Yesterday we took part in a webinar on “Sharing and Reusing Health Training Content: An Introduction to ORB”, hosted by the Better Immunization Data Initiative.
mPowering Frontline Health Workers, Johns Hopkins Center for Communication Program and Digital Campus have just published a report (funded by Qualcomm Wireless Reach) on an open collaborative model for how health worker training content can be delivered in a way that will help to reduce duplication of efforts and decrease the time and cost of deploying mobile learning for frontline health workers. The process described helps to tie up the work we are doing with OppiaMobile and the ORB platform.
Download the full report (pdf, 3.6Mb)
This report represents an initial “blueprint” to create a scalable, locally sustainable, ‘end-to-end’ content distribution process that uses mobile technology to provide frontline health workers (FLHWs) access to relevant health content.
The core of the proposed process aims to: (1) increase content contributions to a centralized content management platform; (2) reduce duplication through collaborative content production and adaptation; (3) shorten the time and reduce the cost required to implement solutions for specific contexts and geographies by making the design process more standardized and systematic; and (4) establish an open collaborative model for the ongoing refinement of the process that can evolve independent of specific technologies. Establishing this process is a first step towards creating a common delivery system that allows organizations to focus on content creation and adaptation in order to accelerate the development of knowledge and skills for FLHWs and the communities they serve.
Despite significant milestones in the use of mobile devices by FLHWs, the inability of mobile health (mHealth) programs to go to scale without an ongoing infusion of external resources continues to challenge the global health development sector. One factor is the lack of evidence of the effectiveness of mHealth, which for government and donors diminishes the value of the investment in mHealth:
The phenomenal growth in the number of new [over 1300 mHealth] services has not, unfortunately, seen a parallel growth in the evidence base of these services, particularly
economic (cost) proof points. 90% of services are reliant on donor funding and/or a consumer payment model, both of which we would argue are unsustainable, given the short term nature of funding and the inability of consumers at the bottom of the pyramid to contribute significantly to out of pocket health expenses.
With increasing affordability of smartphones and steady improvements in wireless telecommunications infrastructure, the failure to scale mHealth solutions will become increasingly hard to explain. If the existing technology already lends itself to scale what are the barriers to achieving that goal, and to do so in a way that is sustained beyond initial donor investment?
In proposing an end-to-end process for content distribution, this report directly addresses the challenges to sustainable scale of mHealth programs.
Extract from posting in the Health Market Innovations blog:
A major barrier to mobile money uptake is the lack of a well-trained agent network to serve and address the financial needs of the community, with the greatest effects felt in remote areas. One way to address this challenge is to explore synergies between CHWs and mobile money agents, thereby leveraging the trust they have built in communities as frontline workers. Training CHWs to serve as “last mile” mobile money agents in hard-to-reach areas could extend the reach of both health services and mobile money.
The additional revenue potential could also be used to incentivize health workers to take up posts in remote areas. CHWs trained as mobile money agents would be well positioned to educate clients and communities about the benefits of expanded access to financial services, including paying for emergency transportation to health services or enrolling in insurance.
HIFA (Health Information for All) has recently published an article on the “application of mobile phones to enhance the provision of essential healthcare information for citizens in low resource settings … [segmented] by types of intended user, draws some conclusions about gaps in provision and makes some suggestions about ways forward.”
You can download the full article from the HIFA website at: http://www.hifa2015.org/wp-content/uploads/Ensuring-that-mHealth-applications-provide-essential-healthcare-information-for-citizens-in-low-resource-settings.pdf.
At the end of last week, Roman and I were at the GETHealth Summit in Dublin. Roman had a poster presentation accepted (get it here) and I was on the mPowering sponsored breakout session on content adaptation.
I was great to get to meet many people who I’ve only ever spoken to on skype, and with the size of the conference (~200 attendees) it was small enough to get chance to make new contacts with some new faces too.
There was plenty of lively discussion during all the sessions, however now I’ve had a bit of time to reflect on it all there are a few comments and queries that are still outstanding in my mind:
- Much of the training appears still to be NGO driven, so although this training may well fit with countries health ministries priorities, until this training becomes a core part of health workers career progression and “professionalisation”, the incentives to attend training may still be limited to per-diems.
- There was little discussion about the quality of the teachers/trainers – for me, the teachers (whether it be via face to face or blended learning) are critical to truly engaging their students in the subject matter, whether or not they have quality content/resources to use. Perhaps this could be a good topic for next years discussions?
