05 Apr Anytime-Anywhere Health Workforce Training: The Path Forward
Roxanne Ward Zaghab, MSW, DM, CKM, is a leader and innovator in online adult education for development and health practitioners and a prolific author on the topic of learner-centric engagement. At the American International Health Alliance (AIHA, a program partner in the HRH2030 consortium), she served as the senior e-Learning advisor working with the Philippines Department of Health (DOH), USAID Philippines, and the HRH2030 program to launch the DOH’s e-Learning platform for health workers, the DOH Academy.
This year, health care heroes have been on the front line of a devastating pandemic. Meanwhile, governments have struggled to keep an estimated 59 million health workers informed and prepared to prevent and treat COVID-19.
My work as an online adult education learning specialist aids resource-constrained organizations in overcoming their geographic, financial, and human resource challenges through use of relevant educational technology solutions. More than ever, I have been encouraged by the low-cost and out-of-the-box solutions that have bypassed costly alternatives this year. Multi-lateral and open-source platforms have set sights on keeping health workers around the world “fit for purpose”.
Can we say this health crisis created new technology generated new opportunities for health workers? I believe we have accelerated progress that was already underway when the pandemic hit. Perhaps the question before us is this: On the horizon, what is our path forward for using technology in responsive and meaningful health workforce training?
Successful initiatives like the ones below demonstrate the value of online and mobile health workforce training.
Because many areas in Africa, Asia, and the Middle East are emerging mobile-first economies, m-learning has accelerated. SMS, social media, and interactive voice response (IVR) deliver urgent messages during an evolving public health crisis. How amazing that simple mobile phones and interactive messages can touch health workers in remote locations, including island groups and rural villages!
Sierra Leone’s model of m-learning reaches their health workforce using a simple phone to close misinformation gaps. Using this agile method, IVR has fueled instantaneous training of Community Health Workers (CHWs). IVR has saved training dollars by replacing face-to-face continuing education, thus eliminating travel requirements. The Mobile Training and Support System (MOTS) was first deployed during Ebola outbreaks and was adapted for the prevention and treatment of COVID-19. CHWs appreciate the immediacy and convenience, as well as the delivery of messages in local languages. MOTS is supported by World Vision and the Grameen Foundation.
The Asia Region: Learning Summit on HIV Index Testing was the first virtual event of its kind to promote such sharing in the region. Originally planned as an in-person convening in Bangkok, which changed due to COVID-19, this unprecedented virtual gathering strengthened regional collaboration and learning exchange regarding country planning, implementation and problem-solving during the pandemic. The three-day online summit engaged 69 invited government and health leaders from 11 countries in real-time multi-lingual, mobile accessible activities. e-Learning delivery facilitated participants’ shared digital resources, successes, and challenges in HIV key populations, case finding, and index testing. We found participants had meaningful instruction and peer interactions across country borders. The online format fostered interaction through mobile chat, profiles, forums, interactive Q&A, and Zoom videoconferencing.
Videoconferencing has been lauded as replacement for face-to-face training interactions for those with internet capabilities. However, overuse of a passive format can result in distraction rather than attention. Rather than risking “Zoom Fatigue,” I recommend methods with shorter, focused micro-learning activities based on how adults respond to digital content. In the end, video is only one technology tool in the kit for health workforce training.
The Department of Health (DOH) Academy online continuing health worker portal in the Philippines has expanded during the COVID crisis. This national mobile-accessible platform reaches health personnel in urban, rural, and island regions including public and private health managers, physicians, nurses, clinical lab personnel, and other health workers. The open-source portal was adapted for the Philippines in 2019 with the work of the DOH Health and Human Resource Development Bureau (HHRDB), and USAID’s HRH2030 program, with the American International Health Alliance (AIHA) leading the work. A growing menu of 18 continuing education modules have tallied over 12,800 + learners. Mobile accessible online and off-line multi-media modules involve frequent knowledge checks for rigor. Multilingual subject matter modules include universal health care, infection control, workforce planning and tuberculosis. During the pandemic, HHRDB created an additional 10-module COVID program completed by thousands. We credit this success to DOH leadership and a sound pre-project assessment of the health workforce needs, the gaps, and realistic communication technologies. The scale-up has been powered by trained local universities and small businesses.
The availability of multi-lingual Open Educational Resources (OER) has mushroomed. No new local investment in technology infrastructure is required. OERs offer tens of thousands of hours of free training modules to health workers (and even health professional students) via mobile and online.
UNESCO’s OER Initiative leads the effort to promote international cooperation in the use, reuse, adaptation, and translation of OER. IBM and SAP partnered in a forward-thinking UNESCO initiative pushing the envelope for even greater use of AI and learning technologies at all levels.
OER use in country health curriculum can eliminate the costly and time-consuming burden of course creation. As health workforce training organizations move away from traditional delivery, I have seen difficulties as current personnel gain new skills. Curation of quality content for local adaption and active coordination with health professional licensing boards are challenges to optimization. Perhaps we can learn from one another.
Since its launch, USAID’s Bureau of Global Health Global Health e-Learning Center, one example of an OER platform, has delivered e-Learning to over 340,000 learners from 243 countries. Over 714,000 learners have earned certificates from the free online hub on current and critical health issues, including vital COVID information. Modules, mini-courses and certificate programs are available for off-line and hybrid use and adaptation. The World Health Organization also keeps current digital public health materials online, up-to-date and accessible in ~ 25 languages which has served over 5 million thus far. The reach of OERs is growing daily.
Lessons Learned. AIHA’s hope is that lessons learned will launch peer-to-peer sharing, collaboration across borders. Scale up of existing technologies, new innovations, and free digital resources show that an “all or nothing” approach to educational technology for the health workforce has been replaced with high-value opportunities.
The Pathway Forward. The post-COVID era calls for universal appreciation for all health workers, especially those serving geographically isolated and low-resource service areas. We also owe thanks to the governments and NGOs who have forged a path in low-cost, easy-to-use technology to fortify health workers for this and future public health challenges.
We look to contextual factors on the horizon to ease the implementation of educational technology tools. Public-private partnerships are pushing forward in LMICs to reduce cell phone data rates and spread low-cost broadband networks.
More than ever, we have a growing hope for the future of “anytime, anywhere” affordable m-learning for the global health workforce.
Photo: A Nurse Supervisor in Leyte District, Philippines, teaches a her colleague how to submit a checklist after an appointment with a patient. Credit: HRH2030 (December, 2020)