Digital Solutions for COVID-19 Response: An Assessment of Digital Tools for Rapid Scale-up for Case Management and Contact Tracing

"...there are many practical challenges to using technological solutions in the context of an epidemic in low-resource settings."

Evidence from the 2014-2016 Ebola epidemic indicates that paper-based contact tracing resulted in delays in communication and response. In the context of the COVID-19 pandemic, digital platforms are being used to support case management and the process of listing, notifying, and monitoring contacts of confirmed cases. However, these digital tools must be designed to meet the needs of healthcare providers and public health officials in particular contexts around the world. Thus, at the request of the Bill & Melinda Gates Foundation, the Johns Hopkins University Global mHealth Initiative (JHU-GmI) conducted a rapid assessment of digital platforms that have an established presence in several low- and middle-income countries (LMICs) and that either have or could be rapidly reconfigured to address COVID-19-related needs. The purpose of the assessment is to serve as a resource for decision-makers in governments and healthcare systems, as well as donor agencies who are engaged in supporting these efforts.

JHU-GmI selected 9 core digital platforms for this assessment based on the fact that they have been used extensively around the world, especially in LMICs. The research process involved working in close collaboration with the developers of the platforms, which include:

1. CommCare, an offline-capable mobile data collection and service delivery platform featuring an application builder designed to allow for easy digitisation of surveys and forms, as well as the integration of decision support, notifications, and SMS (text) messaging.
2. Community Health Toolkit (CHT), an open-source technology designed to support community health systems and frontline health teams delivering care in hard-to-reach communities.
3. District Health Information Software (DHIS2) Tracker, an open-source, web-based application that supports data collection and analysis of transactional or disaggregated data. (DHIS2 Tracker is used for tracking individual data and can be used in a community or facility setting, whereas DHIS2 is used to track aggregate data, typically at a district level.)
4. Go.Data, an outbreak investigation tool developed by the World Health Organization (WHO), in collaboration with partners in the Global Outbreak Alert and Response Network (GOARN) for field data collection during public health emergencies.
5. Open Data Kit (ODK), a free open-source suite of tools that allows data collection using Android mobile devices and data submission to an online server, without an internet connection or mobile carrier service at the time of data collection.
6. Open Smart Register Platform (OpenSRP), an open-source mobile health platform that allows frontline healthcare workers to electronically register and track the health of their entire client population.
7. RapidPro, which allows (via TextIt's instant turn-key hosting) users to visually build multi-platform messaging and voice bots to engage internationally.
8. SORMAS (Surveillance, Outbreak Response Management and Analysis System), an open-source Android and web app that was developed for case management, contact tracing, and surveillance, with a module for the management of laboratory samples and tests.
9. WelTel, whose browser-based interface facilitates virtual care and patient engagement, connecting remote outpatients with the healthcare system via their mobile phones.

The assessment provides an overview of each of the platforms specific to COVID-19. The report also identifies a list of minimum capabilities that a platform must have to be configured rapidly for COVID-19 case management and contact tracing. They selected platforms to assess based on existing deployment, flexibility, and adaptability for COVID-19 use; the ability to support multiple languages; and stakeholder interest in how these applications can be leveraged in response to COVID-19. The assessment also includes the evaluation of the platforms against sample use cases (e.g., patient triage, test referrals, and follow-up).

In brief, the assessment found that DHIS2 Tracker and CommCare stand out in the context of patient triage, referral for testing, and contact listing and follow-up. Both platforms reportedly have turn-key-ready applications for COVID-19 and a history of success with large-scale deployments. Notably, there are many professionals around the globe with experience adapting and deploying DHIS2 Tracker, which allows for more flexibility and local ownership. With CommCare, adaptation and deployment support can be provided at a cost by the organisation that developed and manages the platform. Given its ease of adaptation and deployment, the authors recommend RapidPro if government health officials are interested in remote communication with healthcare workers or suspect cases regarding COVID-19 via a messaging platform.

Most of the applications have been built with global deployment in mind and hence support multiple languages. They also provide good documentation and training materials, per JHU-GmI.

In conclusion, JHU-GmI notes that, if any of the 9 platforms already have a footprint in a given country, with local expertise for implementation, they can be considered for COVID-19 response. "Given the range of functionalities and origins of the different platforms being assessed, this report attempts to not place a value judgement on one platform against another. Rather, it is contingent upon the reader of this report to seek the 'best fit' of the platform for their particular need within the specific context of where the solution is to be deployed."

The document concludes with links to resources on each of the 9 platforms.