- The dreaded ‘pilotitis’ word appeared a few times, with a suggestion to reterm this as ‘phase 1’. I would prefer to use the word ‘research’. Unfortunately, although there was talk of the number of pilots (30,000 – although no idea how this figure was arrived at, it’s certainly a lot), the systematic review of published research presented by Travis Porter (from Tulane Uni) cited a very limited number of published research articles (~55). So there’s a huge mismatch here between the work that’s being done and what has been properly studied and published. Until more results (good or poor) from these projects are published, we could keep repeating the same mistakes.
One of the highlights for me was to see the “CHN On the Go” mobile app being presented (more info on this project). This is work being done in Ghana, with Concern Worldwide and Grameen Foundation and was presented by Jahera Otieno. What’s great for us is that the app is based on OppiaMobile and has been developed/extended in-country with no support from Digital Campus apart from a short skype call over a year ago. This, to me demonstrates that we have taken the right approach in making the OppiaMobile platform open source, and that it’s in a state where others can expand and adapt to fit their needs.
Recently we made a visit to India to support Johns Hopkins Uni CCP in their implementation of OppiaMobile for ASHAs providing family planning advice in their communities in the Bihar region. We’ve been collaborating with the JHU CCP team in India for the last few months, so was great to get the opportunity to actually meet face to face and spend time with the ASHAs and the communities they are supporting.
JHU CCP India have been implementing Project Ujjwal for the last few years (funded by DFID/UKAID) to support improved family planning and reproductive health services in India, focusing on the Bihar and Odissa regions (two of the poorest states in India). One aspect of this project has been to provide health workers with video and media content they can show their clients to help them arrive at the right family planning method for them. So far these videos have been distributed on SD cards on low-end/feature phones, however they also wanted to look at ways in which these videos could be delivered in a more structured way, which is where OppiaMobile comes in.
We have created a slightly customised version of the OppiaMobile app, to include the videos resources for use during their client counselling sessions and also a mobile learning component, to give them easy access to more information about how they can use the videos during their counselling sessions and the various family methods they are expected to provide advice on.
The training was split over two days, with the first day initially orientating the health workers in how to use the smartphones (the model used was Lava Iris 406Q) and the app. The health workers then had a day to try the app in their communities during their counselling sessions. The second training day then followed up on their experiences and to gather feedback. Although this was very initial feedback after using for only one day in the field, we’ll be following them up each week for the next few months. Initial feedback was very positive, several ASHAs informed us that just by being able to show the videos to their clients, this had given sufficient information for their clients to attend the local Project Ujjwal family planning clinic. We expect to obtain more substantive and qualified feedback and results over the coming few months.
The Ujjwal app is freely available on the Google Play store at: https://play.google.com/store/apps/details?id=org.ujjwal.saathi.oppia.mobile.learning if you would like to try it out for yourself.
In addition to supporting the initial training, there were several other important aspects to our visit to India:
- To build up a better picture of the workflows of frontline health workers, especially with respect to how education and training can be integrated into their day-to-day activities, without creating extra workload burdens.
- To begin to build a blueprint of how a locally sustainable end-to-end content production and delivery system could be created to enable the re-use and adaptation of locally relevant content to support frontline health workers’ training needs on mobile platforms, tying in closely with mPowering’s objectives
- Meeting with local content production agencies (e.g. filmmakers).
- Meeting with local software and technical development organisations, specifically to support the ongoing maintenance and development of the localised OppiaMobile for Ujjwal app.
We’re very grateful to mPowering, JHU CCP and Futures Group, for all their support to enable this work and to the JHU CCP India team who have been very enthusiastic about the possibilities and made us very welcome in India.
Finally, many thanks to the ASHAs, who (despite it being a fasting day during the first day training), were very active during the training sessions and we hope these resources can help the great work they are doing in their communities. For me, it was fantastic to get the chance to spend time with them and learn more about their work, challenges and environment, to continue to improve how they may be supported by these new types of technologies.
by Marijs Carrin at Digital Campus
Recently, I was given the timely opportunity by Digital Campus to participate in a four-week online course on Mobile phones for Public Health, which examined the power of mobile technology and its revolutionary role in improving health outcomes worldwide.
The course focused on health education; service delivery and capacity building for health workers; patient care; diagnostics; as well as supply management and logistics. Throughout that month I gained new insight and reflected upon the benefits and remaining challenges of mobile health (mHealth), as we continuously try to adapt our Oppia mobile – health education and training- application to extend its use among health workers on a more global scale.
