Masanga Mentor Ebola Training

Implementation plan - seeking to transform Ebola training

A unique partnership

The MENTOR Initiative

• Global reach• Focus on infectious disease

control and training

The Masanga Network

• Local, community based • Proven national training

network

M2 network providing access to:VHF medical expertiseAdvanced pedagogyCommunity based learningAdvanced training assessmentConnectivity through Global eHealthDistance learning experts

The community care challenge

• We need a way of teaching communities:– how to care for a sick member of their family– how to clean up and disinfect– how to protect themselves, their families and their

communities• and if they do not have the resources they need

to do this, they need know:– what they need – how to request it– This is about advocacy and longer term empowerment

Re-inventing training

What we need – the content• The training needs to be:

– so visually rich that it is so intuitive, it requires no written explanation.

– accessible in a format that would make it accessible throughout the region.

– customisable to ensure it is context specific

– With live voice so a trusted expert or local person can introduce the training or talk through any issues remotely – in their own language.

– Updatable – so it can adapt immediately to new WHO / MOH guidance or teaching innovations

The process• We need to know:

– who has used it– whether they have

understood it – when they are completely

familiar with the procedures– where they are most likely to

make mistakes – how to strengthen those

learning points.

Building infection prevention control and local capacity to contain Ebola across the Continent, creating a lasting, sustainable legacy

The training challenge• UN Mission for Ebola Emergency

Response (UNMEER) estimates that 90,000 community care workers need to be trained in the three countries worst affected – Liberia, Sierra Leone and Guinea.

• Taking the WHO’s list of 15 countries at risk into account, the figure rises to 450,000 health workers which would improve the resilience of a very vulnerable region.

• But there is also the rest of the world – and all healthcare systems are vulnerable

• The WHO also estimate that the next 60 days are critical to bringing the epidemic under control.

Building political ownership• Dr Joseph to build central and local government ownership

– MoH, MoE and DMO– Director of Primary Healthcare services– Abu Conteh – Head of Community Health workers– It is their initiative

• MoH/MoE/DMO define participating organisations– Government hospitals– Private hospitals– Periphery health units– Private companies

• We need clear approval / endorsement – ideally ‘quotes’ for the Telegraph article within the next 2 weeks– aiming for support from the Sierra Leonean High Commissioner, the Hon Edward

Turay on Monday (Dr. Eddie Cole taking the lead) – Practical support from the Diaspora (Dr. Eddie Cole taking the lead)

Implementation plan

• Hub and spoke training– Dispersed peer to peer learning, not centralised– Complementing the major investment in flagship ETCs

• Viral learning spreading faster than the virus– Early adopters spread the word– Remarkable learning experience

• Traditional training evolving to intuitive self learning• Ultimate goals

– Teach communities how to deal with Ebola safely – Train 450,000 CHVs across 15 at risk countries and beyond

The role of Masanga and the STP• Orchestrate national distributed peer to peer learning • Pilot and improve the intuitive training • Design and build the distribution model• Recruit partners through network marketing and selling • Control the process and content• Monitoring and Evaluation of process and effectiveness of

materials, which is key to:– quality assurance – continuous improvement of the material and approach– Prioritisation of training modules

• Set the example for other agencies and countries to adopt and fast follow

Initial training scope

• 2 day full coverage of Ebola response– 1st traditional classroom– Option for online introduction with ALISON (free online e-course)

• Based on WHO / CDC material• includes certification

– Evolve modules to intuitive training as modules completed• The distribution model• Marketing and recruiting partners• Control of content – improvements and versions• Accessing hardware• Accessing the web • Performance evaluation and spread of best practice

Source of training material

• Technical input– Mentor Initiative (Richard Allan)– WHO (Simon Mardel/adviser to M2)– Guidance from Guinea

• Immerse Learning for intuitive learning modules– These are designed to augment official manuals, not to be a

substitute for them• Note:

– There will be continuous revisions – see latest WHO announcement this week

– Need to ensure coherent with MoH guidance– Ensure tailored to local needs and language

Initial trainers and trainees

• Trainers– TCHS faculty

• Trainees– STP students– Qualified nurses– Participants selected by DoH, DoE and DMO– Teachers

The Distribution modelThe goal

• The aim is to build a community based peer to peer network that complements the current investment in ETCs

Creating a distribution network for the training modules

Masanga

14 Districts

1,054 PHU’s

1000 Primary care units

• We are creating a training network which can rapidly share new material as the training evolves from:– Conventional training – Intuitive learning

