20 Ways to Improve mHealth Interventions in Low-Resource Settings

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The GETHealth Summit (Global Education and Technology Health), 6-7 February 2013 in the United Nations, New York City, aimed ‘to bridge the workforce gap in developing countries through new partnerships between innovators in Global Education and Information Technology.

The Summit brought together leaders in health, education and IT to discuss and develop initiatives designed to empower providers in the most resource-limited communities in the world’. It were very inspiring and entertaining days: About 150 optimistic and dedicated people from around the World, a bulk of knowledge and experience and plenty of successes and recommendations (and a few failures).

I am Roos Korste and I would like to bring across the main messages from this summit in ’20 golden tips’:

1. If you want to start a mhealth/mlearning/elearning program in a , you need a comprehensive model from the beginning. Involvement of all stakeholders, including e.g. Ministry of Health, education institutes, private and public organizations, etc. Many pilots strand because one of these parties is not on board.

2. Avoid small pilots which are not scalable. Yes, it is workable, but also scalable? Or as Dr. Hamadoun Touré (International Telecommunication Union, ITU) put it: ‘We can only call a pilot project a pilot when it can fly’.

3. Don’t keep your invention, program or project for yourself; share your project on global networks like Mobile Active or mHealth Evidence.

4. Use, or build on, what is already there, like the infrastructure, devices (all people use a particular cell phone then use that cell phone), training curricula/manuals, people involved in healthcare like faith/traditional healers, even traditional marriage counselors (Dr. Groesbeck Parham, African Center of excellence for Women’s Cancer Control, Zambia).

5. Cooperate, cooperate, cooperate said Ms. Jessica Colaco (Research Lead, iHub, Kenya), among many others. PPPs or Public Private Partnerships seem a must. When, in a special PPP breakout session, Dr. Jeffrey Blander (US Global AIDS) asked the audience ‘who has built a PPP’, many raised their hands. When he asked ‘Was it easy?’, we saw no hands anymore. But when you don’t want to rely too much on a (local) governments or international donor for the funding, and you want your project sustainable and scalable, PPPs seem the only way. Invest in the language/culture barriers, and ‘everyone has to move to the middle’ (quote Mr. Ed Fantegrossi, EDCO/TellAlfthe).

6. Be creative in using local, existing business or solutions for practical obstacles. Or think outside the box. Like the local internet cafe for connections, mPesa, existing groups and corporations, the radio stations, schools, businesses, etc.

7. Choose the right people in PPP. Choose that person who is willing to give your innovative project momentum. Or, as Ed Fantegrossi put it ‘intimacy/friendship is needed for a real commitment over the years’. And yes, you must have some luck too; just find that one person who wants something new.

8. In 2000 less then 2% of the people had access to internet, now 2,6 billion people are online. Great. But don’t forget that still 2/3 of the word population has no internet access (Dr.Touré)! When you want to reach the rural areas think of other communication channels like cell phones. Always keep the end user in mind.

9. Health information is key. Not only for the professionals and CHWs (Community Health Workers), but for the mothers, fathers, lay people as well. Target the whole population if you want to have a great impact with health information.

10. Health care in most low resource settings are provided by women: volunteer CHWs, nurses and midwifes. When you want to have a program with impact, and coverage of the remote rural areas as well, you need to know what these groups or service providers know, need and want. Talk with these people; work bottom up and not top down. Don’t forget the end-user. Address the language barriers. Think of incentives. Is your project or tool attractive for the end user, feasible?

11. Find (local) solutions for the power problem. How long must your device survive without recharging? Solar power solutions? Other batteries? Maybe not the Ipad? but another more suitable apparatus? Look at devices who are made in low and middle income countries; cheaper and more adapted for the use in these settings.

12. Take into account the computer illiteracy or even resistance. Tutors are very important. Train on the health content and computer skills from the beginning; offer continuous technical support.

13. Media illiteracy can be a harmful as well. People have to learn which information from the internet is reliable or not, in order to prevent over-diagnosing. If health care organizations and practitioners are not on the social media with their reliable health information, lay people have less opportunity to find this. Or as Jessica Colaco told the audience ‘If your are not Tweeting and using the ‘#gethealthsummit’, what are you doing here?’.

14. Multimedia trainings, or hybrid models seem the future. Built content on all media and apply what is most feasible and attractive in a particular situation.

15. Use video in the education/training, because it such a powerful medium (Deborah Van Dyke, Global Health Media Project). Try to shoot in the setting and with the people who are going to use the video’s. Use a voice over (easy to moderate for other languages) and keep them brief (5 minutes) and basic (for low bandwidth). But since making your own footage can be expensive and time consuming, search for international video organizations like Global Health Media Project or Medical Aid Films.

16. Use spaced education or continuous on the job trainings. Nice example: illiterate CHWs receive a voice-question every work day. They have to answer with yes or no (SMS). If the answer is wrong she will get an (voice) explanation and the particular question will come back later, until her answer is right. Or as Dr. Relly Brandman (Coursera) put it: ‘Don’t go to the lectures for answers; the real work is the home work’.

17. Content is there, but how to get it? Look for content of training in local training institutes, or invite change makers, start a hub. Use international up to date standards and manuals as well. Don’t invent the wheel again.

18. Crowd is educating the crowd. Let the users share, network and help each other. This is empowering them, and saves a lot of time for the project management/trainers. In this new era you don’t have the teacher (‘knows everything’) and pupil (‘knows nothing’) relationship anymore, but the trainer/educator facilitates learning. Peer-learning is a very strong alternative for the old school methods, and the new technologies give multiple opportunities for chatting, sharing and networking, or ‘the virtual classroom’.

19. Get the nurses and doctors out of their isolation. Specially in remote rural areas being in touch with a colleague can be precious and motivating. In a few projects this was the greatest incentive for carrying on with elearning. This means that a platform with chat, mail, SMS or free telephone time for contact between workers is recommended.

20. Go for official certification and accreditation. The students are the most important. But without a national/international accredited certificate you are not offering them something valuable. Fight cheating and fraud as well. If your training is part of an clear national curriculum, people can not pretend to be more then they are (not everyone who had some training and a white coat is a nurse)

There were 11 parallel breakout session at this summit, and I could, off course, only attend 3 of them. So, I’m sure I missed a couple of golden tips. If you have any suggestion, idea or ‘golden tip number 21′, please comment on this blog or send a mail (in2mentalhealth@gmail.com).
I would like to thank all the presenters and attendees for their input and ideas. And the organization, the GETHealth partners and sponsors as well.

Roos Korste is a psychologist, trainer, and blogger and originally published this post as The 20 Golden Tips from the GETHealth Summit NYC February 2013


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