6 hurdles in health worker training and ways to overcome them

By Erin McGuire

Training health workers in remote locations remains a key challenge for the global development community. The world Health Organization estimates the world faces a global shortage of doctors, midwives, nurses and other health care professionals, as well as a shortage of faculty that can provide high-quality training and mentorship.

Help may be at hand, however, in the form of a series of innovations in electronic learning, electronic health and mobile health — or e-learning, e-health and mHealth, respectively — that can be leveraged to train, deploy, support and empower health workers.

Devex talked to three experts about their experiences in the sector, identifying six obstacles currently faced by aid organizations in the sphere of health worker training and some possible game-changing solutions to overcome them.

1. Train community health workers the right way, using the right curriculum.

Amref Health Africa is that continent’s largest international health nongovernmental organization. Samara Hammond, the CEO of Amref’s U.K. branch, explained that the NGO is now in phase two of its pilot program to train health workers to use simple mobile phones in Kenya. The eLearning project was a collaboration between Amref, Kenya’s Ministry of Health, the Nursing Council of Kenya and Accenture.

Tested on 300 community health workers, phase two is testing scale by increasing that number to 3,000 — and the feedback is encouraging.

“Community health workers loved it,” Hammond said. “There’s always going to be a face-to-face element to training, but we’ve made them able to reduce face-to-face time. It’s given them more flexibility and choice over how and when they learn.”

“I define success by the fact that Accenture and Amref are no longer involved in the program, and it’s running strong. It was completely adopted by the Ministry of Health and the Nursing Council,” she said.

2. Collaborate and share to solve joint problems.

The biggest obstacle in Amref’s eLearning program is access to phone charging points. When community health workers use their phones for training, they have to charge them more, which costs both time and money.

Amref is in talks with a Safaricom offshoot in Kenya, M-Kopa, which sells solar lamps that can be used as charging points and can be paid for through M- Pesa, a mobile phone-based money transfer system.

Hammond said that solving the problem through partnerships is key, sharing with Devex that Amref is also using partnerships to scale the project.

“We’ve developed something that works,” she said. “In Kenya, we’re talking to Sightsavers and Save the Children. And part of phase two will be whether Save the Children can take the platform and train community health workers with it.”

Amref is also collaborating with Accenture, Safaricom and Mezzanine — a technology provider under the Vodafone umbrella.

3. Train health workers in the field to perform consistently and well.

According to Marc Mitchell, lecturer on global health at Harvard University School of Public Health and founder of D-Tree International, the goal should be to train health workers to do specific things correctly and consistently.

“I think distance learning is one piece of that puzzle. I think there’s a need for some face-to-face learning,” he said. He also shared with Devex that teaching is often not focused on what an individual needs to know to do their job.

“We teach disciplines rather than tasks,” he said, stressing that teaching that engages people so they learn effectively and are able to use what they have learned is key.

When different institutions provide different training components, there can be a disconnect.

“I think that what’s needed is a much more integrated approach to training and learning and relearning and achieving your results,” Mitchell said.

4. use technology to augment training.

Mitchell asserted that the way we think about accessing knowledge is different now because we have instant access to information through apps and search engines such as Google.

“And yet we’re not really using that understanding to make new knowledge available to people in new ways,” he said. Especially in low-income countries, nothing has changed. “We need to figure out how to incorporate, not just distance learning, but technology — the fact that you have a phone in your hand; the fact that when you have a question, you can call someone, you can text them, you can look it up.”

5. Get people to serve each other in a way that’s really needed.

Mitchell has found that simply putting phones in health workers’ hands increases their status. It also makes patients more confident in the care they’re getting.

The Harvard lecturer runs a program in Zanzibar to encourage women to deliver babies in health care facilities and Mitchell explained that the rate of health facility births has doubled from 40 percent to 80 percent in the population he studied.

One key part of the program was giving community health workers a phone they can use for a variety of things, including screening women and arranging transportation. Now the cultural norm of delivering babies at home is starting to change.

“That’s what you want to see. And it’s those little changes that just change the dynamic for long enough that suddenly the norm has changed. Suddenly you have a major change that’s really going to affect health outcomes and society in a positive way,” he said.

6. Encourage organizations to work together efficiently in partnerships.

Lauren Woodman, CEO of NetHope — a consortium of 42 NGOs specialized in improving IT connectivity in developing countries — shared some examples from a project carried out in conjunction with Johns Hopkins University that aims to help health practitioners focused on behavioral change to learn best practices.

Woodman has spent most of her career working in partnerships, and stressed a number of important things to bear in mind.

First, everyone has to be clear about the expectations around both long-term objectives and short-term paths to getting there, “so other partners know what you’re working towards is really important,” she said.

Second, communication is critical so be honest about what is and isn't working.

Third, develop starting with small steps.

“Yes, we want to improve maternal health, but what are the steps we’re going to use to get there? And using those interim steps as trust building exercises between everyone involved really improves communication and operation as you get further into a partnership and things get more and more complicated,” she said.

Published by Erin McGuire in www.devex.com. Erin McGuire is a multimedia journalist whose work has been published in The Irish Times. Erin has degrees in psychology, law and journalism. She has worked as a judicial law clerk and as associate counsel at the Board of Veterans’ Appeals, U.S. Department of Veterans Affairs in Washington, D.C. She lives in Dublin, Ireland.

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