Mobile Technology-related Activities To support increased access to health services and information and improved quality of care. Engages in the strategic design, testing, implementation and rigorous research and evaluation of mHealth tools within MVP and beyond, while simultaneously working to advance an enabling environment for mHealth, globally. Collaboration between researchers at the Earth Institute and members of the Department of Biomedical Informatics at the Columbia College of Physicians and Surgeons, the Department of Epidemiology at the Mailman School of Public Health, the Department of Engineering and the Center for New Media Teaching and Learning at Columbia University. Five Sectors: Health, Agriculture, Enterprise, Education and Infrastructure
The frontline for health service provision are community health workers (CHWs). CHWs, in MVP, are located within the villages and are responsible for 100-250 HHs each. CHWs conduct household visits and use paper forms (with a shift to mobile-based forms and reporting) to report information. CHWs report to senior CHWs who report to CHW Managers/Health Facilitators. Re: Health workers: “No other category of worker is so essential to the well-being of the population of every nation.” (Ethn Dis. 2009;19[Suppl 1]:S1-60–S1- 64)
They are trained to provide routine and preventive health services. CHWs used to be trained on an MVP training manual, however, this has ceased as we are transitioning to another training based on the WHO’s newly released CHW curriculum on Caring for Newborn and Children: http://www.coregroup.org/resources/mae-tools to be released in the next few months. Currently, CHWs receive gov’t trainings and CC+ trainings. While the CHWs were receiving training, the trainings provide minimal medical training and knowledge is infrequently reinforced after training. So, we looked into ways that we could provide additional opportunities for further professional development and continually reinforce information on key areas in family planning, reproductive health, care for newborns, malnutrition, diarrhea and infectious diseases [Supporting resource: Mensah JA “Addressing educational needs of health workers in Ghana using distance education”]. One such opportunity was through incorporating and strengthening mLearning in existing mHealth initiatives—CC+ and the Ghana Telemedicine Project. [Mobile learning (mLearning) is defined as learning that takes place via wireless devices (i.e. mobile phones, PDAs, smart phones or laptops) Source: Imperial College London, An E-Learning Glossary ]. Since CHWs already had mobile phones, we felt that it would be relatively feasible.
We had this system and network and needed to determine, what would the purpose of mLearning be?—would it be mLearning for education or mLearning for performance? How can we maximise ownership of the learning experience? Would this be welcome? Software limitations? Infrastructure limitations? Trainings on use, etc.? [Supporting resource: Wishart (2007). “ The Seven ‘C’s-No, Eight-No Nine ‘C’s of mLearning”]. So, this explains why we chose to attempt to integrate mLearning within CC+ which is within this general framework and the Ghana Telemedicine Project, in hopes that we would be able to supplement performance monitoring and a feedback mechanism to address gaps in knowledge.
Drawing from our work and experiences, our priority has been to provide point of care support tools to health workers—both facility and community-based—in new and creative ways. [In part, this led to recognition of our CHW Program by the WHO’s Global Work Force Alliance—award of excellence.] This included the development of ChildCount+ (CC+), which is a maternal and child health SMS-based community health events registry and alert system initiative—can monitor and evaluate performance through reports generated. Reports include performance indicators and health indicators by CHW and in aggregate. As mentioned earlier, CHWs also receive trainings. Complementing CC+ is the Ghana Telemedicine Project. A call centre with a toll-free line has been set-up and there is a physician on-call 24/7. The line will first be open to health workers in the MVP cluster (for piloting purposes) with potential to scale-up. Through this initiative, supervisors will be able to monitor the nature of the calls. The idea is that this monitoring system can then feed back into trainings and addressing knowledge gaps. Therefore, CHWs receive learning opportunities and reinforcement through the trainings, interactions and supervisor reviews via CC+ and the Ghana Telemedicine Project. With that noted, we also looked into developing a more formal mLearning initiative. Through this mLearning Initiative, CHWs would be able to access content/topics covered during their trainings on their mobile phones. http://www.who.int/workforcealliance/forum/2011/hrhawardscs11/en/ http://themillenniumchw.wordpress.com/about-program/
We began content adaptation in late 2008 and early 2009, based on the CHW training manual seen in the previous two slides. The manual is broken down into sections and each section is input into mLearning software as modules. The modules developed to date are: pre/post-quiz; reproductive health (English); reproductive health (Swahili); prenatal care; postpartum care for mothers; postnatal care; hygiene and nutrition.
