At its most fundamental level, the role of mobile technology within health systems should be to improve access to and sharing of valid health information. There is a real opportunity to exploit existing technological capability to provide equitable access to content that, if adapted for each context, could provide a complete educational foundation for a country’s frontline health workforce.
Yet rather than designing a suitable system for delivery of digital content, we’ve let the mHealth ecosystem emerge by chance through independent procurements, mostly at the program level, often resulting in fragmented, duplicated – but disconnected – unsustainable systems.
The few exceptions involve the use of voice or text requiring fees related to connectivity. These systems would also have to be supplemented for training the next generation of frontline health workers (FHWs). They lack the detail necessary for instruction requiring a visual reference such as: distinguishing physical symptoms of diseases, securely donning a PPE or understanding both the process and rationale for data collection.
Whether through an over reliance on more traditional approaches or limited use of digital resources for training, inadequate and inequitable delivery of training for a country’s health workforce is commonplace in most LMICs.
What are the advantages of a national digital content delivery system?
We’re seeing an inevitable shift to the primacy of smart phones as the mobile communication device of choice for FHWs. Private and public stakeholders should be responding to this, moving national health systems towards a mobile optimized, digitally-based curriculum stored within a centralized, curated library which any content provider can contribute to or borrow from.
Using a single delivery system, this content can be delivered to an entire workforce in planned, periodic digital transfers avoiding the costs associated with connectivity and the duplication of content and individual program sponsored delivery systems.
What are the advantages of such an approach?
- It would pay for itself in the redistribution of funding from the reprinting of hard copy manuals to the maintenance of a single delivery system,
- It would provide a means for evaluating what content is working and what is not in terms of health worker training and the promotion of community adoption of healthy behaviors.
- It provides implementing partners a way to deliver their content directly to Frontline Health Workers without having to pay for the development of their own delivery systems.
- Researchers can focus on the impact of content within a comparable, scalable context (i.e. a single country’s health system) thereby avoiding many of the problems associated with the present heterogeneous nature of mHealth evaluations.
- Governments can react very quickly to emergency health crises, such as Ebola, allowing them to publish relevant materials to mobile devices in days rather than months.
Call to Action:
One example of a digital content management process, conceptualized over a year ago, brings together a set of ‘starter’ technologies and implemented them as an integrated platform in select countries to help validate the approach known as Open Deliver.
These technologies include:
- ORB, mPowering’s platform for sharing mobile training content;
- Moodle, a learning management system for course creation; and
- OppiaMobile, a mobile app for delivery of course content.
Similar to the efforts surrounding Open SRP for data collection and Open LMIS for logistics management, Open Deliver aims to provide Governments with a means to institutionalize health workforce training.
Smartphones, and much of the technologies surrounding content delivery, are already commodities. It is pointless for the private or non-profit sector to compete in this market place. Instead the goal should be for both the private and public sector to collaborate on the implementation of a centralized platform that provides a frontline health workforce immediate and continual access to the foundational knowledge necessary to provide routine health services and prevent, or at least rapidly respond to, the next outbreak.
Once this baseline is established, both in terms of health worker capacity and host Government stewardship, it will be much easier to attract private sector investment to build upon this foundational layer with unique and, potentially market viable, services.
By Mike Bailey of mPowering Frontline Health Workers
There are already widely used interoperable open standards for accomplishing this that handle distribution of content to offline devices (notably Open Publication Distribution System (OPDS)used by dozens of servers and apps), packaging (EPUB and TinCan ZIP) and for reporting usage (The Experience API aka TinCan used by 40+ eLearning vendors). I don’t see the case for creating new stacks or protocols when there are interoperable widely used ones in existence.
I like the article, but wonder why Moodle was selected, that is one low hanging fruit. Moodle is a good open source Learning Platform (LMS), however it’s now past its prime. It came up to provide good competition for the proprietary Blackboard which cost anywhere in the region of $50,000 plus. Several Universities left Blackboard and went for Moodle, and it has gained popularity in leaps and bounds. However its 15 minutes are over. In come in Drupal, not only is it a powerful Content Management System and open source, its a framework which allows you to build powerful and a rich real learning environment. At Blue Node Media, we have developed a learning management system for kids (skooldesk) using the Drupal framework. The website can be accessed at http://www.tryskooldesk.com. We believe that learning has to offer much more than simply a platform to download power point slides as is this case with moodle. We have developed interactive content combined with traditional learning objects that make learning fun and creative. Kids are able to take tests and get graded instantly. One of the problems of the traditional education system is that test scores are returned late with little or no steps taken for under performing students. Teachers spends 20 hrs or more marking tests, valuable time lost.
We have also added a robust analytics engine to track kids performance to ensure we can identify strengths and weakness of individual learners (kids). We believe that with such metrics, parents and teachers can find remedies easier through tracking and monitoring their performances.
Most of contributions ICTWorks are veiled attempts to sell ones product. The bottom line is let people experiment with as many options as they want and a winning pattern will emerge. Trying to argue that let’s limit competion because it will cost us money is both futile and misleading. Take the Moodle vs Drupal argument in here. Both systems fit a given situation and there are hundreds if not thousands of people who will argue that Drupal (or moddle) is unsuitable for mHealth/eHealth because of a, b or c. The battle of languages, frameworks etc has been ranging on in the private sector for ages. As ICT moves to international development, it looks like the same battle is being repeated there.
