As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
Mobile delivery of health extension worker training materials
University of Alcala
The information below appeared in the original case study.
mPowering Frontline Health Workers
Roman Blanco and Alex Little
Digital Campus Ltd
Health Care Provider
Services and Applications, Workforce
This case study was originally published in the mHealth Compendium Volume 5, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study, submitted by the implementing organization in March 2021, appear in the final section of this case study.
Health workers in Ethiopia are generally under-trained. The standard training pedagogy can often involve an excessive use of text-heavy, didactic lecturing that lacks the interactive, participatory pedagogy needed for effective adult learning. Moreover, there is little follow up on how health workers use their newly acquired knowledge and skills.1 Research on the introduction of ICT in education has shown that it is effective only when developers understand the strengths and weaknesses of the technology and integrate the technology into appropriate pedagogical practices.2,3,4 To supplement and enhance learning within existing training programs, the UK-based company Digital Campus’ technical and medical team have developed OppiaMobile, an open source mobile learning platform for delivering learning content, video, and quizzes, specifically designed for low resource environments with poor Internet connectivity, such as rural Ethiopia.
The OppiaMobile platform consists of three main components: a Moodle plugin for authoring, the OppiaMobile server, and phone client application. All of the code is open source (GPLv3 license), enabling anyone to set up their own server/client application and customize as necessary. Key features of OppiaMobile include:
Offline access: OppiaMobile assumes that the user has limited Internet connectivity. All features of the learning content and activities are stored directly on the phone’s SD card and therefore function even when offline. When a connection is available, the stored tracking information, quiz scores, details of videos watched are sent back to the server.
Supports video/multimedia: Multimedia content can be included in courses; this would usually be copied directly onto the phone SD card to reduce the course package size, especially when the user has poor or slow Internet connectivity.
Embedded quizzes and self-assessment tests: Quizzes can be included in the courses, supporting a range of question types, including multichoice, multiselect, matching, numerical, and short answers. Feedback can also be provided.
Tracking and monitoring: An analytics dashboard on the server allows teachers, trainers, and supervisors to monitor and track students’ progress in almost real time. This includes quiz scores (including responses given for individual questions) and the length of time users spent on a particular activity.
Multilingual content supported: Activities can be provided in multiple languages, allowing users to switch to their preferred language.
Collaborative editing: Moodle is used for course content development, taking advantage of the existing authoring environment and allowing existing courses in Moodle format to be easily converted to run on OppiaMobile.
Automatic notification of content updates: When a course is updated, users are automatically notified that an update is available and they will not lose the progress indicators.
Customized app and server: All the server and app components are open source.
Gamification: Learners can earn points and badges for completing activities, quiz scores, and watching videos.
Oppia Mobile is being tested to deliver in mobile phones the complete national health extension worker (HEW) training materials, approved by the Ministry of Health, to upgrade its more than 34,000 HEWs. The main outputs of the first phase of this project (18 months) in Ethiopia has been the technical development of the mobile learning platform and the adaptation of the complete HEW training materials: 13 modules covering all aspects of primary healthcare, with additional video content from Medical Aid Films and Global Health Media Project, and hundreds of new self assessment quiz questions.
This is still an ongoing study, having enrolled a first cohort of 200 HEWs in one training center (Mekelle) in northern Ethiopia from September 2014 to July 2015, with a 15-month follow-up of HEWs when they have returned to their health posts.
The training course, comprised of 13 modules, taught over 8-12 months, covers a variety of health topics, including antenatal and postnatal care, labor and delivery, nutrition, family planning, immunization, adolescent and youth reproductive health, hygiene and environmental health, communicable and noncommunicable diseases, and health management. All the materials are released under a Creative Commons license. It provides a source of information that can be used for both preservice and inservice training and to reinforce critical health messages so that health workers feel confident and empowered to deliver effective services in their communities.
The OppiaMobile platform allows mobile-ready offline courses to be developed without the need for technical development. The platform is already in use in Ethiopia, Nigeria, Ghana, and India, and collaboration with the mPowering partnership (http://mpoweringhealth.org/) will ensure the platform and adapted content be used more widely.
While the implementations in Nigeria and India are not currently active, they are active in Ethiopia, Liberia, and Uganda.
Ethiopia: In collaboration with Last Mile Health’s Community Health Academy, OppiaMobile is approved by the Ethiopian Federal Ministry of Health and the Ethiopian Public Health Institute to provide COVID-19 training content (covering infection prevention and control, case management, surveillance, laboratory testing, risk communication, and community engagement) to all health workers across the country. So far, over 10,000 health workers in Ethiopia have installed the app.
Liberia: OppiaMobile is already installed and in use by 3,500 community health workers.
Uganda: OppiaMobile is approved by the Uganda Ministry of Health, in partnership with Makerere University, to provide COVID-19 training content (same course coverage as Ethiopia) to all health workers across the country
In addition to being used successfully in frontline health worker training programs in these countries, OppiaMobile has also been deployed in health programs in India, Liberia, Nigeria, Ghana, Zambia, and Pakistan. OppiaMobile is specifically designed for government needs for ownership, rapid deployment of rich learning content, open source and for deployment in offline or low connectivity environments. An increasing number of countries (including Uganda and Ethiopia) are requiring that digital health tools be hosted, managed, and maintained in-country.
Original Case Study
1. Little A, Medhanyie A, Yebyo H, Spigt M, Dinant GJ, Blanco R (2013). Meeting Community Health Worker Needs for Maternal Health Care Service Delivery Using Appropriate Mobile Technologies in Ethiopia. PLoS ONE 10.1371/journal.pone.0077563
2. Sharples, M. (2000). The design of personal mobile technologies for lifelong learning. Computers and Education, 34.177-193.
3. Welch, M & Brownell, K (2000). The development and evaluation of a multimedia course on educational collaboration. Journal of Educational Multimedia and Hypermedia, 12, 183-202.
4. Quinn, C (2001). Get ready for m-learning. Training and Development, 20 (2), 20-21.
Digital Campus (http://digital-campus.org)