Filming of Malaria Consortium staff doctor counselling a client on proper treatment of malaria. Uganda. (Photo credit: Maddy Marasciulo-Rice, Malaria Consortium)

Malaria in Context

There is an undeniable malaria problem in the world today. According to the World Health Organization (WHO) in March 2014, half of the world’s population is at-risk, hundreds of millions of cases are reported each year, and hundreds of thousands die annually of this disease. Around 90% of these cases occur in Africa, with children under 5 years old making up the largest demographic affected.

The burden of this disease on the health care systems of developing countries is immense: Uganda has the highest malaria incidence rate in the world with 478 cases per 1,000 population per year. Fully half of inpatient pediatric deaths in Uganda are caused by this disease and in Nigeria, the most populous African country, 97% of the population is at risk.

(Source: WHO 2013 Global Malaria Report)

How are the countries of Uganda and Nigeria addressing malaria?

While both Uganda and Nigeria have national malaria control and elimination programs, due to long waiting periods and frequent stock outs of the appropriate medications at local health facilities,  individuals prefer to go to private clinics, pharmacies and local drug shops to solve their health needs. When these pharmacists―often untrained in accurately diagnosing febrile illnesses―see a client complaining of fever, they often presumptively prescribe antimalarial medicines. The reverse scenario is also a common problem: pharmacists do not always give out artemisinin-based combination therapy (ACTs) when it is actually needed.

Pharmacists in Uganda

Pharmacists in Uganda assist customers with recommending antimalarial medications (Photo credit: Maddy Marasciulo-Rice, Malaria Consortium)

Presumptive treatment ― the overuse of antimalarials greatly increases the chances that malaria parasite resistance will develop and spread. In the future we might have one less weapon in our arsenal against these parasites. This overuse also means that the medicine is put over

How can rapid diagnostic tests (RDTs) help treat malaria?

Fortunately, rapid diagnostic tests, or RDTs, allow malaria to be diagnosed quickly, accurately, and cheaply, using only a drop of blood and a few drops of a solution. The problem is―there is no official quality control within the private healthcare sector―the pharmacists who provide the RDT to the patient have no way to choose a good RDT from the many options on the market and the wrong choice could lead to inaccurate diagnosis. Furthermore, many of the RDT sales representatives haven’t been trained to properly explain their product to their clients.

Challenges of RDT Training for Malaria in Uganda and Nigeria

RDTs to test for malaria and drugs to treat the disease are currently available in the private healthcare sector. However, there are several challenges to scaling up RDTs in this sector in Uganda and Nigeria.

1. Lack of training with Rapid Diagnostic Testing Materials

The primary barrier to appropriate care is the lack of training among pharmacists and RDT sales providers about how to use the test and interpret the results correctly to effectively diagnose and treat a range of febrile illnesses.

Malaria Consortium, based in the UK, is one of the world’s leading non-profit organizations specializing in the prevention, control, and treatment of malaria and other tropical diseases. Their projects can be found across twelve countries in Africa and Southeast Asia. The organization strives to find effective and sustainable ways to control and manage malaria through research, implementation, and policy development. They came up with the design for a plan that could greatly help manage the disease in both Nigeria and Uganda:

If the RDT sales representatives and RDT providers can be trained to correctly use the RDTs and recognize the symptoms associated not only with malaria but with other common illnesses, then the burden of misdiagnosis and mistreatment can be greatly reduced. Furthermore, as the sales representatives travel and frequently interact with providers, they can act as trainers and further disseminate the knowledge and skills necessary to accurately diagnose and treat these diseases.

2. Prohibitively high costs

The costs associated with arranging such a training are enormous―between transporting the students and teachers to a centralized location, renting a venue, arranging lodging, and coordinating a schedule, the budget for a large-scale training would quickly be out of control. Additionally, pharmacy owners and other stakeholders working in the private sector would most likely have to assume a loss of revenue during their time away from their business while at a training.

3. Technical limitations

An eLearning platform is much more ideal for these circumstances―it’s flexible, participants don’t need to travel far, you need fewer instructors, and the information can be processed at the student’s pace and repeated when necessary. The information is also standardized and consistent, which means that a large number of people can benefit from a high quality training experience.

