Emily Kiragu, Head Nurse, and Clinical Officer Sylvester Mesa use the MediCapt application at the Voluntary Counseling Treatment Center at the Naivasha Hospital in Kenya, April 10, 2018.
MediCapt app is an innovative digital application that enables clinicians to document forensic medical evidence in sexual violence cases, capture forensic photographs of injuries sustained, and store them securely. For survivors of sexual violence, timely and high-quality forensic examination, evidence collection, and documentation is a vital part of comprehensive care and access to justice. However, in many countries, including Kenya, the quality of medico-legal documentation is severely limited. As a new digital documentation platform, MediCapt sits at the intersection of mHealth technology and legal evidence documentation as a solution for yielding stronger evidence, preserving chain of custody, and improving data security and privacy in cases of sexual violence while minimizing the chances of loss, tampering, or theft of medical evidence.
Innovation Summary
Innovation Overview
Sexual violence is an urgent crisis that affects millions worldwide, impacting people of all genders, ages, and sexual orientation. It is estimated that over 45% of women in Kenya will experience physical and/or sexual violence by an intimate partner or non-partner in their lifetime. Sexual violence is also a major contributor to a broad range of physical, psychological, social, legal, and economic consequences that adversely affect survivors, families, communities, and society at large. The sexual and gender-based violence (SGBV) crisis in Kenya has further been compounded by the onset of the COVID-19 pandemic.
Timely and high-quality forensic medical examination, evidence collection, and documentation are all part of comprehensive care for survivors of sexual violence and are crucial to ensuring survivors of SGBV can access justice. High-quality documentation of the clinical exam after sexual assault has been shown to increase trial, prosecution, and conviction rates of perpetrators. In addition to legal outcomes, timely evidence collection may have other positive effects, such as empowering survivors, validating their experiences, and enhancing survivor agency. The process of documenting forensic evidence of sexual violence is ideally standardized using forensic medical certificates that trained clinicians use to systematically record forensic medical evidence for use in legal proceedings. In Kenya, forensic medical evidence of sexual violence is documented using the Post-Rape Care (PRC) form.
In many resource-constrained contexts, including Kenya, there are reports of low-quality post-sexual violence medical-legal documentation because of numerous factors, including insufficient resources and gaps in training and support. These, in addition to improper management of forensic evidence due to lack of consistent chain of custody mechanisms, remain some of the major factors in the significantly low number of convictions for SGBV, contributing to continued impunity.
To help address persistent shortcomings in forensic documentation and to improve access to justice for survivors in Kenya, Physicians for Human Rights (PHR) – in close partnership with colleagues in the medical, law enforcement, and justice sectors in Kenya, the Democratic Republic of Congo, and beyond – collaboratively designed and developed MediCapt, an award-winning application that enables clinicians to document medical evidence of sexual violence cases on a digital medical certificate (such as the PRC form in Kenya), capture forensic photographs of the injuries sustained, and store this crucial evidence securely in the cloud. MediCapt was developed using a rights-based collaborative design approach that was guided by the Principles for Digital Development.
MediCapt offers a new way to collect and preserve forensic medical evidence to inform police investigations and prosecutions of alleged perpetrators of sexual violence crimes. As a new digital documentation platform, MediCapt sits at the intersection of mHealth technology and legal evidence documentation as a solution for yielding stronger evidence, preserving chain of custody, and improving data security and privacy in cases of sexual violence while minimizing the chances of loss, tampering, or theft of medical evidence.
Among its key features, MediCapt includes sophisticated encryption, cloud data storage, fidelity to the highest chain of custody standards, and tamper-proof metadata. When we add the data-mapping feature, combined data will help to reveal patterns or prevalence of violence. When widely used, MediCapt will strengthen the evidence gathered in individual cases and it will be possible to aggregate de-identified data to establish key epidemiological trends and patterns of criminal activity. Moreover, because MediCapt enables encrypted digital information transfer, it bridges the vast distances that professionals would otherwise have to travel over poor roads, if they had access to vehicles, from healthcare facilities to police stations to submit documentation in sexual violence prosecutions. MediCapt has also been upgraded to accommodate offline use so that clinicians can use it in remote areas where there may be sporadic, limited, or no internet connectivity.
With support from the Kenyan Ministry of Health and with County Governments, MediCapt was first piloted in Kenya in 2018 at the Naivasha Sub County Hospital. A second pilot was conducted at Nakuru County Referral and Teaching Hospital in 2020 and most recently the application was launched at Mukuru Health Centre in Nairobi in September 2022. Currently, the application is being used by 50 end users in Kenya with plans to scale nationally underway. Beyond Kenya, MediCapt is going to be available online as an open-source application. This will make it available across the globe to stakeholders interested in applying this technology to support forensic documentation of sexual violence.
Innovation Description
What Makes Your Project Innovative?
MediCapt is a two-pronged system: first a mobile application that converts paper forensic medical certificates to a digital platform that prompts the collection of standardized forensic evidence; and second, a web-based online dashboard, currently in development, that will allow police officers, lawyers, and judges to securely access pertinent case information.
MediCapt collects information digitally and facilitates the way health facilities report SGBV statistics to national health information systems. It is adaptable and ready to be used in different contexts. MediCapt’s form builder function can adapt the app’s documentation capability to collect information required in different legal jurisdictions and can accommodate local languages.
