In Tanzania, there is one doctor serving more than 18,000 people. To put this in perspective, in the U.S., there is a doctor for every 476 people. Given the shortage of doctors in Tanzania, nurses and clinical officers often serve rural clinics. With only three years of post-high school training, these health care providers are often tasked with caring for 5,000 to 150,000 people on their own.
Part of my job at the Knowledge for Health (K4Health) Project is to expand access to high quality public health training content both globally and in specific country contexts, such as Tanzania. I’ve done this by:
- Facilitating online discussion forums.
- Co-managing the Global Health eLearning Center (GHeL).
- Developing accredited and non-accredited eLearning courses.
- Working with partners on developing blended learning strategies.
- Collaborating on mobile learning (mLearning) content adaptation.
- Exploring the effectiveness of popular social media platforms for the delivery of course content.
Several years ago, I was charged with delivering global health technical content to a closed user group of medical professionals in Tanzania. The closed user group gives doctors a chance talk to each other about the services they are providing and ask context-specific questions of their Tanzanian colleagues. We wanted to enhance their experience by connecting the members to trusted, up-to-date technical health content that would help them provide quality health care services.
As anyone working in the digital health space knows, even the simplest plan can turn very complicated in implementation. We thought that offering the GHeL site to this closed user group of providers would be a quick and easy way to connect them with the health information that they needed. We figured we could have it up and running in six months and then plan for more personalized, two-way exchange and engagement.
In reality, it took almost two years to roll out the GHeL site to the closed user group in Tanzania.
Too often, those who work in international health development are hesitant to admit when things don’t go as planned, but I think there’s great value in sharing the less-than-perfect side of implementation. If we only share our successes, we risk repeating the same mistakes or missing the most efficient path to our end goal: better health outcomes.
What We Did…and What We Learned
According to World Health Organization, access to training is strongly correlated with motivation among health workers. Professional development enables health workers to take on more challenging duties, and it increases job satisfaction, especially when the training addresses their local needs. Mobile phones have great potential to serve as a bridge between health workers and continuing professional development opportunities. They enhance opportunities for peer-to-peer support and knowledge sharing, reducing isolation among those working in rural settings.
In Tanzania, K4Health sought to create a nationwide network of health providers — starting with doctors, clinical officers, and medical officers — by forming a closed user group. A closed user group allows members to make and receive unlimited calls within the group. Our negotiations with the mobile network operator (MNO) allowed members to navigate and take GHeL courses via their phones for free — without being charged for data. Now we are focusing on expanding the network in Tanzania and distilling lessons we can apply to similar activities in other countries.
Recognize and don’t lose sight of the different goals driving your partners.
Without buy-in from all of your partners, it will be hard to get your activity off the ground. Involve partners from the very beginning. In our case, our ultimate goal was to be a nationwide network of health care providers, so we identified the Ministry of Health and Social Welfare (MOHSW), an association of medical providers, and a local mobile network operator (MNO) as critical partners.
The MOHSW is a regulatory body. Why were they a key partner? They could promote the network among health practitioners and validate that registered members are licensed providers. We easily engaged the MOHSW on our health provider network because they saw the benefits and opportunities for health providers and their organizations: Allowing health providers to more efficiently and regularly communicate with each other contributes to higher quality health care delivery and a stronger health system overall.
However, when we used the same pitch to the MNO, they were less impressed. Highlighting the altruistic importance and need for a free health provider network, while a noble pursuit, wasn’t an easy sell given that most health providers have multiple network SIM cards. The MNO wanted to know how offering a free service was going to increase their business revenues. We started the network with just certain cadres of providers so that the MNO could monitor how much the free service was costing them in relation to how much new business it was drumming up from the users of the network.
I now realize that the value international development organizations like mine place on mission-driven activities and approaches is not shared by all partners equally. Mission-driven work is an added bonus for a MNO, but it is not the driving force behind its for-profit business model. Each partner has different goals and competing priorities.
One way to build a strong partnership and a shared understanding of the goal is to meet regularly and in-person; we relied quite heavily on email and virtual check-ins. Don’t underestimate the value of developing strong relationships and partnerships through regular, long-standing, in-person meetings. These regularly-scheduled meetings help you get to know your partners personally and professionally, which helps the group ensure buy-in, foster confidence, promote transparency, and weather personnel changes.
Understand the local IT landscape and allow time to strengthen the capacity of local developers.
Before you do almost anything else, survey the local landscape to see what technology solutions are already in place and understand local IT capability.
Even once you understand the local IT landscape, recognize that technology and software is constantly changing. Make sure you build enough time into your work plan for learning on the job if you want to truly maintain IT interventions in-country with minimal support from headquarters.
We had a third party develop the original communication platform that we used to send messages to our closed user group, which probably made things more complicated for us. Since we didn’t build the platform, not many of staff, locally or at headquarters, understood it. Even though it was an open source technology, we quickly learned that we needed to transition to another platform to ensure technical control and interoperability with other mobile applications and standards.
Even the transition required on-the-job training and virtual mentorship of our IT staff. We still experienced delays while installing and configuring the new platform.
Deliver on your promise quickly.
Finally, make sure members of the network experience the benefits that you promised them as quickly as possible. If we were to do this over, we would delay member registration until we were able to work out the communication platform kinks; test and prioritize the message scripts; and automate the registration, verification, and activation processes.
A valuable closed user group is one in which it is easy to engage and to monitor engagement, especially among early adopters. To encourage early adoption, you must deliver on what you’ve promised in order to demonstrate the value of the service — in this case, connection to colleagues and free access to continuing professional development resources.
In-person events are a great mechanism for communicating value because they provide an opportunity to highlight successful use cases, hear testimonials from early adopters and champions, and strengthen connections that were forged virtually. We used in-person events to promote the network and help health providers register. In the future, we would like to plan in-person member receptions or networking events as a way to continue to promote the value of the network but also strengthen connections among network members.
Learning from Challenges Fosters Success
Asking people to use their mobile phones in new ways requires behavior change and, therefore, time. One way to facilitate this type of behavior change is to make sure that the implementation of a tech solution for health goes as smoothly as possible. There will always be unexpected challenges — some that are in our control and others that are not. Keeping these lessons on partnerships, platforms, and promises in mind from the beginning will help us deftly navigate these challenges.
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