SMS-based messages can improve training retention for health workers, according to the results of a mobile learning and performance support pilot in Uganda released in November. The goal of USAID’s pilot project, called Mobiles for Quality Improvement (m4QI), was to test the use of mHealth applications in the reinforcement of in-person training provided to health workers.

The outcome from the pilot showed that texts messages are a viable alternative for the continued education of health workers located in rural regions. This is a low-cost option that allows workers to learn in the field and does not interrupt their service to clients.  By utilizing an open source product (FrontlineSMS:Learn), the platform can be used for free and is customizable specifically to needs and challenges in new regions. As a part of USAID’s SHOPS (Strengthening Health Outcomes through the Private Sector), the next steps of m4QI project are to seek out other markets to leverage the mobile learning platform in order to further develop the software as well increase scale. The goals of future projects include improving implementation and identifying best practices.

In using the FrontlineSMS: Learn software platform, Appfrica, a software developer company based in Uganda, created a replicable program that sent messages to health workers to support and test their knowledge retention. The platform allowed for the use of basic mobile phones in order to match the phones commonly owned by the health workers. It provided supervisors data to assess which areas of knowledge were not being properly retained by workers. The project ran from September 2010 through August 2011. The intervention was provided to 34 family planning workers on the Marie Stopes Uganda (MSU) staff in six different service delivery sites. The workers’ jobs ranged from receptionists, lab technicians, service providers, doctors, drivers, housekeepers, and managers. By reviewing the behavior of the staff, four indicators were identified as areas of improvement: hand-washing, sharps disposal, instrument decontamination, and pain management techniques. Four messages were created for each indicator in which two were reinforcing, tips, reminders, or encouragement and the other two were review questions in order to test staff knowledge of past training. In order for each of the four messages to be sent twice to the participants, each worker received one message a day, four days a week, for eight weeks.

While it was initially an eight week pilot, it was expanded until August as there were multiple technical problems which caused the delivery of messages to fail. In total, 3,449 messages were sent, and there was an 86.5% success rate of receipt. In response to the assessment questions, there was a 19% response rate. Participants indicated after the pilot that they were motivated by the reminders for hand-washing rules, utilized their training manuals when they received a question about treatment protocols, were able to re-learn steps to properly sterilize instruments, and applied the information they received about pain management during patient interaction. The interviews also revealed that the messages increased the interaction between co-workers about the topics of the messages.

The pilot also provided lessons for future projects. Those include the need for technical support in the field, a greater understanding by project stakeholders to the purpose and role of the mobile application, a more organized orientation and training for participants, and pre-paid airtime for participants to increase involvement.

The SHOPS project is funded by USAID and is led by Abt Associates and includes partnerships with Banyan Global, Jhpiego, Marie Stopes International, Monitor Group, and O’Hanlon Health Consulting. The focus of the project is to use private sector health in order to improve the quality and availability of family planning and reproductive health, maternal and child health, and HIV/AIDS treatment. Within the mobile health arena, the partnership’s goal is to identify mHealth applications and their best practices in implementation and scale.