health enablement & learning platform_medhurst, mbindyo, ramathal

HELP Health Enablement & Learning Platform

Fall CORE Group Meeting

October 16-17 2014

Confidential – not to be shared or disseminated without explicit permission from Accenture & AMREF

Agenda

2

Introduction

Share our approach to using evidence and a

participatory approach in designing an mLearning

solution

Share our understanding of what it takes to

achieve sustainability in mobile learning

Share lessons learnt in developing and

managing cross sector partnerships


The Need for Scalable Health Worker Training in Africa

• There is a drastic shortage of health workers in

Africa. CHWs provide the first line of healthcare; there

is a need for ~200,000 CHWs in Kenya, and ~1m in all

of Africa.

• There is no scalable or sustainable method of

training CHWs, leading to an overburdened public

healthcare system.

• Of the CHWs that have been trained, most have

only received a fraction of the training and tools

they need to be effective

• Training is inconsistent, and many CHWs deal with

real health issues, but have not been retrained for

years

• Many Ministries of Health in Africa have a strategy for

community health, core curricula and content, yet lack

the capabilities to effectively train their health

workforce 3


The Mobile Learning Opportunity

4

• Africa has seen wide-spread usage of mobile

phones. Penetration is 97% amongst the

CHW community

• Mobile technology supports scalable

solutions

• Almost 70% of the health workers still use

basic or feature phones, with smart phones

being a very small minority

Could we demonstrate that even the

most basic mobile technology can

be used to: enhance traditional

learning; reduce training cost; and

increase the pace of learning?


Before Embarking on the Journey…Some Key Questions

• Which communities should we target and what content should

we be training them on?

• Do we develop the mLearning platform independently or should

we partner with other organizations?

• What should be the key characteristics of the mobile learning

(mLearning) platform?

• What are the key tenets and guiding principles that we want to

adhere to?

• How do we differentiate the mLearning platform from traditional

/ distance / computer / other mobile based training?

• How do we measure the efficacy of mLearning both from a cost

and retention basis?

5


Training Approach & Communities

6

Kibera Mwingi Samburu

F2F Training out-

of-scope for Pilot

Completed

Completed

Full F2F training

already

completed so

can only do

Complementary

Pre-Test Post-F2F

Test

Post mLearning

Test

Baseline:

F2F Only

mLearning:

Complementary

mLearning:

Supplementary

F2F

(6 modules)

mLearning

(9 Topics)

~= 30-35 CHVs, 1 CHEW

Training

Method

+

+

9

9

*

* *

* Tests Conducted for M&E Quantitative Data

1 wk 7-9 wks


HELP Partnership Model

7

• Lead the Health Content

Development, Design &

Delivery work

• Lead CHW strategy

• Build learning Methods &

Training/ Capacity

• Lead relation with donors, MOH

and community groups

• Enable service reach to CHW’s

• Enable network integration and deliver the required technology to the users

(Voice, Data etc.)

• Lead the service branding and customer strategy

• Lead the platform and service

definition process

• Provide solutions across SMS,

IVR, USSD, WAP, Handset App

etc.

Mobility Partnership

• Programme & partnership management and capacity building support

• Pedagogy/ learning methodology development support

• Solution development and mobility input

Government of

Kenya


Providing continuous training direct to the phone in CHWs pockets

8

Technology

Components Back-end solution

support

Technology Platform

Mezzanine Helium

Users Platform consumers

and contributors CHW Supervisors Partners Government

Channels Paths for data

exchange - push &

pull

Services High-level platform

capabilities

Blended

Training

Productivity

Enhancement

Tools

Health

Collaboration

Network

Data

Management

Tools

CHW

Engagement

Services

Content Health-related

content

CHWs

Mobile Web Mobile App Desktop Web

Text Video/Animations Photos Audio

SMS Phone Call (IVR)

(Primary) (Secondary)


HELP Core Tenets & Guiding Principles

9

HELP CORE TENETS

• Available for free to all community health workers

• Aligned to the Ministry of Health strategy for community health and

mobile health and gain endorsement

• Leverage and adapt existing content, and make HELP content

available to all

• Leverage current technology that is in the hands of health workers

to drive scalability and sustainability


HELP mPedagogy & Differentiation

10

The HELP mLearning solution is a balanced act

between Pedagogy, Content and Technology

…founded on the characteristics of good

and effective learning

…and orchestrated using a learning chain with right pace, rhythm and tools of mLearning for

long lasting professional development


HELP Innovation & Development

11

CURRENT FEATURES

• Almost any CHW can access the system after only 1.5 days instruction,

making the solution scalable and sustainable

• SMS and audio content delivery is intelligently controlled with an

advanced scheduling system

• A tailored mLearning pedagogy defines multiple interaction and learning

approaches

• Decision trees can support interactive games and diagnosis algorithms

• Assessments can be done through randomised quizzes

• An innovative, flexible and agile architecture has been created for HELP

• Group chat allows collaboration within community units

• Automated reports keep CHWs and supervisors informed and on-track


Demo

• Walk through the features with demo.