 But how do you deliver an eLearning course when your audience has intermittent power and whose computers are not only often out-of-date, but lack the RAM, bandwidth, and software standards that such hi-tech learning platforms have come to expect?

eLearning Solutions for Reaching 3000+ Healthcare Providers for Malaria

Malaria Consortium partnered with TechChange to build a comprehensive digital course to train private sector health workers and RDT sales representatives in this context. This 11 module course includes around 400 slides for 6 hours of content takes participants through the biology behind the malaria parasite, discusses the medical philosophy behind diagnostic practices, and walks users through interactive scenarios for patients presenting a range of symptoms.

Testing TechChange Malaria Consortium modules in Uganda

Sales representatives and drug store owners in Uganda testing eLearning modules designed by TechChange and Malaria Consortium on rapid diagnostic testing for malaria. (Photo credit: Catherine Shen, TechChange)

1. Offline access and Ease of Use

Despite significant benefits such as flexibility and scalability, e-learning courses also face challenges in the developing world. Lack of sufficient internet bandwidth, reliable computers, and computer skills can pose major barriers to a training’s effectiveness.

To troubleshoot the technical issues, this course is designed to require nothing more than a computer and headphones – it comes preloaded onto USB drives so not even an Internet connection is necessary, allowing health workers in even the most rural areas to access this training. A computer tutorial is also included for health workers with little to no prior experience with computers. Our tech team is also devoted to helping solve any other technical issues that arise due to out-of-date software and hardware malfunctions, working as a remote IT team as Malaria Consortium rolls out the project.

 2. Localized content

In addition to including the relevant national laws, case studies, and local examples, the narration features Nigerian and Ugandan voice actors, art, and scenarios to make the training as culturally-relevant as possible.

 3. Hybrid learning

Only one part of the training won’t be computer-based; participants will still practice actually conducting the RDT tests in a face-to-face session before they begin pricking patient’s fingers for diagnosis.

The course is designed to reach upwards of 3,000 healthcare providers in the two countries and build their capacity to effectively serve their community’s needs. We look forward to seeing the impact of this training in improving quality of care in Uganda and Nigeria hopefully in the near future.

To learn more about TechChange’s custom training solutions, please contact us at info@techchange.org.

Emily Fruchterman, Catherine Shen, & Charlie Weems contributed to this post.

After a study-abroad semester in Spain and a summer at TechChange in Washington D.C., Emily Fruchterman is heading back to William & Mary to finish the final year of her undergraduate career. Before heading to Williamsburg to finish her Biology degree, she looks back on her summer internship at TechChange as an educational technologist.

1. How did you hear about TechChange?

At the start of 2014, summer internships were the last thing on my mind. I was off to spend the semester in Seville, Spain, and any thought relating to life-after-study-abroad was a painful reminder that my time in paradise wouldn’t last forever.

When my final exams forced me to face reality, I wasn’t quite sure where to start my search (the ocean between me and potential employers seemed pretty daunting). A friend referred me to internships.com, where I found out about TechChange.

2. Why did you choose TechChange to spend the summer between your junior and senior years?

TechChange piqued my interest with its goal of using the power of technology to advance social change. The broad range of courses that demonstrate the utility of technology to a very international audience showed me that this was more than a cursory commitment. Contributing to an organization with such goals seemed like a worthwhile way to spend the summer.

On a personal level, TechChange seemed like a great complement to many of my previous experiences at nonprofits and NGOs doing research while giving me new exposure to a startup culture. TechChange’s upcoming projects also aligned well with my interest in public health, plus the networking opportunities afforded by spending a summer in DC seemed too good to pass up.

3. What are your interests?

While I’m generally interested in the field of development, my passions really lie with public health. I’d really like to work for organizations (like TechChange) that have projects relating to the various aspects of health and healthcare – although my dream is to work for an organization that coordinates healthcare responses and works to improve health outcomes on an international basis. I’m also an avid coffee drinker, science fiction fan, and aspiring flamenco dancer (my time in Spain might have influenced this last one).

