MSH’s Innovation Challenge (INCH) Fund Supports Mobile Learning in Malawi

Community health workers in Malawi, with the mobile phones they are using to receive health information. {Photo credit: MSH.}Photo credit: MSH.

In the rural Salima district of Malawi, where the closest health facility is more than a day’s walk away, community-based health workers provide the first and often only line of care to families who need health services. While it is essential that these health workers remain up-to-date on current medical norms and knowledge, this proves challenging considering that most villages in Salima do not have electricity, let alone internet.

Mobile phone technology has become a valued tool to connect rural health workers with the information they need. Capitalizing on the successes demonstrated by various mobile health projects, Management Sciences for Health (MSH) recently funded a pilot project to test the use of mobile learning to improve access to and use of correct health information among community health workers in Salima through the MSH Innovation Challenge (INCH) Fund. The INCH Fund seeks to identify promising innovations in field projects that have the potential to improve health outcomes, and help replicate and scale tools, models and approaches that have proven effective.

The INCH Malawi project was built on the foundation of the prior Knowledge for Health (K4Health) Malawi project. Implemented by MSH from 2009–2011, as part of the global K4Health project managed by the Johns Hopkins University Center for Communications Programs, K4H Malawi used mobile phone and text technology to provide more than 600 community health workers with immediate access to up-to-date relevant health information. A post-project evaluation showed that participants improved efficiency of referrals and widened service coverage.

The INCH pilot intervention spanned four months, and worked with 53 of the community health workers and their district-level supervisors who had been part of the Malawi K4Health project. Following refresher trainings with this group, the INCH Malawi project conducted a gap analysis of basic family planning information through surveys sent to the health workers’ mobile phones. The results of this survey informed the design of a series of frequently asked questions (FAQs) regarding basic family planning services that were sent to the health workers. They were invited to respond to these questions to test their knowledge of the correct response. Participants received 100 units of mobile airtime per month that both supported the cost of responding, and rewarded them for participation.

The evaluation of the INCH Malawi pilot yielded interesting results. In focus group discussions, four out of the 15 community health workers interviewed noted that they referred to manuals before responding while two of them discussed their responses with their friends. The community health workers indicated that they never had taken the time to read family planning manuals before. The INCH project provided the necessary motivation, as well as encouraged them to consult with peers. With regard to knowledge gain, 13 of the community health workers interviewed indicated that they felt they knew more at the time of the evaluation than they did prior to the project.

It is impossible to measure results at the outcome level since this was a short pilot program, but the responses seem promising. Of the 53 trained health workers participating in the targeted learning module, 34 sent answers to the FAQs. As one community health worker in Salima noted, “When we started working as community-based distribution agents we followed everything according to the book. However, as we were getting used to the job, we started creating shortcuts, and soon enough, those shortcuts became the rules… The INCH project reminded us of the procedures as we went to read our manuals again.”

The conclusions drawn from the focus group demonstrate that mobile learning plus the use of incentives may be an effective way of managing and monitoring quality of service provision as well as monitoring the knowledge and practice of community health workers. The Salima District Health Management Team is currently looking for additional funding in order to continue and expand this program to ensure that all rural health workers are informed and able to meet the needs of their clients.

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