- Client platform: (eg: Windows, MacOS, Linux)
We are about to set up Medic Mobile in Lilongwe, Malawi for a small nonprofit home visit nursing program for vulnerable mothers and infants. We are purchasing Fire tablets for the nurses to use the App out in the field and we also want to purchase a computer for the office to upload the data to. Please advise which computer (and/or operating system) would work best. We were told Windows did not work as well as Mac or Linux. Is this true? We were hoping to purchase a PC laptop in US and bring to Malawi this January to launch the system. Any advice would be welcomed!
@meerababa - welcome to the CHT forums!
We have some great docs on Self Hosting, which is what you’re looking to do. Be sure to check hosting requirements as well.
To answer your question about operating systems, Linux is our preferred OS for production deployments - check out Ubuntu Linux!
Finally be aware that the Google Play Store is normally used to deploy the the CHT Android app. Amazon Fire devices do not both the Play Store or the Chrome browser (it uses Silk), so you’ll have to research other deployment methods as documented on our CHT Android publishing page. This may include side loading or possibly leveraging the built-in progressive web app (PWA) features in Chrome, as Silk is untested.
Let us know if we can help with any other questions!
I very much appreciate your response. I apologize but I am not the tech person, only a program and content expert. However, I will pass this info on to whoever ends up helping us on the tech side.
I have been looking at Ubuntu Linux so this is a wee bit familiar to me. Do you have any suggestions of the best computers that would run this operating system?
Also, re Fire tablets. I see that there may be an issue (but seems manageable?). Do you recommend a different tablet tht would not have issues or need special consideration to download the app from google play?
Thank you,
Meera
When it comes to specific server hardware recommendations, it’s best to think about the problem holistically. To this end, the location that has the best Internet connectivity, best power, best theft protection and ease of backup, is cloud hosting. A lot of CHT deployments use Amazon Web Services (AWS) for this, but any hosting provider should work. You’re otherwise welcome to research hosting directly in your Lilongwe facility, but it’s not the recommended path given all of the inherent shortcomings.
Low and middle-income country’s, like Malawi, often have Internet connectivity issues - the CHT was engineered to work around this! Indeed, most deployments of the CHT don’t count on any devices having regular connectivity.
As to which devices are best, as long as they can run Chrome or the CHT Android app, they just need to meet our hardware requiremets and software dependencies (links are both to different sections of the same page).
Again, thank you for this helpful information. I am in the process of consulting with a tech person to help me digest this information. What I understand so far is that one does not really need a ‘specific office computer’ to upload the data to. Instead the data (collected by the nurses out in the field with their tablets offline) can be uploaded directly to a cloud ‘host’ such as Amazon Web Services.
In my naiive mind, I envisioned the nurses returning to the office and connecting to the office computer somehow (either through wifi or hardwire) and uploading their daily assessments. However, what I am understanding from you is that the nurses still return to the office where there is an internet connection and just upload their data directly from their tablet to the cloud host and skip the computer altogether. The office computer can still access that data to make analyses, etc. (as well as anyone else who is interested in that data such as the executive director who lives in the states). Do I understand all of this correctly now?
One question remains: We have adapted the CHT forms a bit to specifically cater to our needs. For example, we removed prenatal visits because we are only care for postpartum women. I had digital health students do this work and thus they were needing to make these changes on a ‘host computer’ (my understanding). I am also in the process of following up with one of the students (so please forgive me that I do not have all this information–the students keep graduating and I’m left with partial information). This is why I was thinking we needed a ‘host computer’ with an operating system such as Linux or Mac because they had informed me that they could not work on Windows to make the changes to the forms. I should find out soon where the actual ‘changes’ have been stored. So here is my question: Since we made changes to the CHT platform/forms, and we may want to make changes in the future, is this when we would need to have a ‘host computer’? Or can we now just get away with using a cloud host now that most of the changes have been made? I guess I am obviously trying to avoid buying a rare system such as Linux if I can.
And, one more question. You say that the Fire Android may have its own specific compatibility issues. Do you suggest a different tablet to use then? Or is it easy to overcome this issue with what you suggested? We are not married to Fire tablets (although the price looks reasonable).
Again, I cannot thank you enough for your kind patience and prompt responses.