Share with other countries

The MENTOR Initiative in Liberia

Sharing skills and insights

Peer to peer distribution model

• Masanga orchestrates and controls • Masanga trains the National Master Trainers (NMTs)– Work in pairs and cover all 14 districts

• Each District trains the District Master Trainers (DMTs)– Work in pairs and cover 10 PHUs and the communities

served by the PHUs– Eg Tonkolili needs 20 DMTs to cover 102 PHUs

• Each community elects a Community Ebola Task Force to be trained in basic modules by the DMTs

Moving into the communities

• DMTs go into the communities in pairs• Identify the community influencers (CIs)• DMTs pre market intuitive learning to CIs• Select the Community Ebola Task Force• Intuitive training modules complete• DMTs train the Community Ebola Task Force • The CIs advocate the training to the rest of the

community

Hardware and connectivity

• Define hardware specification and minimum operating system– Initial release is lap top / PC based (not tablet / Android)– Subsequent versions tablet enabled after 3 months, subject to

funding– Immerse Learning responsibility

• Create an inventory of hardware• Identify cheap sources of new hardware• Global eHealth Foundation – see http://www.gehf.org/ has

offered to provide support / advice on improving connectivity wherever this may be a limiting factor

• Plan evolution to most practical means of rapid distribution

Budget

• Training material development• Logistics• Communications• Power• Incentives for trainers• Salaries

Urgent action1. Feedback on implementation plan - all2. Use plan to finalise THET application and submit early next week 3. Other grant funding applications4. Prepare budgets based on

– Immediate follow up in the next 2 weeks ahead of Telegraph launch– likely revenue scenarios– Implications for cash flow

5. Communications– Preparation for Telegraph journalist visit – need to be able to illustrate local

leadership and as much of this cascading process as possible– Press release around trialling of first Immerse module– Input into next Lancet blog– Support with social media

6. Mobilise international network to respond to Telegraph appeal – Brian Roche plus

Questions

• Implementation plan – Geoff• MENTOR / Immerse – Nicholas• Governance - All

Appendix

• Immerse approach• Timeline for Development• MENTOR and its Ebola programme in

Monrovia• Articles, blogs and comments by the team• Who to direct any questions to

The Immerse approach

• Illustrative screen shot

Learning, reinvented…

Hydrogen sulphide health and safety scenario Demonstrates a single-player experience, with option for collaborative audio, which puts user through a series of scenarios based on assessing and reacting to a hydrogen sulphide leak. https://vimeo.com/100887254

Immerse Learning platform demo Demonstrates the full capability of the Immerse Learning platform. https://vimeo.com/95771024

Suggested timelineWeek beginning

27 Oct 3 Nov 10 Nov 17 Nov 24 Nov 1 Dec 8 Dec 15 Dec 22 Dec

Milestones Irish Forum for Global Health Conference

Telegraph visit to field

GeHealth Foundation trustee meeting

Training module

Prototype PPE

PPE PPEDecontamin-ation

Develop-ment

PPE PPE PPE Decon-tamination

Decon-tamination

Decon-tamination

? ? ?

Versions 1.0 Expert review

1.1 User group review

1.3 Field Review

1.42.0 2.1

1.52.2 2.3

1.62.4

Distribution Network

Training programme defined with Masanga

STP trainers identified

Trainers introduced to Immerse training material

Training begins in STP satellites centres and training trainers

ALISON (10,000+ users registered with an interest in Ebola)?

ReachCountries

202

2003

2,000?

20,000?

Monitoring and Evaluation

Field ReviewTexas Tech Review of 1.4

Field Review at STP sites

Texas Tech Review of 2.4

Versioning1.0 Prototype 1.1 Expert review1.2 User Group1.3 Field Review1.4 Release

Assumptions3 week development cycle2 week training

Modules1.PPE2. Decontamination?3. Safe Burial?4. Supportive care?

Overview of the MENTOR Initiative

• Since 2002, The MENTOR Initiative (MENTOR) has been responding, in close co-operation with other humanitarian organisations and affected country partners, to – improved prevention and control of a wide range of other vector

borne diseases (VBDs) – in Africa, Asia, the Americas and the Middle East.

