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

Lead Research Organisation: University of Oxford
Department Name: Education


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.


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Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000649/1 01/10/2017 30/09/2027
1925922 Studentship ES/P000649/1 01/10/2017 30/09/2021 James O'Donovan
Description My work has three key findings:

1. Lay persons, commonly known as Community Health Workers, can be trained to deliver primary ear and hearing care in remote and rural communities. This is an important finding because there is a huge shortage of trained health workers to address the burden of ear and hearing disease in low and middle income countries.
2. The use of mobile technologies can help to support CHWs supervision in this context. This is an important finding because very little work has been undertaken to date exploring the use of mobile phones to support the work of CHWs in an on-going fashion. I have found that the use of mobile phones is both feasible and well accepted, and helps to increase collaboration among CHWs, as well as their supervisors.
3. I have explored novel methodologies for exploring challenges faced by CHWs. This includes the use of participatory visual methods, such as Photovoice. This is important as it helps to reposition the perspective of research from the participant, rather than the researcher. In theory this should make research projects and their outcomes more responsive to the needs of participants whom the results are intended to benefit.
Exploitation Route The outcomes of this funding will be put to use by others in the following ways:

1. The local organisation who I was partnered with are responsible for the training and maintenance of 1250 CHWs in the Mukono District of Uganda. They will use the findings of my work to help inform their CHWs supervision strategy.

2. The World Health Organization are in the process of redesigning their primary ear care training programme for health professionals globally. My findings will go directly to informing this strategy.
Sectors Healthcare

Description My findings are being used in the NGO sector by Omni Med, an NGO responsible for the training, supervision and maintenance of 1250 CHWs in Mukono District Uganda. My findings around how mobile phones can be used in the supervision of CHWs will directly inform their supervision policies going forward. My findings are also being used by the World Health Organization to inform their primary ear care training programme which is accessed by thousands of health workers globally. Specifically there will be a greater focus on blended learning and on-going supervision and training built into the programme.
First Year Of Impact 2018
Sector Healthcare
Impact Types Societal,Policy & public services

Description World Health Organization - Division of Ear Care and Hearing Loss 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution I have helped to inform the redesign of the WHO primary ear care training manuals
Collaborator Contribution The WHO have allowed me to attend meetings, share my findings, and provided me with expert support from ENT surgeons and audiologists in my own research design.
Start Year 2017