Mobile training and support (MOTS) service—using technology to increase Ebola preparedness of remotely-located community health workers (CHWs) in Sierra Leone

Abstract

Background: The Ministry of Health in Sierra Leone has developed and operationalized the national Digital Health Strategy to guide integrated roll out of e-health/mobile health solutions. The goal is that "by 2023 an effective and efficient ICT enabled system supports delivery of quality, accessible, affordable, equitable, and timely healthcare services and moves Sierra Leone closer to achieving universal health coverage". Investing in digital platforms for the education of community health workers (CHWs) in Sierra Leone is a critical strategic approach to strengthening the country's readiness for future Ebola outbreaks. A new national curriculum for this target group is being implemented that is based upon classroom training approaches. In a country where many CHWs are remotely located, the use of technology can be an enabler to reach such individuals with key training content to repeat the most important messages. Here we describe the piloting of a mobile training and support (MOTS) service for CHWs using interactive voice response (IVR) technology in Bo district of Sierra Leone. This training platform delivers voice recorded training content in local languages on the topics of Vaccines and (Ebola) Disease Surveillance & Outbreak Response. Methods: MOTS was developed in collaboration with the Sierra Leone Ministry of Health & Sanitation. Training content was customized in line with the national training curriculum and case reporting requirements. Local ethical approval was achieved and a test protocol involving recruitment of 125 consenting CHWs was implemented in Bo district of Sierra Leone. Two training modules-one covering vaccination and one covering outbreak response and disease surveillance were delivered to the mobile phones of participants as audio messages in the preferred local language. Knowledge change was assessed largely through pre-and post-quiz assessments also implemented through IVR. Results: Knowledge acquisition was observed in the 123 CHWs completing this pilot assessment. The extent of knowledge acquired was higher with the Vaccine training module when compared to the (Ebola) Disease Surveillance & Outbreak Response module. The technology was readily accepted by this population and their engagement was such that they also provided important elements to be improved prior to further implementation. The order in which training modules are delivered as well as general fatigue of the IVR methodology for participating in the quiz assessments may be of importance and requires further investigation. Conclusions: Technology should be considered when planning delivery of training to CHWs and can be positioned as a vehicle by which repetitive aspects of important training content can be reinforced without the need for additional classroom presence of the CHW community. Sustainability of such solutions requires cost containment and subsequent software accessibility for authorities in resource limited settings.

Community health workers for pandemic response: a rapid evidence synthesis

“…A majority of the studies included in the review were qualitative (n=11) 7-17 followed by descriptive crosssectional studies (n=9), [18][19][20][21][22][23][24][25][26] pretest and post-test studies (n=6), [27][28][29][30][31][32] literature reviews (n=3), [33][34][35] mixed-methods studies (n=2), 36 37 guidelines (n=2), 38 39 one systematic review, 40 one randomised controlled trial 41 and one case report. 42 Key characteristics of the included studies are presented in table 1.…”

“…In Sierra Leone, for instance, the Mobile Training and Support programme (an e-health training for CHWs on pandemics) used a decentralised reporting structure with outreach to individual CHWs and was reported to be useful. 29 Appropriate training helped CHWs overcome fear and become more confident about providing and delivering care and helped them deal with a broad range of challenges. Transparency in communication that included sharing of information from supervisors motivated CHWs to be involved and mitigated the fear frequently encountered during pandemics.…”

Community health workers for pandemic response: a rapid evidence synthesis

“…CHWs and their supervisors required appropriate training and supportive supervision for community sensitisation, awareness and risk communication during pandemic outbreaks and the lack of these was noted as a significant barrier to effective service delivery. (7, 9, 13, 16–18, 20, 21, 25, 29, 32, 34, 37, 38, 40) In most of these studies, it was reported that appropriate training in skills and knowledge related to disease outbreaks led to an improvement in awareness of the disease, screening and reporting. In qualitative studies, it was reported that there was a change in perceptions of CHWs, leading to more proactive involvement in disease prevention and control.…”

Evaluation of the ebola virus disease preparedness and readiness program in Uganda: 2018 to 2019

“…The restrictions and curfews during COVID-19 have magnified this challenge. Sierra Leone and other countries have demonstrated case study examples for mobile-based training and support training for EVD (MOTS) [ 29 ]. Uganda has used a short message service (SMS) based system called “mtrac” for IDSR and health management information system reporting and training.…”