SlideShare a Scribd company logo
http://digital-campus.org
© 2013
Improving Health Extension Workers' training and effectiveness
through continuous skills improvement, knowledge assessment
and patient management processes
GPAF Innovation Project July 2013 - October 2016
Mobile Learning for Primary Health
Workers
http://digital-campus.org
© 2013
Asia
Bangladesh
India
Indonesia
Mongolia
Myanmar
Nepal
Pakistan
Qatar
GPAF project
Technical & Content development
Worldwide
project partners
R&D
http://digital-campus.org
© 2013

Inadequate training and
very text-heavy.

Little follow up on how the
skills and knowledge
learned are applied.

Low skilled birth
attendance and PNC rate

Need for a professional
career development
program
BMC Human Resources for Health
http://www.ncbi.nlm.nih.gov/pubmed/23171076
Primary health care system
challenges in Ethiopia
http://digital-campus.org
© 2013
Digital-Campus theory of
change
Strategies Outputs Outcomes Impact
Increase
ANC/PNC
knowledge
retention
Bridge the
digital gap
among women
Improve
quality of
ANC/PNC care
Achieve
MDG goals
Quality
education
Gender
Equality
Develop a
M-learning
Platform
Mobile-adapt
official training
content
Good health &
Well-being
Resources to
scale innovative
local solutions
Invest in
innovation
Mhealth
Open source
technologies
Creative
Commons
content support
http://digital-campus.org
© 2013
• A cohort of 157 HEWs at
Mekelle TVET (promotion
2015-16.
• Supplementing 1-year face-to-
face training with additional
multimedia and quiz activities.
• HEWs Level IV training
content – 13 modules – all
mobile adapted to run offline –
but focus on ANC & PNC.
• We supported HEWs whilst in
training centre.
• We followed up ongoing
usage and knowledge
retention once in health post
for up to 11 months.
http://digital-campus.org
© 2013
Mean Age (29 yo) Married (> 80%) Children (1.6 avg)
http://digital-campus.org
© 2013
Phase I: m-learning platform
development and content
adaptation

First 12 months.

Development and testing
the OppiaMobile platform.

Adapting the HEWs level IV
official training content to
be used in mobiles.
http://digital-campus.org
© 2013
What is OppiaMobile?
OppiaMobile is the first rich-
content open source mobile
learning platform specifically
designed for users in low
bandwidth/connectivity
environments.
http://digital-campus.org
© 2013
OppiaMobile learning platform

Supports video, quizzes
and other activities.

Works when completely
offline – all activities
stored on device.

Specially designed for
slow broadband networks
(2G).
http://digital-campus.org
© 2013
OppiaMobile learning platform

Currently designed for Android,
but can be extended to other
mobile operating systems.

Designed to support existing or
new training and teaching
programmes in all professional
areas.

Supports multilingual content.

Text to Speech – the client app
can “read aloud” text pages.
http://digital-campus.org
© 2013
How it works

No need for
programmers to
maintain and update
learning content.

Course content can be
collaboratively edited
and produced in
Moodle.
http://digital-campus.org
© 2013
How it works

Activity tracking, quiz
results, video views all
submitted to server –
trainers and
supervisors can track
student progress.

Students gain points
and “badges” based
on their usage and
quiz scores
(gamification).
http://digital-campus.org
© 2013
Customised OppiaMobile
versions
All open source - can install your own server and
create your own client app

Use your own themes/logos for the client
application
http://digital-campus.org
© 2013
Official training content for Level IV
HEWs
http://digital-campus.org
© 2013
HEWs level IV training content

13 Modules to upgrade the
theoretical knowledge of the
country’s 40,000 Health
Extension Workers.

These Modules cover the full
range of health promotion,
disease prevention, basic
management and essential
treatment protocols to improve
and protect the health of rural
communities in Ethiopia.
http://digital-campus.org
© 2013
OppiaMobile adapted HEWs level IV
courses
http://digital-campus.org
© 2013
OppiaMobile adapted HEWs level IV
courses
http://digital-campus.org
© 2013
Student and teachers dashboard:
automatic activity tracking
http://digital-campus.org
© 2013
We developed a glossary english- tigrinya
for medical terms
http://digital-campus.org
© 2013
ANC & PNC Checklist app
http://digital-campus.org
© 2013
Phase II: testing the application
with HEWs at Dr. Tewelde training
centre

From April 2015 until
August 2015.

Training workshops:

Android phones

ANC/PNC checklists

OppiaMobile
http://digital-campus.org
© 2013
Mobile Phone baseline
survey

Mobile phone use by HEWs. Findings:

99.5% of the HEWs do have mobile
phone (Mostly feature Nokia and Techno
phones)

91% did not know how to use Internet.

> 90% did not have an e-mail or social
media account.

>90% were not confident using a
computer.

>37% of HEWs did not have electricity at
home to charge their phones.
http://digital-campus.org
© 2013
Mobile Apps pre-installed
http://digital-campus.org
© 2013
Training workshops
http://digital-campus.org
© 2013
Understanding HEWs
challenges
http://digital-campus.org
© 2013
How to use smartphones
http://digital-campus.org
© 2013
http://digital-campus.org
© 2013
HEWs level IV graduation
http://digital-campus.org
© 2013
Phase III: testing the application
with HEWs at their health posts

From December 2015
to October 2016.