This has posed a challenge that I will discuss later.
These are the sites that have launched this mLearning Initiative. The first sites were Kenya, Tanzania, Uganda and Ghana in 2009. CHWs were trained on the reproductive health module. The training only took a few hours. In Malawi, I conducted an informal tutorial with two of the health facilitators who oversee the outreach nurses and the CHWs – it literally took 10 minutes. Their phones were outfitted with the reproductive health, hygiene and nutrition modules. I would like to note here that the mLearning by no means supplants the CHW Trainings. The feedback received from those who use and still use the modules are overwhelmingly positive: users found it easy to use; not always having to call nurse or other health team members for knowledge support; no need to carry around large training manual as a reference; there is the possibility of assessing CHW knowledge and CHWs wanted more quiz questions in module-end evaluation! The positive feedback may be the initial ‘wow’ factor of utilising mobile phones in this manner [Supporting source: Sharples et al. “Mobile Learning: Small Devices, Big Issues”].
As for the challenges, I need to be honest. In the remainder of this presentation, I would like to share with you several challenges that have contributed to us not being fully active with the mLearning Initiative activities in roughly one year. First, priorities and what has been identified as greatest need—which is point of care support. With our energies focusing on the existing initiatives (CC+ and Ghana Telemedicine Project) that provide direct point of care support, which is what we believe contributes most towards this and the health goals in MVP, the man-power and energies have not focused on the mLearning Initiative. It is put on the backburner. Going forward, the mLearning Initiative would need dedicated energies and time. Downloading the modules has posed difficulties for us. Current set-up, is user must have mobile connected to computer to download the modules or updates to the modules. . The content needs to be reviewed and constantly updated. We are looking into different software packages with Ericsson that would allow us to provide downloadable links and easily update modules and content/allow for customisation of content and easy updates. We also would like this software to have a more straightforward mechanism of monitoring and tracking, which is the next challenge to note. As noted earlier, information provision and performance monitoring are already possible through CC+ and the Ghana Telemedicine Project, so is there technically a need for this in mLearning Initiative or can it link in with the existing structure? For mLearning in a more general sense—how would we evaluate this? What metrics are there/in use? What about the long-term? Other challenges/lessons learnt (and some of these have been prolific challenges or limitations identified in the literature): * Limited storage capacity of phones limits content * Non-English versions can have lengthier text and such content has been known to cut-off on screen * What works on the software simulator does not always translate well to phones * Not all phones have the ability to download the modules (OS compatibility matters) * Content needs to be specific to context (users, culture, etc.) We definitely are working with our partners at Ericsson to develop way forward. These challenges and lessons learnt through our experience are not only unique to MVP’s experience with mLearning. We should proceed with caution as things are not as straight-forward as we may think. We may also want to look into ways that we could better situate and/or enhance mLearning within existing mHealth initiatives/point of care support tools in particular to further leverage health outcomes. We look forward to having your thoughts and perspectives on this and moving forward together.
Center for Global Health and Economic Development The Earth Institute, Columbia University Nadi Nina Kaonga, mHealth Program Coordinator http://cghed.ei.columbia.edu/?id=projects_mhealth mHealthEd 2011 , Cape Town, South Africa 6 June 2011 MVP mLearning for CHWs
How it Works: User Access User downloads module onto Java-Enabled Phone from .jar file on computer Module is readily accessible from phone ’s menu for use (even in presence of no network connectivity) Photo Credit: WhiteAfrican, FlickR
Launching the mLearning Initiative Dertu, Kenya Mwandama, Malawi Ruhiira, Uganda Mbola, Tanzania Bonsaaso, Ghana MVP sites that have launched mLearning