Emily with TechGirls

Emily goes over how to create an online course with the TechGirls on TechGirls Job Shadow Day 

4. How did you use your TechChange internship to explore your interests?

Fortunately for me, TechChange had several different public health related courses this summer. I was able to engage with a course on Malaria, for use in Nigeria and Uganda, as well as take on a large part of a facilitated course on HIV for clinical and non-clinical care providers. Both of these have been extremely valuable experiences, as I’ve not only learned a great deal about both illnesses, but also looked at how to structure health-related interventions and training programs.

5. What did you do at TechChange this summer? What was your role at TechChange?

The instructional design team was finishing up a self-paced course on Malaria when I arrived in June. I was not only able to help with edits and testing, but built a few interactive elements. I got more experience building out lessons, writing storyboards, and coming up with engaging lessons while working on other instructional design projects.

I got my first taste of the facilitated platform as a teaching assistant (TA) for a course on Social Media for Social Change, during which I familiarized myself with WordPress and the structure/pacing of a four-week course. This came in super handy, as a couple weeks later I started to manage content development and build out the four modules for the course on HIV treatment. I also helped write several blog posts relating to projects, participated in meetings with clients, and taught the TechGirls from Tunisia and the Palestinian Territories how to create online courses.

6. What did you learn during your time at TechChange?

The first big thing I learned was how to use Articulate Storyline. This eLearning program might look like a fancier version of PowerPoint, but it has it’s tricks and idiosyncrasies. It was very cool to learn how to create interactions, design variables, and troubleshoot glitches to develop quality modules. This was super useful, as it helped me think about learning in a much more user-centered way.

I also learned to be much more comfortable in front of the camera – while I still had my fair share of outtakes, it became a lot easier to speak to a blinking red light instead of an audience. I learned how to manage time during interviews, ask the right kinds of questions, and (most importantly) what to do with my face when I wasn’t the one talking.

My tech skills also improved – my co workers tried to show me some coding basics (parts of which I picked up on better than others), I increased my audio editing abilities, became super familiar with WordPress, created several graphics, and set-up and took down AV equipment.

I also improved my communication skills by working closely with various members of the team on different projects and writing emails/participating in phone calls with clients.

Emily

Emily in the recording studio at TechChange before recording a live session for a course

7. Did your TechChange experience end up going as you expected?

In some ways – based on my impressions of TechChange from their website and my interview, I’d expected to find a group of young and tech savvy individuals interested in promoting social change.

I hadn’t expected how much support they’d give me for pursuing my own ideas from the get-go. I think it was my second or third day here that I suggested an interaction be added to a part of a self-paced course to a member of the instructional design team. The response I received – “great, want to build it?” – really surprised me. I’d barely started learning the program, was still figuring out where I fit in, and yet was already being offered the chance to work on the product. This “great, want to build it?” philosophy was present throughout my internship here – I had a lot of flexibility and opportunity to build off of assigned tasks.

8. Would you come back to work at TechChange one day? Why?

Yes, and without a second thought. TechChange has to be one of the best work environments I’ve ever encountered; it’s fun and collaborative, the work is engaging, and the company is small enough that everyone can play a variety of roles. You might be hired as an educational technologist, but you’ll have the chance to do a little bit of graphics editing, write blog posts, sit in on business development meetings, teach a course, and have your voice featured in animations.

More importantly, this work has real value. The courses developed by TechChange are used by different organizations around the world to train staff members and health providers, as resources to newly-formed NGOs, and to put the spotlight on the role technology can play in the developing world. TechChange collaborates with organizations that work for real, sustainable change, and TechChange alumni go on to do incredible work. Being a part of this team has been a wonderful experience.

9. What advice would you give to future TechChange interns?

Take initiative! This is an awesome opportunity to grow your skill set – make use of that. If something needs to be done, volunteer to do it. Even if it’s not something you’ve done before, the team will support you and make sure you learn how to do it well. The TechChange team is also super supportive – if there’s something you want to learn about (even if it’s not directly related to your job), they’re more than happy to help.

