Efficient and Convenient Remote Capacity Building of Frontline Health Workers in Angola

By Anya Fedorova, Country Representative, PSI Angola; and Janet Patry, Digital Health and Monitoring Training Consultant, PSI 

Imagine being able to train frontline healthcare workers anywhere in the world on case management, through a device already in the palm of their hand.

In June 2020, the Angolan National Malaria Control Program (MNCP), through the U.S. President’s Malaria Initiative (PMI)/USAID technical assistance and funding, launched an eLearning platform specially designed to build the capacity of healthcare workers efficiently and conveniently.

Our approach was to enable frontline public sector health workers to access vital knowledge and skills building information, in a user-friendly way that was flexible and tailored to their technological needs and unique learning styles. To achieve this, PSI Angola partnered with Angolan start-up company Appy People, a leader in digital innovation for health.

A Torrent of E-Knowledge

PSI Angola and Appy People developed the eLearning platform Kassai –or, a torrent of knowledge, after one of the biggest Angolan rivers—which PSI implements through the USAID-funded Health for All project.

What is Kassai? We outline below:

        1. The target audience is diverse in age, experience, skill level and digital engagement, hence we sought a solution that could reach most of our learners on devices they are already using.

Kassai is a Moodle-based training solution accessible online through computers and tablets, and both on and offline through internet enabled mobile phones. All training modules are in Portuguese. For the percent of healthcare workers using basic handset phones and unable to access the internet, we taught basic digital skills to support uptake and set up learning stations within facilities providing tablets for the providers to access Kassai.

        2. One of the benefits of an eLearning platform is the user’s ability to learn at their own pace and during the time of day that works best for them.

This eliminates complex logistical planning for large group training and reduces the amount of time away from the clinic which ensures facilities can remain fully operational during training periods. In order to reduce transactional costs, UNITEL, the largest private telecommunication provider in Angola, provides free internet access for public healthcare workers to stream the courses through their devices. This engagement with UNITEL is a part of a long-term private sector partnership program with PMI and PSI.

       3. Kassai currently offers five comprehensive malaria courses that cover all aspects of malaria case management.

Each course starts with a pre-test to evaluate the current knowledge of the learner. The video course covers technical aspects of counseling, diagnostic and treatment and provider-client communication skills. To keep the learners engaged, the courses continually assess knowledge through interactive quizzes, simulations, and case studies. Kassai courses and downloadable learning materials are available at any time for maximum convenience.

As of March 2021 there are 900 nurses and doctors enrolled on the platform for different courses. The ongoing plan is to have another 2,000 healthcare providers enrolled and actively engaged with the platform by end of year. For many of our nurses and doctors Kassai was the first experience with digital technology and eLearning, so it has been very important for us to collect feedback from the users. Through field observations, surveys, and phone interviews, we have been able to improve the course content and site functionality in real time. This is something that would often take months to achieve in a classroom environment. In the digital sphere, we can adapt to changing needs faster and more efficiently.

“I am happy to use it (Kassai platform) because I can access it at home on my phone and review the courses.. and internet is free as well.” — Teresa Francisco, Licensed Nurse from Provincial Hospital in Zaire Province, Angola

KEY INSIGHTS FROM USERS

        1. To reach providers: advertise, advertise, advertise 

Health care providers perceive access to training as a ‘’restricted’’ commodity, neither easily available, nor regularly accessible. Very often it is provincial authorities or clinical directors who approve providers’ participation in the training.

And even when providers learned that Kassai is a digital training platform, many of them assumed that it would only be available on ‘’dedicated’’ tablets to ‘’selected’’ providers. It was not immediately obvious that any nurse can access the platform from his or her personal phone any time, even at home! This insight is really important for the marketing and communication campaign to the nurses promoting Kassai.

        2. To digest learning material, bite-size learning works best

Providers have the ability to go back to – and repeat – lessons within any module at any moment while learning on Kassai, which means they can absorb the lesson at their own pace. This contributes to better ‘’digestion” of the learning material. The ability to stop the course and take a break at any moment, then return to the course and resume or repeat the session is seen by providers as one of the biggest benefits of this way of learning.

Access to data also improves supportive supervision. For hospital managers, clinical directors, and quality assurance supervisors Kassai platform features analytics dashboards that showcase learners’ success rates and identifies gaps in knowledge where more focused support is needed.

OPPORTUNITY AHEAD

The public sector has realized that the platform opens doors to continuous medical education not only in malaria but in other health areas, which are not always readily available to them.  In September 2020, USAID, PSI and Appy responded quickly to providers’ needs and added a module on a new type of injectable contraception, subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) to the platform, with more courses in family planning to come in early 2021.

To increase providers engagement with the platform, Kassai will launch a forum where providers will be able to ask questions on topics of interest and receive advice from their peers and experts. A cost effectiveness study to compare eLearning training of providers to traditional classroom training – and linking it with quality-of-service delivery – is planned for 2021. This study will inform sustainability plans for the provider capacity building in Angola.

Teresa Francisco, Licensed Nurse from Provincial Hospital in Zaire Province, Angola.

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