My preferred aspects of the course were:
- The vast amount of resources (videos, documents, presentations, exercises, links) available on mHealth;
- Learning about various mHealth tools and getting hands-on experience using them;
- The framework and taxonomy used in classifying mHealth projects (Dr. Alain Labrique, Founding director of the Johns Hopkins University Global mHealth Initiative);
- An outline of current evidence and projects.
The presentation by Dr. Labrique, one of the most respected professionals with years of experience in the field, was particularly useful and very inspirational to me. He shared a detailed synopsis of lessons learnt, opportunities and ideas around mHealth today, and allowed me to extend my knowledge regarding the definition, use and future of mHealth.
Dr. Labrique’s words have encouraged me to start thinking more outside the box. Innovation is critical in this field (also for development) and the examples of how it has changed the game are vast. Indeed, he emphasised that the success of mHealth interventions has to go beyond technology. The most important aspect, I learnt, is to create simple, sustainable and efficient solutions to health systems that are dynamic, crosscutting and moreover accessible to all. In a nutshell, mHealth is about people (or beneficiaries), not phones.
Finally, as we move forward in trying to develop, improve and adapt our app, I will keep Dr. Labrique’s words ingrained in my mind: not to ignore that mobile platforms need good design and functionality, but it needs to be equally fun and creative so that the end user (i.e. in our case health workers) “will want to continue to use the system beyond just being part of a routine job description.”
Filling the huge gap between technology and people is a challenge of the digital era. There is a lot of potential for great things to be achieved – and many have been already – but it is, in my opinion, essential that we don’t loose focus of the purpose and feasibility of the whole endeavor.
Our colleague, Araya Abrha (now Dr Araya) has made available the summary of his doctoral thesis “The use of mHealth for Maternal Health Care in Ethiopia”.
Since one of the papers contained in his thesis is still pending publication, we’re unable to post the whole thesis here, however if you would like a copy then please contact Araya directly (at email@example.com)
Following our release a few weeks ago of the mobile-ready versions of the HEAT maternal and child care modules for our OppiaMobile platform, we have now completed the adaptation of the remaining HEAT modules. This work has been made possible through funding from mPowering Frontline Health Workers and UKAID (DFID).
Which modules have been adapted?
We have adapted the following HEAT modules:
- Antenatal Care (Parts 1 & 2)
- Labor and Delivery Care
- Postnatal Care
- Integrated Management of Newborn and Childhood Illness (Parts 1 & 2)
- Communicable Diseases (Parts 1-4)
- Non-communicable Diseases (Parts 1 & 2)
- Adolescent and Youth Reproductive Health
- Hygiene and Environmental Health (Parts 1 & 2)
- Health Management, Ethics and Research
- Health Education, Advocacy and Community Mobilisation (Parts 1 & 2)
- Family Planning
How have the modules been adapted?
The HEAT modules were originally written for the upgrade training for the Health Extension Programme in Ethiopia and is the approved upgrade training by the Ethiopia Federal Ministry of Health.
For the mobile-ready adaptation process, we have removed specific references to Ethiopia and Health Extension Workers, along with cross references between different sections of the content. We anticipate that this will make it much easier for other organisations providing frontline health worker training to reuse/repurpose the content for their needs. However, the original full versions with all the Ethiopian references are also available.
We view the content adaptation as an iterative process, so we will constantly be working to improve the content with additional media and quiz content. We also welcome any feedback and suggestions on how to improve the adaptations (see below).
How can I access them?
There are 3 different ways to access the content – depending on your needs:
- You can download the modules to run offline on your Android smartphone directly from the OppiaMobile learning app.
- You can browse the content directly on our Moodle server. Although this applies the same stylesheet as when the content is viewed in the OppiaMobile app, the navigation and layout isn’t identical to the mobile app. This option is likely to be useful if you’d like to get a feel for the subject areas covered by the modules and the activities included.
- You can download the Moodle backup versions of these courses. This option is designed for you to be able to install the courses on your Moodle server for the purposes of providing localised versions, perhaps to fit your curriculum, or with references to the country/region in which you are delivering training.
Can I reuse/adapt these courses?
Yes certainly, all the courses are released under a Creative Commons license, and we have specifically chosen media content which is also released under an open license. So you are free to adapt these courses to fit your needs.
Have any questions or would like to provide feedback?
We welcome any questions, feedback or suggestions on these courses or if you would like to discuss with us how you can integrate mobile learning into your health worker training programme. Please contact us at: firstname.lastname@example.org
Digital Campus has been collaborating with Araya for the past 4+ years, so we’re really pleased he’s now completed and we look forward to continue to working and collaborating with him once he’s back in his full time role in the College of Health Sciences at Mekelle University.