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HELPHealth Enablement & Learning Platform
Introduction
4 June 2015
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa2
Background
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Many developing and emerging countries are facing a severe shortage, and
significant skills gap, of frontline health workers
The Challenge: A Shortage of Trained Frontline Health Workers
3
By 2035, there will be a global deficit of 12.9 million skilled doctors, midwives and nurses.
This shortage is particularly critical in rural and remote areas.
Frontline health workers play a key role in reducing maternal & child mortality & combatting major diseases.
Skilled Health Workforce to Population Ratios in 2013
Low (<.23%)
.23% to .35%
.35% to .59%
High (>.59%)
Density of skilled health workforce
Source: 2013 WHO Report, A universal truth: no health without a workforce
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Community Health Workers (CHWs) help to fill the health worker gap, providing
basic health care & education to their communities, families and children
The Roles, Responsibilities and Impact of Well-Trained CHWs
4
Evidence shows CHWs can improve health outcomes for large populations in
under-served regions.
Source. http://www.coregroup.org/our-technical-work/program-learning/community-health-workers/327-review-of-chw-effectiveness-for-mdgs
Full utilisation of CHWS could save 3.6 million children’s lives each year
PROMOTION
PREVENTION
TREATMENT
REFERRAL
• Prenatal & postnatal visits to health facilities
• Pregnant women to seek care at delivery
• Anti-malarials for fever
• ORT for diarrhea
• Antibiotics for pneumonia and dysentery
• Vaccine & nutritional counseling
• Use of insecticide-treated bed nets
• Mother-to-child HIV transmission
• Recognize danger signs for mothers, newborns, children and refer
• Follow up post-health facility visit
1
2
3
4
CHW Roles and Responsibilities CHW Impact
DATA COLLECTION
5 • Disease surveillance
• Mother & child data collection
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
However there is a pressing need for a more sustainable, scalable approach to
CHW capacity building
The Challenges in CHW Capacity-Building
• Following 10 days pre-service training CHWs are often left with little or no ongoing support.
• Refresher training is uncommon.
• Access to peer & supervisor support is variable, especially in rural areas.
5
Increasing demand for CHWs
Need for ongoing training & support
Face to face training is expensive and time-intensive
• Ministries of Health are strengthening their community health policies, particularly around the training and support of CHWs.
• They need require partners and new capabilities to support this.
• Running ten-day face to face training sessions takes a lot of time (for implementers, Community Health Extension Workers (CHEWs) and CHWs).
• The costs of face to face training limit scale (travel, accommodation, venue etc).
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
This presents an opportunity to realize lasting health change by providing CHWs
with the knowledge and skills to break the cycle of poor health & poverty
The Opportunities for HELP to Support CHW Capacity Building
• There is increasing global recognition of the importance of CHWs
• Ministries of Health (MOHs) are developing strategies, curricula and content for CHWs
• CHW training organisations want to collaborate to enable scale and sustainability
• 97% of CHWs have a mobile phone
6
HELP provides a more sustainable, scalable solution for CHW capacity
building, leveraging the mobile phone in the CHW’s pocket and available to all
CHW training organisations.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa7
Introduction to HELP
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Our sophisticated learning manager system schedules delivery of curriculum topics & learning activities, following our mPedagogy.
HELP is a mobile phone-based tool to train and empower CHWs flexibly,
when it suits them
An Introduction to HELP
8
CHEWs can use mobile reports to monitor CHW progress, identify top performers & motivate learning. Each user had a personal digital record of their training.
Health decision trees support real-time diagnosis of prevalent diseases, as well as introducing gamification to motivate learning.
Our group chat feature promotes collaboration & discussion of health issues between CHWs & CHEWs.
HELP works on even the most basic mobile communication channels, delivering content in English & Swahili.*
Content search allows users to access any mTopic, as they need.
*Smart enhancements in development
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
1.
2.
3.