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Yes - precisely! The exact same software you were envisioning running on the office computer will simply run in a secured cloud server. Any authorized user can access it and will be able to work offline as needed. Further, devices can use any Internet they may find, no matter how slow or infrequent it is. Thus devices can be at or away from the office. Staff at the office itself can use a browser on laptop or desktop machine to access the same CHT server.
Not quite. As mentioned above there is nothing different from a users perspective about a PC in an office or a cloud based server. There’s also not a difference from a developers perspective when it comes to an app built for the CHT. Developers test by pushing to a local CHT instance for development and then, when ready, push that exact same app to the production instance where real patient data is stored.
Yes, you can get away with a cloud host, but with a few corrections. It is best not to think of a CHT app as frozen in time, unchanging on the server. A normal CHT app will always have changes be made as new features are needed and bugs are found. Per above, they will be made in development and then pushed to production. It is a best practice to use a revision control system to track changes to this app using a revision control system like GitHub or GitLab among others. After changes have been made, tested and committed to revision control, they are then pushed to production.
The other correction is that while Linux is indeed quite rare in the end user desktop world, it is the defacto software to use on servers: in 2019 for example, 96% of the top 1 billion servers ran on Linux. Ubuntu Linux is free to run. The long term support (LTS) version will have free updates for 5 years. After 5 years, it is free to update to the next LTS version.
Finally, cloud based servers are very rarely owned and are almost always rented. A very modest one which just meets the minimum hardware requirements can cost as low as $20USD/month. Your fee ensures uptime and connectivity as well as avoids the pains of hardware failure, among many other benefits.
It is not recommend to use an Android device that doesn’t have the Play Store or the Chrome browser. Medic does not recommend a specific device vendor, they just need to meet our Android requirements.
I suspect that you’re both looking to come up with a budget as well as come up with explicit hardware and software recommendations for your project. If so, not having a recommendation is likely not helpful 
Don’t be afraid to research and purchase a single test device to see if it works, and then scale up from there! Also remember that unlocked Android phones can be used just as well as a tablet with the CHT. They will be WiFi only and not use a SIM, thus incurring no monthly costs. The more current an Android device the better!
MrJones,
You are so kind and helpful (whoever you are). I am learning more and more by your responses. I had recently contacted a person who was seeking an App developer in Malawi to specifically work on her project using CHT. I thought maybe she found one and they could help us. When I described to her our needs, she thought CHT was way more or ‘bigger’ than what we were trying to accomplish and suggested to seek something simpler like REDCap for example.
We are an extremely small non profit with 3 employed nurses, 1 program director, and a couple of local drivers. We provide nursing care in the homes of Malawians in their villages and have about 250 patients/clients on average at one time. We are desperately trying to move to electronic data collection/record keeping on our clients rather than paper. That is why we thought CHT would work for us. We have no real tech person on staff but we have some funding to hire one to help us launch whatever App we decide to use. Do you think CHT is more than what we need? It will only be the nurses using it out in the field as we have no community health workers. The nurses work independently. We just need to better track our data/their assessments, etc. I’ve had students working in the US thus far on modifying the App to better suit our needs.
One other question I have is related to the Linux system. Do you think we would need the set up (the Linux OS on some computer) on ground in Malawi or could we continue to do the development here in the US as long as the staff on ground in Malawi have the App loaded on their mobile devices and have regular connection to the internet where they can upload their data to the cloud server? At least as a temporary situation until we found tech support on ground in Malawi? Like it seems as if they wouldn’t need access to Linux unless they were needing to modify or fix bugs, correct?
Thanks so much,
Meera
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@meerababa - I work at Medic! While I have a vested interest in everyone succeeding in their ventures, it is very much a desired outcome that any member of the community here on the forum can provide advice for those in need.
When coupled with a dedicated tech person, even if only for a small number of hours per week, the CHT would be a good candidate to remove the paper workflow in a field office.
Do note that any workflows that are not created in the initial application will need to be added by a developer at a later date and cannot be done by non-technical staff.
It is not recommended to set up a computer in a field office as the server for the CHT. Not only will it be a challenge to deploy proper physical and software security measures, development can proceed against a cloud hosted server now as well as using the cloud hosted server as production when you go live in Malawi, connection issues and all.
Medic does host a number of CHT instances - if you’re interested in seeing if our services are a match for your project and it’s budget, let us know!
Note that I’m on holiday until Nov 29th. While another forum member may reply before my return, my replies may be delayed.