April 2024 CHT Round-up call recording and notes

Thank you for your active participation in our April 2024 Round-up call. Here is the link to access the call recording and below are summarized notes from the call.

Agenda 1 - Community Story Presentation and Demo - Using CHT to strengthen nutritional service delivery in Nepal.

Agenda 2- CHT v4.6.0 release and community contributions.
This is the most recent version, which was released on March 26, 2024. The new features and improvements available in the release include:

  • Form performance improvements especially for forms with complex calculations, compared to v3.15, running complex forms on 4.6.0 is approximately 60% faster. It was exciting that we had a community member validate these performance gains, thank you @magp18 for the wonderful feedback.
  • CHT v4.6.0 has a script that helps deploy CHT core to a kubernetes cluster. The script is a combination of bash and python that uses helm to take your helm values and push it to the kubernetes cluster. Kubernetes is a new recommended way of hosting CHT, gradually partners are expected to migrate from docker compose. Internally, Medic is using EKS cluster (AWS hosting service) and this has enabled Developers to easily deploy CHT core instances to EKS cluster to carry out tests in a more production-like environment. The instance is publicly available, has a valid certificate and it would be great if community members and partners can test it.
  • Descending contact searches improvements, which allows a user to select specific contacts such as members of the current household.

The release has loads of other improvements and bug fixes, you can find the CHT v4.6.0 release notes here.

On the call, the Product team also highlighted a few recent community contributions to the CHT core that will go into the new releases, this includes the countdown timer feature contributed by the Living Goods (LG) team and the Date xPath functionality which was contributed by the Western Cape team; the Date xPath functionality allows one to calculate the difference between two dates. Kudos to the LG and the Western Cape teams for their contribution to the CHT core.

Agenda 3 - Focused Working Groups updates.
a) Client Performance Updates.
The Care team is working on improving app performance to make sure that CHT is fast for CHWs. Application Performance Index (APDEX) is used to measure performance and it helps one to know where CHWs are experiencing slow page loads. The APDEX work has been merged and is scheduled to be in CHT v4.7.0, the documentation is already out. Since the performance data is part of the existing telemetry system, there are no new features that partners need to turn on to collect APDEX data. To make sure things are faster for CHW, the team has to utilize the real telemetry data from actual CHWs. If you want to help make your CHT app be faster for CHW, please reach out to @michael/(michael@medic.org) directly or on the forum.

In the meantime, the Care team has started to work on speeding up areas that CHWs interact with every time they use the app. The team has set up a few CHT instances with realistic configuration and loaded up thousands of documents for test users and developed testing scenarios that simulate several days of CHWs interactions and they are currently running tests on physical devices. These tests on physical devices does replace the need for telemetry data but allows the team to create a baseline that will enable them to evaluate the performance improvements, As the first goal the team is working on speeding up the list view and detailed view on the contact page.

b) Empowering Supervisors.
A typical CHT hierarchy has 1 supervisor per one community health unit (CHU). Another common scenario in most of the deployments is one supervisor oversees CHWs in multiple CHUs. Some projects have approached the second scenario with workarounds such as having additional hierarchy levels and some supervisors have been having multiple logins, these approaches have not been optimal. To help improve the supervision process, the Care team is working on a solution that allows supervisors to be associated with multiple community health units. The team has already done initial usability tests and the team plans to start technical work on this soon. If you have supervisors that support CHWs across multiple community health units, please reach out to @michael to share your specific supervision needs.

c) Current and future CHT navigation updates.
Over the past year, the Product team has been making incremental changes to the CHT UI to align more closely with the material design patterns and familiar apps that users use. Some of the earlier efforts to update the UI that the team has worked on include updating button bar to floating button, updating the design of Search and Filters features. In Q2 2024, the team will be finalizing the navigation design, this will include: changing the top bar from tabs to a title, updating the menu to be drawer and moving the buttons from tabs to buttons at the bottom of the bar. The team hopes to facilitate easy use of these changes and learning with new users. The changes will be released with training cards to explain the changes and the Care team would also like to connect with partners who would like to be involved in the roll out of these changes, Please reach out to @Nicole_Orlowski and @leah to share the specific support you would like to get in terms of the uptake of these changes and participate in the usability tests.

d) 2024 Q1 user interviews updates.
The Care Teams has been conducting interviews with end users (mostly CHWs and Supervisors) to understand their experience with CHT. To date, the team has collected 176 stories from 138 interviews which have been synthesized into insights. Some of the feedback that users have shared include the app taking long to load, UI is difficult to navigate, it is hard to find people the users are looking for, challenges with onboarding and training, it is hard to handle and secure sensitive information and much more feedback. The team is already working on improvements to address these challenges.

The Allies has also been conducting interviews with App Developers and Data Scientists to understand their experience of building CHT apps. To date, the team has conducted 37 interviews and collected 105 stories. The App Developers have shared feedback that it is difficult to find and make sense of errors when setting up CHT, it is challenging to understand key CHT concepts due to lack of concise instructions or insufficient documentation and it is difficult to extend the functionality of the CHT to continue to improve the CHT experience for all CHT end users. You can read more about the 2024 Q1 interviews updates here.

The team is grateful to partners and community members who have collaborated to make these interviews happen, The Product Focussed Working Groups looks forward to speaking with more partners and community members, reach out to @Ziithe , @leah and @Nicole_Orlowski, if you would like to share more feedback on CHT.

e) CHT Android updates.
The Allies team has been working on the CHT Android updates. Recently, it was reported by MOH Kenya eCHIS team that the eCHIS app for a few users was crashing, especially for users who are using Android versions 14. The team was able to work on changes that target the Android 14 api in CHT android APK, this change have been backported to other Android versions. In Android version 12+, a feature that allows one to register an URL of intent and have it work is broken because of new changes that are mandated by Google. The Allies team has started working on the Android side of changes and later on the team will be working on complimentary CHT core changes.

f) CHT interoperability efforts.
The Ecosystem team is currently working on an interoperability initiative in Nepal in collaboration with SunyaEK (a CHT technical partner) and Nepal Ministry of Health. The teams are working on a project that aims to have the CHT interoperate with the OpenMRS to support antenatal and postnatal community and facility referrals based on FHIR standards The team will leverage this work to enhance the lost to follow up reference application.

We look forward to seeing you at the next CHT Round-up on May 9, 2024.