The design and evaluation of a mobile learning intervention for the training and supervision of community health workers

This project relates to the Information and Communications Technology and Development theme of the call.

Through this innovative 2-year mobile learning project, the Institute of Education, University of London (IoE) and the African Medical and Research Foundation (AMREF) aim to advance the training and supervision of community health workers (CHWs) in Kenya, resulting in improved access to primary health care for the marginalised communities of Makueni County and the Kibera informal settlement. This is important because supporting poor communities gain access to health care by training CHWs and connecting them to the local health system can help reduce poverty.

CHWs are community members who provide basic medical services. Research consistently evidences CHWs pivotal role in providing equitable health access in support of poverty alleviation by preventing and diagnosing diseases like malaria and HIV, treating minor ailments, referring patients and providing support and care for pregnant women and babies.

This project will work closely with CHWs and their supervisors to collaboratively design, develop implement and evaluate a mobile learning intervention that better connects CHWs and supervisors. The innovative nature of this intervention will mean that for the first time CHWs will have a mobile portfolio of their practice, easily accessible reference material on their phone and the ability to share practice related questions and resources with their colleagues through activities which promote peer learning and reflection. Supervisors will be better informed of CHWs' training needs and AMREF will gain a better insight into the nature and frequency of their two-way interaction and into the specifics of on-the-ground support structures needed for intervention implementation. Kenyan policymakers will benefit from policy briefings demonstrating how our mobile intervention supports affordable, equitable and effective access to health care.

The improved mobile-based supervision and training will link CHWs more closely to the local primary healthcare system so as they can be more effective in reducing poverty through improving the access of local communities to health care.

Who will benefit from this activity?
The project's research questions address five groups of beneficiaries. The three direct beneficiaries will be: (i) the 64 CHWs and (ii) 8 supervisors directly involved in the project and (iii) AMREF in Kenya. The two indirect beneficiaries will be (iv) the Kenyan Ministry of Public Health and Sanitation (MOPHS) and (v) the communities the CHWs serve in Makueni County and the Kibera informal settlement in Southern Nairobi.

How will they benefit from this activity?
(i) CHWs will benefit from increased communication with their supervisors thus improving their integration with the local primary healthcare system.
(ii) Supervisors will also benefit from the improved communication links and will be able to better tailor their support to CHWs as they will have asynchronous access to CHWs' personal practice data (including the points where they requested help) for the first time.
(iii) For AMREF the main benefits will be (a) access to a grounded dataset to better understand and analyse CHWs learning needs (b) an evidence-base of how CHW service delivery is improved by the intervention and (c) specifics of the on-the-ground support structures needed for intervention implementation.
(iv) The Kenyan MOPHS will benefit from iterative policy briefings on the role of mobile learning in CHW supervision and training, inputting into specific implementation strategies at community level.
(v) The communities in Makueni County and Kibera will benefit from improved access to health care.

What will be done to ensure that they have the opportunity to benefit from this activity?
(i) In order to build capacity at the NGO level, the project researchers will share their research methods expertise and AMREF staff will be encourage to take part in data analysis according to their skills and interests.
(ii) In support of this training, two members of AMREF staff will undertake a two capacity-building trips to the IoE.
(iii) The participatory action research (PAR) approach ensures that CHWs and their supervisors will be participants in the entire research process, with the priorities of CHWs and their supervisors addressed through genuine collaboration and the co-construction of knowledge.
(iv) The stakeholder inception workshop, held at month 1, will ensure that the project is fully grounded in the local context and focuses on the poverty-relevant practices of CHWs.
(v) The mobile application wil be made freely available under a creative commons licence.
(vi) Findings will be reported back to all participants in appropriate formats (e.g. story narratives and case studies) using venues arranged through the support of local community organisations.

The legacy of the research will be managed building on the expertise of AMREF in developing their nurse training eLearning programme in a public-private partnership with Accenture, the Nursing Council of Kenya and the MOPHS and then passing it over to the Nursing Council to scale-up and run independently. We will learn from and build on this strategy for seeking wider use and uptake of our mobile learning intervention as opportunities arise.