We believe we can strengthen the health system broadly by focusing on building
the capacity of the community health workforce from the ground up
Impact Framework (Theory of Change)
Enabling health workers to be
better at their jobs providing
first-line healthcare
o On-demand access to essential
information, tools and services
o Collaboration tools for knowledge
sharing & support
Better equipped health
workers provide better care
and have higher
performance, leading to
improved community health
Provide effective, high quality
training to more health
workers, more efficiently
o Blended learning reduces F2F reqts
& improves learning experience
o Structured pedagogy delivers high
quality MoH-approved content and
drives impact
More health workers are
better at their job which
increases motivation, job
satisfaction and retention
9
Improve health worker
performance and strengthen
workforce management
o Build capacity of supervisors with
richer content and supervision tools
o Connect CHVs to the formal health
system and create digital records of
their training and career
development
All aspects of the health
system strengthen due to
health workers having more
capacity and supervisors
better able to manage the
health workforce
Outcomes ImpactHow
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP has an all-around compelling value proposition for our key stakeholder
groups
HELP Value Proposition
10
Ministry of Health
An impactful, efficient method of building and managing
the capacity of the health workforce at scale and
strengthening the health system by growing talent
Implementers
A powerful service that can integrate well into your
programme and drive real value and impact, backed by a
reputable partnership
Supervisors
An efficient and effective way to manage your health
workforce and build your capacity as a manager in a
critical role for the Ministry of Health
Integrated Programme Partners
Better educated and equipped health workers strengthen
service delivery through improved performance and
motivation
Donors
Solid value for money solution providing high quality
training to the health workforce in alignment with the
Government and in collaboration with multiple partners
Community Health Workers
A powerful service always available to you to help you
build your skills and career in health, creating a personal
digital record of your training, while supporting you to
deliver great care to your community
Content Partners
A powerful solution for delivering content and learning on
a scalable platform that combines our mPedagogy with
sophisticated technology for the best learning experience
Influencers
Better educated and equipped health workers strengthen
service delivery through improved performance and
motivation
See ‘Our History’ for details on the impact and effectiveness of HELP.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa11
How HELP works
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Our unique, innovative mPedagogy is followed within each mTopic to enable high
quality, enjoyable learning
The HELP mPedagogy
12
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
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP content is developed in collaboration with the Ministry of Health, based on
the Ministry of Health’s CHW Curriculum
List of Available HELP Training Modules
13
Content available on HELP*
Curriculum Basic Modules
1. Health and Development in the Community
2. Community Governance and Leadership**
3. Communication, Advocacy and Social Mobilization
4. Best Practices for Health Promotion and Disease Prevention
5. Basic Health Care and Lifesaving Skills
6. Management and Use of Community HealthInformation and Disease Surveillance**
Other Modules (not based on the Curriculum)
7. Non-Communicable Diseases (Technical Module)
8. Ebola
9. Trachoma
*Details in appendix**Not currently fully available on HELP
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP delivers capacity-building content and tools to mobile phones through text
(SMS & USSD) and audio (IVR)*
The Technology, Content, Tools and Channels behind HELP
14
TechnologyComponentsBack-end solution support
Technology Platform
Mezzanine Helium
UsersPlatform consumers and contributors
CHEWs
ChannelsPaths for data exchange - push & pull
ToolsHigh-level platform capabilities
Blended
Training
Productivity
Enhancement
Tools
Group Chat
Tool
Supervision
Tools
Content
Search
ContentHealth-related content
CHWs
Mobile Web Mobile App Desktop Web
Text Video/AnimationsPhotosAudio
SMSPhone Call (IVR) USSD
USSD
Greyed out=in development
*Smart-enhanced HELP is in development
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP is built on Mezzanine’s Helium platform
HELP Technical Architecture
15
CHW / CHEW
SMS USSD IVR
Gateway
Infobip
Safaricom
- App Server- App Logic
vXML Browser
Helium DBSMS Content
Moodle LMS
LMS Manager
Gateway- Content
Infobip
UI- Menu Builder
Infobip
HeliumWeb App
Moodle Web App
Safaricom VM
Tech Support
Gateway
Safaricom
-vXML- Content
Safaricom VM
Safaricom VM
IVR Support
http xml
?
Batch mode Reporting Batch mode Schedule, Users, SMS Content
IVR Content
Mezzanine Kenya
USSD Support
Safaricom
Function
Where does it reside
- Content (IVR, SMS)- Schedule (TSA)
- Reporting- Users
KEY
Scheduler
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP is driven by a cross-sectoral partnership, leveraging the partners’ capabilities
and expertise to deliver a highly impactful, integrated mHealth solution
16
Lead the custom development of the technology platform and provide multi-channel mobile health solutions.
Mobility Partnership
Kenya Ministry
of Health
Provide regulatory oversight & technical guidance to ensure project plans & implementation approaches are of high quality in line with the national technical guidelines.