Chris, I would like to agree with you but your arguments are myopic, and shallow. If there is a good tool out there there is no harm in mentioning it. Chances are you have used neither platform and are probably not the best authority on this topic. It’s not a battle of frameworks, languages. That is locker room talk. I pointed out some of the strengths of Moodle, but its architecture is flawed and outdated and can no longer meet the modern demands of a powerful content management system (LMS in this case). It was designed for a time where learning involves downloading power point presentations. Moodle is good and there is no doubt about that, but if someone is shopping for a powerful learning management system, there s no contest. Drupal beats it hands down without a fight, You can even argue for a custom built platform if you have millions of dollars in your budget, but to call this a language fight, you surely can bring up more meaningful topic for discussion. Several US Federal agencies are switching to Drupal, they have seen the light, but you can choose to stay in a dark corner, and remain with the little knowledge you have, if it gives you a good night sleep.
I think the absence of any more valuable insight in your response proves the point I was making. No amount of bad mouthing from you (i.e. myopic, shallow, etc) nor pushing into unsound suppositions (i.e. chances are you used neither platform) can hide the truth that this is a languages/platform argument. As for using US Federal agencies to justify Drupal strength – I have no response to that. A study of US Federal Agencies will show that they use multiple systems/environments/frameworks etc. In short, your response is adding very little value to the issues I raised.
An inept inability to comprehend basic concepts could be the problem here not lack of invaluable insights
For your information, Drupal didn’t become powerful by waving a magic wand, a strong community network, and a lot of corporate money funding and donating back code, including federal agencies obligating contractors to donate back the code, is the real magic, this kind of network I have not witnessed in any other open source platform, the closest being Linux, but again you might say that Windows and Linux are at the same level, it’s all about choice right. Stick your day job and comment about issues you really have a grasp with.
What day job Cavin. I last did that in 1998. I have a legion of satisfied customers who can attest that I provide quite sound advice on most things tech. Just yesterday, I was called in to give a short talk to two clients that had decided to embark on tech projects without a Change Management stream. After an hour they both said, we “hope to see you in our project soon”. And why am I telling you all this? Because I believe that your huge appetite for saying quite childish assumptions will have you declaring “Or, you have no day job, so you have no money” or something as ridiculous as that. You really amaze me Cavin. And this is my last response to someone like you. So have your last word which I predict will be full of sound and fury and no value at all. Bye Calvin!
Hi all,
Just to add some extra info/response here on some of the comments already made (and full disclosure – I’m a developer for both ORB and OppiaMobile technologies mentioned in the article – so naturally will be a little biased…)
OpenDeliver is designed to be a process rather than a standard or a specific set of technologies – to help country ministries manage their health worker training content. All the technologies mentioned are just examples of what *could* be used (and the particular set mentioned is being used already). Also they are all open source technologies, so there’s not a ‘hard-sell’ on these.
I agree that Moodle feels a bit aged now – but in the context here it’s only being used as a course authoring system, end users wouldn’t be accessing Moodle directly. There’s nothing here that specifically prevents Drupal/Blackboard/other being used instead – just the hooks to link these up.
In terms of existing standards (EPUB etc), the process tries to encapsulate not only eBooks, but video, quizzes and other interactive content that may be used – the important issue for the main health worker user group is that all the course content can be delivered offline, and tracking of course activity usage (eg videos viewed, quiz results etc) is recorded and sent to a server when a connection becomes available.
There’s nothing to stop this process integrating with TinCan/Experience API and it’s not envisaged as being a replacement for this API either. We’ve actually already done some work in linking activity from training content (as OpenDeliver describes) to data collection tools (eg recording patient visits and supervisor/mentoring activities) using exactly the TinCan API.
Anyway – I hope this is useful extra info,
Cheers,
Alex
Hi Alex,
Thanks for the extra info posted there. On standards : EPUB3 is just an XHTML website inside a zip file: so it can contain interactive exercises, quizzes, videos etc. Thinking EPUB is just for books is a common misconception. TinCan zip files which are generated by most eLearning authoring tools can also contain dynamic/multimedia content. Those standards do indeed enable offline delivery / tracking of such content already and can be integrated with Moodle as well as any other Learning Management System that supports the Experience API.
Good to see that the Experience API as a means of reporting is on your radar.
If one is going to take the approach of being Moodle exclusive as far as I understand Moodle’s current app already supports offline content playback (including SCORM).
-Mike
Thanks Mike,
For Moodle and working offline – as far as I’m aware it only supports offline use for some activity types. I don’t think that yet there is a way to pre-download a whole course for offline use, each activity needs to be downloaded separately. But it may have changed since I last checked out the Moodle mobile app.
Cheers,
Alex
Let me just echo Alex’s sentiments here. As the author of this piece I wanted to communicate the advantages of a collaborative approach towards providing a means to deliver educational content on a large scale. As long as certain guidelines are respected (such as the Principles for Digital Development) than the implementation of what are already proven technologies should be achievable. The technologies listed in the article meet a criteria that helps ensure sustainability and institutionalization by host governments – any technology that meets this criteria should be sufficient.