Investigating the design,implementation and impacts of an mHealth based educational video training program for Community Health Workers(CHWs)in Uganda

My research will focus on the educational, socio-cultural and health impacts of teaching Community Health Workers (CHWs) in Uganda via a mobile technology platform. According to figures released by the World Health Organization (WHO) there will be a worldwide shortage of 12.9 million health workers by 2035.(1) This shortage is magnified in low- and middle-income countries (LMICs). In order to bridge this gap, the WHO has emphasised the importance of training Community Health Workers (CHWs) to ensure basic healthcare needs are met.(1) CHWs are defined as lay people with little formal education, working in their communities to promote important public health messages and provide basic healthcare.(2) A 2016 report entitled "Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations,"(3) highlighted the length of training for CHWs varies enormously from country-tocountry. In Nepal, female CHWs are trained for 18 days, whereas in Zambia, they receive 12 months of training.(3) CHWs can play a vital role in the monitoring and management of sick children. 52 percent of under-five deaths in Uganda in 2014 were due to diahorrea, malaria and pneumonia (DM&P) a figure that is both shocking and unacceptable given that all three diseases are treatable and preventable.(4) One specific training program aimed at reducing childhood mortality from DM&P is Integrated Community Case Management (ICCM), which is traditionally delivered by CHWs.(5) The aim of ICCM is to help strengthen the identification and basic community level treatment of DM&P, whilst also providing CHWs with training manuals and supervision and encouraging behaviour change at a community level as a disease prevention tool.(5) Although it has been shown to have success, common criticisms of the program, include inconsistent styles and duration of teaching, difficulties for CHWs to attend long training days often held at inconvenient times in distant locations, and little ability for post-training supervision.(6) One solution to increase the quality and prevalence of CHW training has been the use of mobile technology as a training tool. This concept falls under the umbrella of mHealth which is defined as using "mobile computing, medical sensor, and communications technologies for healthcare." (7) It has many potential applications including, but not limited to, training and education, disease management, point of care documentation and patient communication.(7) There is great potential for the expanded use of mobile technology in East Africa given widespread cellular network availability and existing high use of mobile phones.(8) By designing a culturally appropriate video-based training program loaded onto low-cost android tablet
devices, I hope to explore the potential of mHealth in educating a cohort of 400 CHWs in Uganda. The research I carry out will help to ascertain the educational effectiveness of video based training using mHealth tools, explore the socio-cultural and financial impacts of implementing an mHealth based training program, and help to better understand the challenges and solutions in program design. This is important since very few studies have explored the educational value of mHealth as a training tool for CHWs in LMICs and even less work has been done to explore the socio-cultural, and ethical impacts of implementing such programs. Not only does this carry enormous importance for researchers, NGOs and governments working in this field, but it also has significant public health impacts that are likely to affect the health of thousands of children for whom CHWs are responsible.