Provide the extensive telecom infrastructure and data centres required to deploy the HELP solution across Kenya.
Own vision and ultimate strategic direction of HELP. Provide day to day project leadership and community engagement.
Build the capacity of the core team by providing expertise in program strategy, delivery, technical design, mobility, and learning methods. The Accenture Foundation provides funding.
The Roles within the HELP Partnership: Bringing Together Leading
Organizations
Funding
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa17
Working with Others
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
We want to work with you to leverage HELP in your programmes
HELP differentiators
• HELP is a unique mobile solution to enable CHW capacity building.
• HELP is aligned to the MoH national strategy, curricula and content.
• Our supplementary training approach, agreed with the MOH, allows a reduction in face to face training.
• CHWs get an individual digital training record.
• We have shown the improvements in quiz scores, and enjoyment of CHWs, in our pilot.
• Training with HELP provides value for money and is better than face to face training alone.
• HELP is built on a strong cross-sectoral partnership.
• We have the ability to scale to other countries and cadres of health worker.
• We can integrate with other programmes and solutions.
18
We’d be very interested to speak further with you to craft an opportunity to work with your organisation to support your health workers.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Set strategy
Provides mLearning services
Train
Implementers
We are talking to many stakeholders within this ecosystem
Some Example Stakeholders Within this Ecosystem
19
Ministries of Health Donors
Community Health Workers
Solution Partners
Influencers
HELP• Leadership & Programme Mgmt • mLearning Innovation & Development• mLearning Deployment• Operations• Technology
Delivery Partners
INDICATIVE
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP’s capacity-building tools are complementary to other mHealth tools
How HELP Can Complement Other mHealth Solutions
20
Data Collection &
M&E
ExamplesJamii SmartCommCare
HELP Vaccines Mgmt
ExamplesmVaccination
Supply Chain
Examplese-Health
AfricaCommTrack
“Integrated” Process Services
Enab
leme
nt
Learnin
g
MiddlewareMezzanine / Dimagi / Other
Android Platform
1 2
3
1
2
3
Health Learning• mPedagogy/ Structured Learning• MoH Curricula for CHWs & CHEWs• Over 50 mTopics available;
supplementary approach reduces F2F training reqts
• Basic & Smart Phone Capable
Enablement (Capacity Building)• Job Aids• Diagnostic Trees/ Algorithms• Group Chat• Supervision Support• Data Utilization & Analytics/ Feedback
loop
Integrated Services• Programme & Process Integration• Integrate content and training• Share data/ analytics for feedback • Works across Middleware Solutions (on
Android)
Our Focus
Enabled by the capabilities of an experienced cross-sectoral organisation
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
HELP provides a structured set of offerings which have been developed
based on clear need and opportunity to make impact
HELP Offerings
21
Pre-service & In-Service Training
Enablement Tools & Services (Silver)
Learning manager
Group Chat
Content Search
Job Aids
Supervision Support
Decision Trees
xx
Pre-Certified Supplementary
Training(Platinum)
Refresher Training(Gold)
Programme-Specific Training
Community Education
(messaging/ podcasts)
Additional Services
Curriculum & Content Development
Mobile Content Development
Training Design Advisory
Training Delivery Advisory
CHEW Pre-Certified Training
(Smart)
Performance Management
Reports
Digital Training Records for
Health Workers
Workforce Management
Data
Structured Learning
Enablement Tools
Health Worker Supervision
Content & Training Advisory
Mo
bile
Tec
hn
olo
gy S
olu
tio
nSe
rvic
es
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
The HELP team would work with any potential partner to design roles and
responsibilities to ensure a successful programme
HELP Roles & Responsibilities
22
HELP provides Partner manages
Project Management
• Introductory meetings to plan programme• Weekly support calls with the Project &
Operations Lead
• Joining introductory meetings and weekly support calls
Face to face training
• Train the trainer session for your staff from our experienced project leads:• how to train supervisors to train CHWs
(how to use HELP)• how to manage first line support calls
(more complex queries escalated to the HELP team)
• Any face to face training for CHWs (including on the National Curriculum and How to use HELP)
• Training supervisors in how to train CHWs
Operations
• Management of users and content on the HELP platform
• Providing names and mobile numbers for all CHWs to be trained, and their supervisors, in the provided template
INDICATIVE – TO BE DESIGNED SPECIFICALLY WITH EACH PARTNER
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Would You Like To Know More?