12


HELP Phase I Outcomes

13

CHW, Samburu

• 300 CHWs & 18 CHEWs in three

Kenyan communities (rural, urban

& nomadic)

• 9 mLearning topics rolled out

• 216,946 SMS delivered to CHWs

• 8,357 health-related group chat

messages have been sent

between CHWs and CHEWS

within community units

• 140,675 minutes of IVR audio

shared (1,500 feature length

movies)

“I never knew a phone could be used to

learn. The information is more in-depth

and detailed then face to face. I will be

able to deliver a high quality service.”

CHW, Kibera

“I now feel more connected to my fellow CHWs

through the group chat . Promotes unity within

CHWs, sharing information will keep us together”

Training delivered Early Outcomes*

*M&E from the 5 month pilot with 318 health workers is being

evaluated and will be available in June


Reduction in Face to Face Training & Costs

14

0

2

4

6

8

10

Baseline With HELP

Nu

mb

er

of

da

ys

fa

ce

to

fac

e t

rain

ing

2x increase in CHW

training throughput

Support by our advanced blended learning approach

providing continuous learning


HELP Innovation & Development

15

FUTURE FEATURES

• Integration with 3rd party platforms

• Smart phone features including

– Location-based services

– Rich media such as video and audio

– Offline packages that can be downloaded to a smartphone

• New forms of interaction and quiz games, including weighted questions

• SMS and news broadcasts

• Client-controlled access to content

• Content search capability

• Points and badge rewards

• Text and audio polls and surveys


HELP is a unified mHealth solution that drives improvements in

health system performance at all levels through a range of

integrated, mutually reinforcing services

16

Targeted Medical Supplies

& Health Curriculum &

Content

Medical Inventory Needs,

Community Surveillance

& Health System

Performance

Ministry of Health

Health Facility

Community Health

Worker

Community Health Data &

Health System Requirements

CHW/V Supervision,

Targeted Ongoing Training

CHW Community

CHW Community

Knowledge Sharing

& Support

Community

Basic/ Preventative Health Delivery,

Diagnosis & Triage Support

Health Needs &

Demographics

• Integrated Learning Management (Moodle) (S)

• Inventory Management (e.g. SMS for Life) (S)

• Incentive/ Reward Management (e.g. M-Pesa)

(B/S)

• Birth/ Death & Vaccine Registries (S)

• Health Information System Integration (B/S)

• CHO/EW Supervision Tools & Reports (B/S)

• CHW/V CHO/EW Direct Connect (B)

• CHO/EW Training Content (B/S)

• Advanced Learning & Rich Media Content (S)

• Community Surveillance & Data Collection

(e.g. Jamii Smart) (S)

• CHW/V Training Content (B)

• Micro-Data Collection (B)

• CHW/V Group Chat (B)

• Health Decision-Trees (B)

• Job Aids (B)

• Gamification (B)

Incentives/ Pay for

Performance

HELP Features

District to National Levels Community Level Facility Level

(B) Basic Phone (S) Smart Phone

Bold = Developed; Non-Bold = Phase II; Italics = On Roadmap

HELP: the unified solution across the health system


AMREF

eLearning

AMREF Community

Training

Bridging the “health access gap” through a convergence of

technology & services across the health system

17

Doctors

Nurses

Clinical

CHEWs

CHWs

Laptop Tablet Smart phone Basic phone Face to Face

He

alt

h w

ork

er

ca

dre

AMREF

HELP

Additional Services to Drive Convergence

• Smart-phone Application Development

• Rich Media combined into mPedagogy

• Integrated Learning Management System

• Inventory & Supply Chain Management

• Data Collection & Community Surveillance

• Monitoring & Evaluation / Analytics

• HW Performance Management & Pay for

Performance

Benefits from HELP Convergence

• “Always on” access to appropriate training for all health cadre

• Available to all users on any device

• Opportunity for continuous learning and career advancement

• Richer and more complex content integrated into mPedagogy

• Integrated LMS allows easy interface to update/ refresh content

• Feedback loops across cadre drive reinforced learning

• Provide reach of services to the community level on basic, with

sophisticated services on smart for advanced mHealth support


Our Vision for Continued Development of HELP

18

Phase 1

mLearning Viability

(Pilot)

2013-2014

Phase 2

mLearning Expansion (Post-Pilot)

2014-2015

Phase 3

mLearning as a

Business Solution

2015-2016

Phase 4

mLearning as a

Platform Service

2017-2018

Learning

Content

9 CHV mLearning

topics

+ 20 CHV mLearning topics

+ 42 CHEW mLearning topics

+ Accredited Courses

+ Partner content/

elective (open source)

content

+ Content

Marketplace (e.g.

mPowering open

source content)

Mobile

Device

Basic phones Basic phones

+ Smart phones

Smart phones

+ Device recognition

Smart phones

mPedagogy Complementary

Static Content

Mobile Self-Study

+ Supplementary

+ Gamification

+ Interactive Content + Dynamic Content

(e.g. User generated)

+ Social Learning

Scale 318 CHVs + 2,400 CHVs

+ 300 CHVs from 2 Partner

Organizations

+ 60 CHEWs

+ National Rollout (i.e.