A key part of MediCapt is the Toolkit. An ecosystem of supporting materials that include user manuals, training curriculums, institutional protocols for forensic documentation and survivor-centered care and troubleshooting guidelines.
What is the current status of your innovation?
MediCapt is being used in four health facilities across Kenya and DRC with a total of sixty-three end users. The latest pilot sites in Goma, DRC and Nairobi, Kenya are still in the pilot phase of the application. The other two health facilities are at an advanced phase of the project and are ready to transition to sustainable use of MediCapt.
PHR is also updating the MediCapt Toolkit that will include training materials, monitoring and evaluation guidance, institutional protocols, troubleshooting guidance, and clinical guidelines. This will support future users of the application. In addition to this, PHR has also been working on a sustainability framework to assist sites using MediCapt to put in place structures to support MediCapt use in the long-term.
Finally, as part of PHR’s scaling approach to MediCapt, we are working to make the software code open source to be utilized by a range of potential actors in diverse contexts, including low resource settings.
Innovation Development
Collaborations & Partnerships
MediCapt was co-designed by healthcare providers, law enforcement, and legal professionals in DRC and Kenya. The co-design process ensured that clinician end users who intended to use the tool provided feedback at every stage of design. As a result, the application is designed to function in the settings where end users work. MediCapt is being used in three public hospitals in Kenya. With the support and partnership of Nakuru and Nairobi County governments, MediCapt is now at the scaling stage.
Users, Stakeholders & Beneficiaries
The end users of the mobile-based MediCapt application are clinicians involved in providing forensic documentation services for survivors of sexual and gender-based violence. Through the online web-based dashboard, law enforcement officers and the courts will securely access these forensic forms for use in the prosecution of these sexual offences.
Innovation Reflections
Results, Outcomes & Impacts
To help solidify our evidence base demonstrating the effectiveness of MediCapt, PHR completed a formal evaluation in Kenya to determine whether using the application results in clinicians collecting more complete and higher quality standard medical forensic documentation compared to using paper forms. Results from this study showed that MediCapt was well-received in the areas where it has been piloted and dramatically improved the quality of forensic documentation of sexual violence as compared to documentation using paper-based forms. The application’s use has been regarded as feasible and sustainable, both standardizing and improving the quality of documentation across sites. It is anticipated that this improvement will increase the likelihood of successful prosecutions, strengthening accountability for alleged perpetrators and improving survivors’ access to redress and justice.
Challenges and Failures
When piloting the application, we encountered an initial hesitation from a few end users that was caused by unfamiliarity with MediCapt, lack of confidence in their skills to use the hardware, and the perception that this would increase their workload. With subsequent trainings and support, this attitude changed, as they better understood the benefits of MediCapt and gained the skills to use it.
Some technology challenges we experienced included the selection of appropriate and available hardware. For example, selecting equipment with readily available parts for maintenance purposes.
Piloting MediCapt requires a strong technical support team to support end users as they familiarize themselves with the application. End users occasionally forget their passwords, experience challenges with synchronization, and require time to gain confidence using the hardware. This initial support will encourage them to keep using the application and resist any temptation to revert to paper-based forms
Conditions for Success
MediCapt was originally designed to be used in resource-constrained settings where access to secure, private and quality forensic documentation was not guaranteed. Despite it being a tech-solution, MediCapt was designed with features that enabled it to be used in low-resource contexts. For example, it does not require to be connected to the internet while the clinician is completing the form during a patient encounter. However, the use of MediCapt in this context needs to be accompanied by the suite of training curricula for forensic documentation of evidence of sexual violence.
Medical facilities and/or county governments overseeing healthcare provision will be expected to meet the running costs for the application, which include purchasing hardware (I.e., tablets), training costs as well as ongoing maintenance for the equipment. This cost is approximately $700 per end-user.
Replication
MediCapt is also being piloted in the DRC, a country where there has been long-standing impunity for sexual violence crimes, especially those committed in the context of war and continuing violence. PHR is partnering with HEAL Africa, a center of excellence in sexual and gender-based violence care and treatment in Goma to implement MediCapt at their facility to serve survivors in the surrounding region.
PHR intends to identify, develop, and nurture strategic partnerships with Governments and like-minded organizations to enhance forensic documentation of sexual violence in different geographic settings and legal jurisdictions. These partnerships will lead to impact at a multinational level depending on the selection of partners that PHR works with. At the same time, MediCapt’s code will also be open source allowing for access by a wider range of stakeholders. Beyond sexual violence, MediCapt can also be used for forensic documentation in other use cases such as torture around the worl
Lessons Learned
Institutional capacity development provides a strong foundation for successful implementation. MediCapt alone cannot teach effective documentation of sexual violence. To implement the tool at partner hospitals, we must conduct a progressive suite of trainings to improve capacity to respond to sexual violence including forensic documentation, forensic photography, and multisectoral collaboration.
Mastering the application takes time and there is a steep learning curve, but it gets easier with practice. Practice with standardized patients was particularly helpful in gaining confidence in using the application successfully with a patient.
Responsible technology that has an impact takes time to develop. As PHR is working to implement MediCapt in different contexts, it is critical to employ a collaborative approach, and this takes time. Together with partners, we are consistently refining the tool as well as our training curriculums to ensure they are tailored to end users and add value.
Status:
- Implementation - making the innovation happen
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Date Published:
29 July 2023