Get in Touch with the HELP team
23
Mike PuglisiAccenture HELP Delivery LeadEmail: [email protected]
Caroline Shakwei MbindyoAmref Health Africa eHealth Programme ManagerEmail: [email protected]
Get the latest news and additional resources on our website at ehealth.amref.org/help and find us on Facebook n and Twitter .
Jackie KiarieAmref Health Africa HELP Project ManagerEmail: [email protected]
Trip AllportHELP Partnership FacilitatorEmail: [email protected]
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa24
Appendix
• Glossary
• List of Available HELP mTopics
• Phase 1 Report
• Phase 2 M&E Framework
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Common terms are defined here
Definitions
Term Definition
CHEW Community Health Extension Workers, CHW supervisor, often a nurse or Clinical Officer.
CHV Community Health Volunteer, term used in Kenya as CHWs are volunteers.
CHW Community Health Workers, broader term referring to a community member, chosen by their community to provide basic health and medical care to their community.
Collaborative platform Platform based on a partnership model which allows implementers to use, and contribute to, the HELP solution.
HELP Health Enablement & Learning Platform
mTopic Training topic delivered through a mobile phone.
mLearning Learning through a mobile phone.
MOH Ministry of Health
Shared service A service made available to any health worker training and enablement implementer, based on a per health worker cost.
25
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa26
List of Available HELP mTopics
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Our mContent is aligned to the Kenyan National Curriculum and developed with
the Ministry of Health
List of Available HELP mTopics (1/2)
27
Key
Available in 2015
F2F only
# MoH Curriculum Module # HELP mTopic
1 Health and Development in the Community 1 Importance of Health
2 Health and Development in the Community
3 Role of CHWs in the Community
4 Sustainable development in the community
5 Kenya Essential Package for Health
2 Community Governance and Leadership N/A Concept of good governance
N/A Roles and functions of CHC
N/A Effective leadership
N/A Leadership Styles
N/A Community Problems and Problem solving skills
3 Communication, Advocacy and Social Mobilization
6 Basics of Communication
7 Basics of Counselling
8 Advocacy
9 Community dialogue
4 Best Practices for Health Promotion and Disease Prevention
10 Health Promotion
11 Health Promotion Activities
12 Care of New-borns and Infants
13 Family Planning
14 Ante Natal Care
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Our mContent is aligned to the Kenyan National Curriculum and developed with
the Ministry of Health
List of Available HELP mTopics (2/2)
28
# MoH Curriculum Module # HELP mTopic
4 Best Practices for Health Promotion and Disease Prevention
15 Danger signs in pregnancy & after delivery
16 Danger Signs in children under five years
17 Maternal and Child health nutrition
18 Water safety, Hygiene & Sanitation, Hygiene & Sanitation
19 Common diseases in the community
20 Promotion of healthy lifestyle
21 Substance Abuse
22 Sexual and Gender Based Violence
5 Basic Health Care and Lifesaving Skills 23 Basic life saving skills & injury prevention
24 First Aid
25 Referral
6 Management and Use of Community HealthInformation and Disease Surveillance
N/A Management and Use of Community Health Information
26 Community based disease surveillance
13 Non-Communicable Diseases 27 Non-communicable Diseases
14 Other 28 Ebola
29 Trachoma
Key
Available in 2015
F2F only
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa29
Phase 1 Report
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
The profile of the CHWs who took part in HELP Phase 1 varied across the three
pilot sites (Kibera, Mwingi & Samburu)
Profile of the CHWs in Phase 1
30
48%
52%
Samburu
Male Female
43%
57%
Kibera
Male Female
25%
75%
Mwingi
Male Female 0%
5%
10%
15%
20%
25%
30%
35%
Samburu Kibera Mwingi
Age Group (years)
<25 25-29 30-34 35-39 40-45 >45
0%
20%
40%
60%
80%
100%
Samburu Kibera Mwingi
Years of Service as a CHW
< 1 year >1- 2 years >2-3 years >3-4 years >4-5 years >5 years
0%
20%
40%
60%
80%
100%
Samburu Kibera Mwingi
Highest level of education
None Primary Secondary Tertiary
Percentage of male and female CHWs in the three pilot sites
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
During the pilot, mTopics from the national CHW curriculum were delivered to 300
CHWs across Kenya, who will reach 30,000 people
mTopics delivered in Phase 1
• Family planning
• Antenatal care
• Danger signs in pregnancy
• Danger signs in new born and under five
• Maternal and child nutrition
• Maternal and child and nutritional assessment
• Common diseases in the community
• Basic life saving skills and injury prevention
• Sexual and gender based violence
• Kenya essential package for health
31
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Training with HELP was very effective, improving CHW post test scores by an
average of 15%
The effect of the different training approaches on quiz scores
32
We tested three training approaches:1. Face-to-face: learners received complete training using the traditional face-to-face approach.2. Complementary: content covered in face-to-face training was also delivered through mLearning to provide
repetitive exposure to the learning content. 3. Supplementary: learners received some of the content through face-to-face and the remainder through
mLearning. This was aimed at assessing if mLearning alone was effective.