200,000 CHWs)

+ New Cadres (e.g.

Nurses, Health Officers)

+ New Market

Segments

Integrated

Services

mLearning + CHEW Support Tools

+ Data Collection (Jamii Smart)

+ Stock Management (eHealth)

+ mVaccination

+ LMS / experiential learning

+ Additional Integrated

Services

+ mMoney (mPesa)

+ mInsurance

+ Supply Chain

Operations Basic support + Enhanced reporting

+ Proactive Messaging

+ Helpdesk Management

+ Call recognition


Our vision is to scale HELP with Partners & Donors to drive a

significant, sustainable contribution towards the 1m CHW goal for

Africa by 2020

19

2015-2016 2016-2018 2018-2020

I: Collaborate for Replication II. Scale as a Coalition III. MoH Ownership for National Access

• Engage large-scale donors to scale

HELP to drive significant impact; commit

to significant targets together

• Gather substantial evidence of impact,

scalability and sustainability

• Refine deployment model through

partners for scale and strengthen

operations center and support

• Continue advancement of content and

new features

# CHWs trained using HELP

200-500K

50-100K

20-30K

• Impact, scalability and sustainability

clearly demonstrated

• Advocate for MoH ownership

• Support MoH capacity building to

enable ownership & long-term

sustainability

• Continue to replicate

& scale across Africa

• Collaborate with health partners in Africa

to replicate the solution across countries

• Continue to strengthen value proposition

and sustainable business model

• Work with MoHs to ensure alignment with

the National Strategy & endorsement

• Apply community-based approach to

content development and innovation

• Share learnings and approaches for

improved blended learning and new

mHealth applications

Aspirational – For Discussion


Lessons Learned – Solution Delivery

• Involve stakeholders and MoH throughout the process

• Use participatory approach during design of solution – involve CHWs

in proof of concepts, UAT etc.

• Design solution using patterns and building blocks that can be

reassembled to do new functions, e.g., gamification, virtual townhall,

micro-data collection

• Solution for today but design for tomorrow

• Conduct baseline studies to better inform solution approach and M&E

• Maintain balance between functionality, financial viability, and

technology approach

20


Lessons Learned – Sustainability

• Start with sustainability in mind

• Bring together the “right” partners at the start and as needed

• Create a clear value proposition for governments and donors that

demonstrates a more efficient and effective approach to training, and

demonstrate clearly the economic impact this will have on health

• Create demand for the service from the community level and with

other implementers; continue to refine the value proposition with

both as you scale and learn together, which can drive further impact

and efficiencies, thereby improving the overall value proposition and

sustainability

• Bring your own device v/s provide the device

• Consider bringing in other value-added services alongside learning -

what is the right package of services?

• Interoperability, standards and collaboration

21


Lessons Learned – Managing Cross-Sector Partnerships

• Be open, honest and transparent – don’t shy from difficult issues – bring

“tough love” to the partnership

• Critical to work with all the partners to understand deeply their true agendas in

the partnership – it is usually more than just doing good, which is ok, and it is

important to design the programme to meet other objectives of the partners

• Be prepared to evolve the partnership – take time to reflect at different

point along the journey and shift roles as needed to keep the partnership on

track

• Consider enlisting a ‘partner broker’ (internal to the partnership, or external)

that can help hold the partnership together, acting as a ‘center point’ that

continues to drive forward all of the partners and maintains the aim of the

partnership as people/ agendas/ issues change (can even help maintain the

identity of the partnership across different organizations)

• Deal with issues/ challenges head-on and immediately

• Put strong governance in place to help manage complex issues openly and

together putting partnership objectives ahead of individual ones

• Be sure to give credit to all of the partners regularly

22


Above all else…

23

It’s not the absence of problems that defines success, but

rather how you deal with them…as there will definitely be

many issues along the way

Copyright © 2014 Accenture All rights reserved.


Would You Like To Know More?

Caroline Shakwei Mbindyo

AMREF eHealth Programme Manager

Phone: +254 20 699 3000

Email: [email protected]

Vernon G. Allport III "Trip"

Accenture Development Partnerships

Global Programmes Africa Lead

Phone: +27 83 388 9444


Get the latest news and additional resources on our

website at http://help.amref.org, or contact the HELP

programme managers

Noel Ramathal

Accenture Senior Manger

HELP Delivery Lead

Phone: +1 (312) 693-4409


24

mailto:[email protected]


http://help.amref.org/


health enablement & learning platform_medhurst, mbindyo, ramathal

Government & Nonprofit

explicit permission

mobile based training

community health

health workforce3

training cost

health content development

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