No. field_name field_type english_long
Fields to automatically capture for each
respondant
1 User ID Integer User ID
2 Given Name String Given name
3 Family Name String Family name
4 Phone Number String Phone number
Form fields
1 locality String (list) Locality
2 survey_date Date Date
3 qty_soap Integer Quantity of soap distributed (bars)
4 qty_aquatabs Integer Quantity of aquatabs distrbuited
5 qty_pur_packets Integer Quantity of PUR packets distributed
Quantity of chlorox liquid distributed
6 qty_chlorox_liquid Integer (gallons)
Quantity of chlorox powder
7 qty_chlorox_powder Integer distributed (kg)
8 qty_ors_packets Integer Quantity of ORS packets distributed
Number of people reached by hygiene
9 num_hygiene_message Integer messages
Number of people with cholera
symptoms referred to treatment
10 num_cholera_referrals Integer center
Number of people with cholera
symptoms who were provided ORS by
11 num_provided_ors Integer the CHW
Number of males under 5 years old
12 num_males_under_5 Integer with cholera symptoms
Number of males 5 or older with
13 num_males_over_5 Integer symptoms
Number of females under 5 years old
14 num_females_under_5 Integer with symptoms
Number of feamles 5 or older with
15 num_females_over_5 Integer symptoms
Total number of people who died in
the community due to cholera in the
16 num_weekly_deaths Integer past week
Number of households visited where a
17 num_symptomatic_households Integer person had cholera symptoms
18 num_latrines_inspected Integer Number of latrines inspected
Fields discussed but not included
Number of radio spots (assume this
shouldn't be reported by the CHW)
Age breakdowns of 5-14, 15-59, 50+
validatio
english_short creole_long creole_short n_rule
Nimewo
User ID Nimewo itilizatè itilizatè
Given Prenon Prenon
Family Sinyati Sinyati
Phone Nimewo Telefòn Telefòn
Locality Lokalite Lokalite N/A
Date Dat Dat N/A
Soap Kantite savon distribye (ba savon) Savon >=0
Aquatabs Kantite Akwatab distribye Akwatab >=0
PUR Kantite Sachè PUR distribye PUR >=0
Chlorox liquid Kantite kloròks likid distribye (galon) Kloròks likid >=0
Kantite kloròks en poud distribye Kloròks en
Chlorox powder (mamit*) poud >=0
ORS Kantite sewòm oral distribye Sewòm oral >=0
Hygiene Kantite moun nou bay mesaj sou
messages ijyèn mesaj ijyèn >=0
Kantite moun ki gen sentom kolera
Referrals ke nou refere nan sant tretman refere >=0
People provided Kantite moun ki gen sentom kolera Moun ki jwenn
ORS ke ajan kominotè a bay sewòm oral sewòm oral >=0
Kantite ti gason ki gen mwens ke 5 Ti gason =0
Kantite gason ki gen 5 kan ou plis ke
5 kan ke nou jwenn ak sentom
Males >=5 kolera Gason >=5 >=0
Kantite tifi ki gen mwens ke 5 kan
Females =0
Kantite fi ki gen 5 kan ou plis ke nou
Females >=5 jwenn ak sentom kolera Fi >= 5 kan >=0
Deaths in last Total moun ki mouri ak kolera nan Mò semèn
week kominote a nan semèn ki sot pase a pase >=0
Symptomatic
households Kantite kay ke ou vizite ki te gen
visited yon moun ki te gen sentom kolera Kay vizite >=0
Latrines
inspected >=0
validation_msg_en validation_msg_cr defau
glish eole lt Comment
Possible to get list of all
N/A N/A N/A villages?
N/A N/A Today
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative N/A
Cannot be negative
ZL Mobile Initiative Cost Estimates
Summary
Item Software Hardware Airtime Cost
Option 1: FrontlineSMS 0 $3,767.90 ###### $13,439.90
TextForms
Option 2: CommCare w/out 0 ###### $967.20 $13,465.95
GPS
Option 3: CommCare w/ 0 ###### $967.20 $24,085.95
GPS
Constants
Number of CHWs 125
Gourdes/Dollar 0.0248
Option 1: FrontlineSMS Text Forms
Software Costs
Item Amount
In-house programming 0
Subtotal 0
Hardware Costs
Phone Unit Cost Unit cost Number Total Cost
(Gourdes) (Dollars)
Nokia 1661 (SMS only, 909 $22.54 125 $2,817.90
candybar)
Laptop server $750.00 1 $750.00
GSM Modem $200.00 1 $200.00
Solar chargers $22.00 125 $2,750.00
Subtotal $3,767.90
Airtime Costs
Item Estimated Cost per Cost per Number of Total
SMS SMS SMS CHWs Annual
messages (Gourdes) (Dollars) Cost
per week,
per CHW
SMS messaging 20 3 $0.07 125 $9,672.00
Subtotal ######
Total cost for first year
Item Cost
Software 0
Hardware $3,767.90
Airtime $9,672.00
Grand Total #######
Option 2: CommCareHQ without GPS
Software Costs
Item Amount
In-house programming 0
Subtotal 0
Hardware Costs
Phone Unit Cost Unit cost Number Total Cost
(Gourdes) (Dollars)
Nokia 2730 (GPRS, candybar $99.99 125 $12,498.75
form factor)
Solar chargers $22.00 125 $2,750.00
Subtotal #######
Airtime Costs
Item Estimated Cost per Cost per Number of Total
Kb per Kb Kb CHWs Annual
week, per (Gourdes) (Dollars) Cost
CHW
GPRS Internet 20 0.3 $0.01 125 $967.20
Subtotal $967.20
Total cost for first year
Item Cost
Software 0
Hardware $12,498.75
Airtime $967.20
Grand Total #######
Option 3: CommCareHQ with GPS
Software Costs
Item Amount
In-house programming 0
Subtotal 0
Hardware Costs
Phone Unit Cost Unit cost Number Total Cost
(Gourdes) (Dollars)
Nokia C5 (GPRS and GPS, $184.95 125 $23,118.75
candybar form factor)
Solar chargers $22.00 125 $2,750.00
Subtotal #######
Airtime Costs
Item Estimated Cost per Cost per Number of Total
Kb per Kb Kb CHWs Annual
week, per (Gourdes) (Dollars) Cost
CHW
GPRS Internet 20 0.3 $0.01 125 $967.20
Subtotal $967.20
Total cost for first year
Item Cost
Software 0
Hardware $23,118.75
Airtime $967.20
Grand Total #######