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.
During the last weeks we’ve been training a cohort of 160 HEWs and their tutors/ trainers in Tigray (Ethiopia) on how to use OppiaMobile. These first training workshops are simply to get the HEWs and Tutors used to the phones, find out what problems and issues they may have, navigating the courses and activities, recharging, completing quizzes etc.
The training is going quite well, and the HEWs (mostly women) seem very eager to learn how to use the phones and soon became quite comfortable using them. Over the coming weeks we’ll introduce more OppiaMobile functionalities and we’ll find out what challenges may exist and the feasibility for using smartphones for training support in this environment.
We had a few of technical issues that we are looking at, but this is to be expected given that we’re still in the technical feasibility stage. One of the issues we’re still finding is the level of English of the HEWs, so we are working to provide a glossary of the most common medical terms and definitions in both English and Amharic / Tigrinyan.
Congratulations to our colleague, Mahmud Abdulkader, who has just completed his PhD in “Intestinal parasitosis and under-nutrition in Ethiopia. Prevalence, risk factors and prevention”. Digital Campus has been collaborating with Mahmud for the past 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 (Ethiopia).
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.
We have just published in Human Resources for Health a new research paper, “Mobile health data collection at primary health care in Ethiopia: a feasible challenge”. This article gives a detailed account of Community Health Workers’s experiences using mobile health data collection tools. Here is the abstract:
Mobile health (mHealth) applications, such as innovative electronic forms on smartphones, could potentially improve the performance of health care workers and health systems in developing countries. However, contextual evidence on health workers’ barriers and motivating factors that may influence large-scale implementation of such interfaces for health care delivery is scarce.
A pretested semistructured questionnaire was used to assess health workers’ experiences, barriers, preferences, and motivating factors in using mobile health forms on smartphones in the context of maternal health care in Ethiopia. Twenty-five health extension workers (HEWs) and midwives, working in 13 primary health care facilities in Tigray region, Ethiopia, participated in this study.
Over a 6-month period, a total of 2,893 electronic health records of 1,122 women were submitted to a central computer through the Internet. Sixteen (69.6%) workers believed the forms were good reminders on what to do and what questions needed to be asked. Twelve (52.2%) workers said electronic forms were comprehensive and 9 (39.1%) workers saw electronic forms as learning tools. All workers preferred unrestricted use of the smartphones and believed it helped them adapt to the smartphones and electronic forms for work purposes. With regards to language preference, 18 (78.3%) preferred using the local language (Tigrinya) version of the forms to English. Indentified barriers for not using electronic forms consistently include challenges related to electronic forms (for example, problem with username and password setting as reported by 5 (21.7%), smartphones (for example, smartphone froze or locked up as reported by 9 (39.1%) and health system (for example, frequent movement of health workers as reported by 19 (82.6%)).
Both HEWs and midwives found the electronic forms on smartphones useful for their day-to-day maternal health care services delivery. However, sustainable use and implementation of such work tools at scale would be daunting without providing technical support to health workers, securing mobile network airtime and improving key functions of the larger health system.
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.