• MENTOR has been heavily engaged in leading and delivering evidence based strategies and technical guidance for VBD control

• The organisation seeks to work in partners with other NGOs/PVOs, FBOs, UN agencies and national Ministries of Health

Building on existing health delivery systems

• The unique community based relief model developed by The MENTOR Initiative has proved highly effective in three contexts:– Conflict-based crises: eastern Chad, Central African Republic, Syria, South

Sudan – Rapidly onset natural disasters: flooding in eastern Kenya, Cyclone Nargis in

Burma and the Yogyakarta earthquake– Epidemic response in North Eastern and Western Kenya, Somalia– Recovery and development stages that follow these crises: Angola and Liberia

• The ultimate goal is to reduce the vector borne disease burden on emergency-affected populations. This is achieved through a combination of The MENTOR Initiative's three key activities: – targeted capacity development– field support– and operational research

MENTOR in Liberia

• The MENTOR Initiative has worked closely with the Ministry of Health – since the organisation’s arrival in Liberia in 2003 during the

conflict– Through to the present

• This partnership has included :– collaboration on updating policies and guidelines,– joint planning– training of health workers and communities– development of health promotion materials – and logistical support when necessary.

MENTOR supporting the Ebola response in Liberia

• The Ebola outbreak in Liberia has severely hampered delivery of healthcare, preventing access to basic drugs

• Ebola is infecting thousands of people in Monrovia and centralized treatment units are unable to handle the large numbers of patients, forcing communities to respond on their own while waiting for Ebola response teams.

• This proposal aims to support urban communities with a comprehensive set of solutions, equipping them to safely care for anyone with fever, humanely isolate suspected Ebola cases and bury family members.

Tackling Ebola in the slums of Monrovia

• Bushrod Island and West Point have a population of approximately 240,000 people living in densely populated slum communities. It is also home to Liberia's main port, warehouses and the commercial centre of Monrovia.

• West Point is a small peninsula covered in densely packed houses at the mouth of the Mesurado river.

• Bushrod Island– In the North of Bushrod Island, Duala market is a trading hub, receiving goods from North Western

Counties of Liberia and Sierra Leone, although currently trade is limited by checkpoints at the Sierra Leone border and in Bomi County.

– It is also an important shopping destination for anyone living within driving distance and people take taxis here to purchase imported rice and meat, returning to their home counties and outlying regions of Monrovia.

– It is also a centre for healthcare, including Redemption Hospital, the second largest hospital in the country (acting as a transit centre), along with numerous private clinics, pharmacies and medicine stores.

– Island Clinic is preparing to receive patients in a newly constructed treatment unit. • Clara Town on the Southern end of Bushrod Island and New Kru Town in the North have the

largest populations, and both communities have been transmission hot spots from the beginning of the outbreak.

OFDA (US Government) funding is supporting the MENTOR programme

• This funding will enable MENTOR to:– Send teams to educate communities in Ebola prevention, rebuild trust and respond

to concerns and rumours– Provide logistics and 2 cars for ambulance teams staffed by government workers.– Provide logistics and 2 trucks for collection and burial of bodies staffed by

government workers.– Hold simple memorial services and provide grave markers for victims.– Train community leaders in managing high-risk contacts, enabling community based

isolation which is humane and provides food, water and a chemical toilet.– Bring safe means of fever monitoring to communities by providing CHVs with

training and infrared thermometers.– Train and equip pharmacies to safely dispense malaria drugs using appropriate PPE.

• MENTOR has provided the seed funding for the first Immerse training module

For more information – articles, blogs and comments by the team

• Diagnosis– http://globalhealth.thelancet.com/2014/10/06/ebola-what-went-wrong

• Networked training– http://globalhealth.thelancet.com/2014/10/21/networked-approach-improving-resilie

nce-communities-confronted-threat-ebola• Transforming learning

– http://2020education.org/profiles/blogs/tell-me-and-i-forget-teach-me-and-i-remember-involve-me-and-i?xg_source=activity

• Example of the reach of internet learning in West Africa– http://2020education.org/profiles/blogs/understanding-the-ebola-virus-how-serious-i

s-it-and-how-might-the?xg_source=activity• Example of the use of technology to provide remote access to experts in

difficult places– http://globalhealth.thelancet.com/2014/10/03/sustainability-technology

• Fostering innovation and improved processes through adaptive design in training see comment:– http://globalhealth.thelancet.com/2014/10/10/evaluating-ebola-interventions-adapti

ve-designs-should-be-commonplace• Immerse training examples from Health and Safety training in the Oil and Gas

industry– a single-player experience, with option for collaborative audio, which puts user

through a series of scenarios based on assessing and reacting to a hydrogen sulphide leak https://vimeo.com/100887254

• Tweet #ebola3.0 and #ebolatraining