Remote follow-up
(OppiaMobile
Dashboard, phone
calls, SMS)

Regular field visits

Monthly top-up (50
Birr)
http://digital-campus.org
© 2013
Electricity HP
Network HP
No
Yes
http://digital-campus.org
© 2013
Good network but no electricity in
HP
http://digital-campus.org
© 2013
Electricity Home
Network Home
No
Yes
http://digital-campus.org
© 2013
No
Yes
http://digital-campus.org
© 2013
OppiaMobile automatic activity
tracking
http://digital-campus.org
© 2013
Health Posts visits
http://digital-campus.org
© 2013
http://digital-campus.org
© 2013
Health Post visits and
monitoring
(video)
http://digital-campus.org
© 2013
Group Monitoring
http://digital-campus.org
© 2013
Phase II: testing the OppiaMobile
platform with HEWs at the
training centre
RESULTS
http://digital-campus.org
© 2013
COC
May 2105 Aug 2105 Nov 2105
http://digital-campus.org
© 2013

Usage stats for the training period:
 1 million activity hits.
 80,000 quiz attempts, with responses to 600,000
questions.
 16,000 video views.
•
Very few technical issues, students and college
dean/tutors very happy with app and content
(from satisfaction survey).
OppiaMobile main usage
statistics (May 15 - July 15)
http://digital-campus.org
© 2013
HEWs looked at all Modules
http://digital-campus.org
© 2013
>13 wks
8-11 wks
4-8 wks
Students activity (May – July 15)
http://digital-campus.org
© 2013
P= 0.001 (Mann-Whitney test)
Antenatal Care module test
results
P= 0.29 (Kruskal-Wallis test) P= 0.001 (Kruskal-Wallis test)
Pre-quiz (May 2015) Post-quiz (July 2015)
http://digital-campus.org
© 2013
Pre-quiz (May 2015)
Post-quiz (July 2015)
Pre-quiz ANC Post-quiz ANC
http://digital-campus.org
© 2013
P= 0.014 (Mann-Whitney test)
Postnatal Care module test
results
P= 0.63 (Kruskal-Wallis test) P= 0.001 (Kruskal-Wallis test)
Pre-quiz (May 2015) Post-quiz (July 2015)
http://digital-campus.org
© 2013
Pre-quiz (May 2015)
Post-quiz (July 2015)
Pre-quiz PNC Post-quiz PNC
http://digital-campus.org
© 2013
Certificate of Competence
national exam results
(Nov 2015)
1st time
2nd time
http://digital-campus.org
© 2013
Phase III: testing the OppiaMobile
platform with HEWs at their
health posts
RESULTS
http://digital-campus.org
© 2013
Less than 6% of phones had any
hardware issues in 16 months
(lost/stolen, broken or malfunction)
Normal
Lost/stolen
Malfunction
Broken
http://digital-campus.org
© 2013
Phones were not locked
http://digital-campus.org
© 2013
HEWs also installed other apps…

Medical
Dictionary

First Aid

English-Amharic
Dictionary
http://digital-campus.org
© 2013
2615
15935
58165
7414
23080
11551
18972
35850
4142
7753
8085
19335
40272
22120
21058
8673
13325
14525
18883
16502
12092
84134
23761
46173
25988
12472
18640
8863
10910
28672
35542
6032
47112
14711
12455
15237
480
13452
37564
5015
42767
30930
17498
27657
51126
32647
55287
22895
23421
22428
7774
7950
9250
16466
27304
2054
13850
Bizu Tadele: 217.109 !
OppiaMobile activity
http://digital-campus.org
© 2013
Post-training evaluation: antenatal care
June 2016Test (June 2016)
Excellent
Good
Passed
Not passed
http://digital-campus.org
© 2013
Antenatal
care
evaluation
Test (June 2016)Test (May 2015)
Excellent
Good
Passed
Not passed
http://digital-campus.org
© 2013
Post-training evaluation: postnatal care
June 2016Test (June 2016)
Excellent
Good
Passed
Not passed
http://digital-campus.org
© 2013
Postnatal
care evaluation
Test (June 2016)Test (May 2015)
Excellent
Good
Passed
Not passed
http://digital-campus.org
© 2013
Postnatal care visits 0-48h
(Dec 15 - July 16)
Source: eHMIS
http://digital-campus.org
© 2013
Antenatal care - at least 4
visits (Dec 15 - July 16)
Source: eHMIS data
http://digital-campus.org
© 2013
• This project is innovative
and relevant.
• There are clear results and
overall the project scores
A+.
• The project represents very
good value for money.
GPAF QAV Visit Report
(January 2016)
http://digital-campus.org
© 2013
Further info/links
• Get the app on Google Play
• Documentation: http://oppia-mobile.org
http://digital-campus.org
© 2013
Thanks!
Contact us at:
roman@digital-campus.org

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