50%
60%
70%
80%
90%
100%
Face-to-face Supplementary Complementary
The effect of the different training approaches on quiz scores
Before face-to-face After face-to-face After mLearning
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Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
0%
10%
20%
30%
40%
50%
60%
70%
Which topics were most useful to your routine work?
Family planning was rated as the most useful mTopic, and the Kenya Essential
Package for Health as the least useful
CHW feedback on the mTopics
33
0%
10%
20%
30%
40%
50%
Which topics were challenging / difficult?
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
There was a range in mTopic completion and mTopic quiz scores across the
three pilot sites
Uptake of HELP
34
50%
60%
70%
80%
90%
100%
Kibera Mwingi Samburu
Completion Rates for the best, and worst, topics
Family Planning Kenya Essential Package for Health
50%
60%
70%
80%
90%
100%
Kibera Mwingi Samburu
Scores for the best, and worst, topics
Family Planning Kenya Essential Package for Health
• The ‘Family Planning’ mTopic had the highest completion rate (92% average across the 3 sites).
• The ‘Kenya Essential Package for Health’ had the lowest uptake (77%) – with a notably low uptake in Kibera (59%).
• Completion of the mTopic appears to be correlated with high scores in Mwingi and Samburu, but not Kibera.
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Littleappreciation
Phonehanging
Duration oftraining
Groupinteractions
Wronganswers
Venue
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Power Lateresponse
Delayedresponse by
HELP
HELP notresponding
Small screen Manipulatingthe phone
• “Motivating factors were that learning was interactive through:• The stories used in teaching• Role plays were interesting• Rewards for completion• The CHEWs took the courses to see what CHWs were learning”
• “The use of mobile phone for learning was unique and a new experience that we enjoyed.”
• “The mLearning made it easier for us to learn new things.”
• “I would like this to continue, I never knew learning can be done through the phone, I only knew how to send messages and use Mpesa”.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Knowledgeon health
issues
Mobilelearning
technology
Technologyuse
Learningmade simple
Groupinteractions
Gifts Free airtime
CHWs liked using their mobiles for learning and enjoyed the group chat functionality,
but struggled with power, technology issues and lack of appreciation
CHWs Perspectives on HELP
35
What did you think of HELP?
What did you like about HELP? What hindered you from completing all of the topics?
What did you not like about HELP?
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
Ninety-seven per cent of the CHWs were happy using a mobile phone for
learning
User experience feedback
36
Yes
No
Very good
Good
Fair
Difficult
Yes
No
Samburu Kibera Mwingi
Were you happy with the experience of using your mobile phone for learning?
What was your experience of manipulating the mobile phone?
Did you manage to go complete all of the topics?
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
CHWs appreciated being able to access HELP flexibly, in their own time and on
demand
CHW feedback on the benefits of HELP
37
0%
10%
20%
30%
40%
50%
60%
I canaccess info
in anemergency
I gainedknowledge
I can workand learn
It savestime
I can chatwith
colleagues
It's simple I gotexperience
What did you like about HELP?
0%
10%
20%
30%
40%
50%
60%
Need to HELPothers
Improvelearning skills
Handling healthproblems
Interestingtopics
Mobile useinteresting
What is your motivation for continuing to work with HELP?
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
However CHWs faced a number of challenges when using HELP
The Challenges of the Phase 1 Pilot
• CHWs reported difficulties accessing the help desk.
• CHWs would run out of memory on their phones and so have to delete content SMSs (a Search feature has been added to address this).
• The presence of other projects in implementing sites created some misunderstanding and expectations amongst CHWs.
• CHWs struggled with USSD (this has since been dropped).
38
0%
10%
20%
30%
40%
50%
No smart phones Delayed answers Limited phone memory Poor network Lack of allowance Battery problems Topic repetition
What challenges did you face when using HELP?