By Lauren Bailey, TC309: mHealth – Mobile Phones for Public Health alumna

Lauren Bailey

My final project for TechChange’s mHealth online course overlapped a final project for a master level global environmental health course. I’m currently working towards a Master of Public Health degree, concentrating in global environmental health, and specifically focusing in water, sanitation, and hygiene (WASH). I recently became interested in mHealth and decided to do my global environmental health course project on mHealth in the WASH sector. Since I was new to mHealth, I kept the project simple, touching on some basics. This background document includes: (1) applications of mHealth in WASH; (2) case studies; and (3) recommendations.

Throughout TC309, I became increasingly interested in how mHealth can be applied to behavior change, a major component of reducing WASH-related illness. The mHealth online course has been a wonderful way to learn about the different applications of mHealth, the challenges and successes of programs, and the future possibilities of mHealth. I’ve been inspired by many of the articles, discussions, and live presentations and am now incorporating mHealth into my master’s thesis.

Here is the infographic I created, using Piktochart as part of my course project:

mHealth-in-WASH-infographic_Lauren Bailey

Highlights:

  1. Mobile phones offer a means to reach most at-risk populations, particularly those in rural areas, to change health outcomes.
  2. More individuals in most African countries will have access to a mobile phone than they will to an improved water source by 2013.
  3. Mobile phones have been deployed over the past decade as tools to improve water, sanitation, and hygiene.
  4. Client education and behavior change communication, data collection and reporting, financial transactions and incentives, and supply chain management are potential mHealth applications categories.

To read Lauren’s entire final project from the online course, mHealth: Mobile Phones for Public Health, please click here.

Interested in learning more about how mobile phones are impacting WASH, healthcare, and promoting health worldwide? Register now for our 4-week online on mHealth here.

 

Mercy (pictured with Maeghan Ray Orton from Medic Mobile) at UMCom workshop in Malawi

Posted by TechChange alumnus, Neelley Hicks, ICT4D Director of United Methodist Communications.

Mobile phones seem to be everywhere in Africa, and they’re keeping people in touch with health, education, banking, and community empowerment.

“Email and Facebook are problems…but this text messaging – it’s no problem,” says Betty Kazadi Musau who lives in the Democratic Republic of Congo (DRC).

In early August 2013, I spent the week with Mercy Chikhosi Nyirongo, who provides healthcare in communities in Malawi. Recently, she took an online course through TechChange called “Mobile Phones for Public Health.” She wondered what impact mobile phones could have on her health program in Madisi, so she conducted a test.

The problem: HIV+ men were not coming to the support group and health management classes.

The test: Separate into two control groups – one would receive text reminders about the next meeting and the other would not.

The results: Out of the 20 who did not receive text messages, five attended. Out of the 30 who did receive text messages, 25 attended and were standing in queue when she arrived.

One client said, “You reached me where I was.” This isn’t a small thing. Often community health workers walk miles to find someone only to learn they are away. But the mobile phones stay with the person – making them much easier to reach.

Mercy conducted this test directly through her mobile phone and it took her nearly all day. But with FrontlineSMS, she can enter mobile numbers easily for group messaging. She said, “After the online course, the UMCom workshop (in Blantyre), and these conversations, my eyes have become wide open.”

Join us in our next round of Mobiles for International Development and mHealth: Mobiles for Public Health online courses! 

To read the original post on Neelley’s blog, “Stories in ICT4D”, please click here.

It’s hard not to get excited about the work being done bringing health care into the digital age. Mobiles have the potential to increase efficiency at nearly every step of health care provision. These efficiencies aren’t hypothesized—waiting to develop given improvements in technology or infrastructure—they’re being realized right now in clinics and health systems around the world.
​Imagine two clinics in rural areas, Community Health Workers (CHW) in one are overburdened searching through paper records to identify previous drug treatment regimens, unable to confirm children with diarrhea are receiving oral re-hydration salts, travelling hours carrying blood samples and results back and forth from the nearest hospital where tests can be preformed.

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