specific CHT deployment and have a partner specific logo and display name.

7 are full time staff. 1 contractor.

Agnes Kabalyanga, a versatile professional skilled in business administration and finance, co-founded Guild Digital Foundation, focusing on sustainable digital interventions for refugees. Brian Ssennoga, as Director of Digital Health at Last Mile Health, advocates for ICT4D. Emmanuel Denis Ssendagire, a software engineer, develops innovative solutions such as a pharmacy stock management web app. Charlotte Akongo, a tech enthusiast, collaborates effectively in software design. Barbra Esther Namuli, Operations Lead at Guild Digital Foundation, excels in organizational management. Owen Kasule Muhereza and Edwin Rugoogamu, adept software developers, lead transformative projects, utilizing technologies like Django and ReactJS, contributing significantly to digital solution advancements. 

As a team, we have been developing and refining our solution for over three years now.

We actively target diverse talent pools through partnerships with organizations focused on underrepresented groups in tech and healthcare. Through equipping hiring managers with unconscious bias, we eliminate bias in the hiring process.

We offer flexible work schedules and remote work options to accommodate individual needs and attract a wider talent pool. This can be especially helpful for working parents, caregivers, or those with long commutes. By offering flexible work arrangements, we ensure that talented individuals are not excluded from opportunities due to personal circumstances. We also provide opportunities for professional development regardless of background or experience level. This ensures everyone has the tools to succeed.

We cultivate a culture of open communication and psychological safety where team members feel comfortable sharing ideas and concerns without fear of judgment. Gathering regular feedback through surveys and anonymous reporting systems to identify areas for improvement fosters diversity and inclusion.

Business Model for Scaling to All 13 Refugee Settlements in Uganda and Beyond:

• Grants and Funding from UNHCR and Other Donors: As a non-profit organization focused on serving refugees, our primary revenue stream will continue to be grants and funding from UNHCR, as well as other international donors and humanitarian organizations. These funds will support our initial operations and expansion efforts.

• Partnerships with NGOs and Government Agencies: Collaborating with non-governmental organizations (NGOs) and government agencies working in refugee settlements will be crucial for scaling our operations. These partnerships may involve joint funding applications, resource-sharing agreements, and leveraging existing infrastructure and networks to reach more refugees effectively.

• Program Fees for Training and Capacity Building: To sustain our operations and cover ongoing expenses, we can generate revenue through program fees for training sessions, capacity-building workshops, and other educational initiatives aimed at enhancing data analysis skills among health system decision-makers in refugee settlements. These fees can be structured to be affordable for local organizations and agencies, ensuring accessibility to our services.

• Consulting Services for Data Governance: Offering consulting services on data governance structures to refugee settlement administrations, NGOs, and other stakeholders can provide an additional revenue stream. These services may include advising on the establishment of data policies, protocols, and frameworks to mitigate risks and ensure data privacy and security.

• Expansion to Other African Countries: As we successfully scale our operations to all 13 refugee settlements in Uganda, we can leverage our experience and expertise to expand to other African countries facing similar challenges with data utilization in refugee health systems. This expansion may attract additional funding opportunities from international donors and increase our impact across the continent.

• Corporate Partnerships and Sponsorship: Collaborating with corporate partners interested in supporting refugee health initiatives can provide supplemental funding for our programs and activities. Corporate partnerships may include sponsorship for events, in-kind donations of technology or equipment, or cause-related marketing campaigns to raise awareness and support for our mission.

• Earned Income Initiatives: Exploring earned income initiatives, such as selling merchandise or offering fee-based services to non-refugee communities or organizations, can diversify our revenue streams and contribute to financial sustainability.

By diversifying our revenue sources, prioritizing partnerships, and leveraging our expertise, we can develop a sustainable business model to scale our operations to all 13 refugee settlements in Uganda and extend our reach to other African countries, ultimately maximizing our impact on refugee health and well-being.

Diversifying our revenue sources, prioritizing partnerships, and leveraging our expertise, through that we shall scale our operations to all 13 refugee settlements in Uganda and extend our reach to other African countries, ultimately maximizing our impact on refugee health and well-being.