Based on interviews with 245 CHWs and three focus groups with 36 CHWs.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa39
Phase 2 M&E Framework
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
An essential aspect of Phase 2 is to extend our understanding of the impact of
HELP
The Phase 2 Monitoring & Evaluation Approach
40
• Measuring outputs, outcomes and impact of the programme
• Evaluating the effects on CHW & CHEW employability.
• Health worker empowerment, job satisfaction and long-term retention
• Interactive, rather than didactic, relationship to a knowledge and skills resource
• Extend engagement of communities and patient populations in managing health care.
• Technology platform and 3rd party integration
• Ownership of HELP by stakeholders
• Alignment to MoH Community Health Strategy & government policy
• Potential funding models • mLearning contribution to learning
outcomes.
Project performance and resultsQualitative shifts in health system capacity and performance
Conditions necessary for scalability
We are following a structured results-based approach to enable simple, consistent and objective metrics of performance and achievement.
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
We are evaluating CHW outputs, health system capacity and performance
outcomes and health impacts
The Phase 2 Monitoring & Evaluation Framework (1/2)ACTIVITIES OUTPUTS CAPACITY
OUTCOMES
Mid- Phase II
HEALTH SYSTEM
PERFORMANCE OUTCOMES
MID-LATE Phase II
IMPACT ON HEALTH
1.1.1 Technical Working Group for
mobile content development identified 1.1 Ownership of the mobile learning
process by relevant stakeholders
engaged in the implementation of
Community Health Services (CHS)
1. Improved
skills of CHWs
and CHEWs to
be more
effective in-
health service
delivery to the
community
1. Higher quality healthcare
service delivery by CHWs
1.1.2 Mobile learning topics from the
CHW curriculum identified
1.2.1Mobile learning topics from the
CHEW curriculum identified (March
2015)
1.2 Appropriate learning pedagogy
employed in development of learning
content
1.2.2 Appropriate Mobile learning
pedagogy employed in development of
mobile learning content development
1.3 Comprehensive mobile learning
content for CHWs developed to
complement and enhance face to
face training
Lasting health change
in Africa through
improved access to
health care and
improved health and
economic outcomes
The project will
eventually support
thousands of
community health
workers in Kenya, with
the initiative
extending to other
countries in the
future.
2.1.1 Identify project implementation
sites ; Rural, Nomadic and Urban sites
for Phase II deployment
2.1 2940 CHWs trained using the
mobile learning solution
2.2. Identify ~3000 CHWs in AMREF
supported projects for mobile learning.
This will be sourced through AMREF
and their existing partnership networks
2.2 60 CHEWs trained using the
mobile learning solution2. Reduced attrition rates of
CHWs
41
Copyright © 2015 Accenture & Amref Health Africa. All rights reserved.
Confidential – not to be shared or disseminated without explicit permission from Accenture & Amref Health Africa
We are evaluating CHW outputs, health system capacity and performance
outcomes and health impacts
The Phase 2 Monitoring & Evaluation Framework (2/2)
ACTIVITIES OUTPUTS CAPACITY
OUTCOMES
Mid- Phase II
HEALTH SYSTEM
PERFORMANCE OUTCOMES
MID-LATE Phase II
IMPACT ON HEALTH
3.1.1 Adapt the learning requirements
to technical requirements
3.1 System meets the design
specifications to support mobile
learning
2. A feasible,
scalable and
extendable
mobile learning
technological
platform
developed.
3. Increase the adoption of
innovative technologies in
reducing duplication, driving
efficiencies and providing
evidence for building stronger
health systems
Lasting health change
in Africa through
improved access to
health care and
improved health and
economic outcomes
The project will
eventually support
thousands of
community health
workers in Kenya, with
the initiative
extending to other
countries in the
future.
3.2.1 Adapt the CHW and CHEW
requirements for the HELP solution to
technical requirements 3.2 System supports third party
integration, resulting in an increased
number of partners utilizing the HELP
solution
3.2.2 Adapt third party requirements to
technical requirements
3.2.3 Implement the HELP solution
4.1.1 Develop criteria and work plans
for 3rd party partner organization
involvement
4.1 Relevant stakeholders involved in
capacity building of community
health workers identified and
integrated into the HELP Platform
4.2.1 Implement the HELP solution4.2 300 CHWs trained by third party
stakeholders using mobile learning
42