PJ Wall, Lucy Hederman, Tochukwu Ikwunne (Trinity College Dublin), Saffa Andrew Koroma, Fredrick F Kamara, and Christian Boombu-Johnson (World Vision Sierra Leone) discuss the Mobile Training Services (MOTS) platform, an mHealth initiative taken in Sierra Leone to provide training to community health workers during COVID-19.
According to The Lancet (2020) the COVID-19 virus was expected to result in high numbers of deaths in Africa. This is because of under-resourced and fragile public health systems, lack of access to preventative measures, barriers to testing and lack of training of health staff. However, this high death rate has not materialised as yet and mortality rates in Africa have been lower than many countries in the Global North. There are a variety of reasons put forward to explain this including Africa’s relatively young population, lower rates of obesity, and familiarity of dealing with previous infectious disease outbreaks. Sierra Leone is one example of a country whose public health systems have had to deal with infectious disease outbreaks over the last decade. These include the most widespread Ebola virus outbreak in history between May 2014 and March 2016 which resulted in a total death toll of 3,955 with 11,308 deaths across West Africa and Africa’s biggest cholera outbreak in 2012 with 22,885 reported cases and 298 confirmed deaths.
Sierra Leone has also placed significant emphasis on using technology as a key weapon in the fight against disease outbreaks. In particular, mobile technologies are viewed by the Ministry of Health and Sanitation (MoHS) as an integral part of healthcare projects with many mobile health (mHealth) initiatives being launched over the past few years by a variety of non-governmental organisation (NGOs). Taken together, this would seem to make Sierra Leone uniquely qualified to deal with the current COVID-19 pandemic. Thus, it should not be surprising that the Sierra Leonean Government in collaboration with NGOs operating in the country are using their vast experience to prevent the spread of COVID-19 by leveraging technology and mHealth.
The MOTS Training Platform
One mHealth-based COVID-19 initiative of note is the result of a collaboration between the MoHS, World Vision and Grameen Foundation. The initiative is designed to provide community health workers (CHWs) and other frontline health care delivery staff with remote training on the COVID-19 pandemic through the mobile training services (MOTS) platform. The MOTS platform was successfully used in the battle against Ebola throughout 2015 and 2016. It is now planned to use this platform to train CHWs and other frontline staff about COVID-19 and safe practices around the virus. One important objective is to use the MOTS platform to reach CHWs as physical face-to-face engagement creates serious risks under the current circumstances. The digital platform will ensure that CHWs and frontline workers are not physically mobilized and assembled together for training and hence the chances of contracting and transmitting the coronavirus are reduced. A further objective is to provide training to CHWs based in remote parts of the country that may be particularly vulnerable to COVID-19 as a result of limited access to information about the virus and associated safe practices such as hand washing and social distancing. This approach also reduces the cost of training since CHWs do not have to converge in a central location.
The deployment of COVID-19 and non-COVID-19 training and education on the MOTS system will be guided by the MoHS and managed overall by World Vision. The processes and content will be informed by 3 key technical working groups within the MoHS – the CHW hub, the health education hub, and the eHealth coordination hub – with all content being reviewed and approved by both the MoHS and World Vision before airing to the CHWs. The training will then be facilitated through modules using interactive voice responses (IVRs). The rationale of facilitating training via IVR is to enhance conceptualization and interpretation of the module content. To achieve this, IVR content developed will be translated and recorded into the local languages used by the CHWs. This approach is to combat issues around literacy as the majority of CHWs cannot read or write.
CHWs training on the MOTS platform
The COVID-19 MOTS initiative includes online monitoring of CHWs to ensure they complete the training modules, with the CHWs being monitored and supervised by their respective in-charges during training to ensure completion of the training and to enhance ownership of the process. Households engaged in training can also be monitored online in an attempt to improve on the mother and child health indicators which could be adversely affected by the outbreak. Inclusion of CHWs into the MOTS deployment is voluntarily and each CHW will need to have access to a functional mobile phone. CHWs who participate in the programme will not receive any additional financial reward but will be provided with non-financial incentives such as infection prevention and control materials as motivation to participate in the programme. The COVID-19 MOTS initiative will run between June and November 2020, with training already provided to 1150 CHWs in the Bo and Kambia districts via their mobile phones. The rationale is to make implementation of MOTS sustainable and cost effective with the overall plan being to scale this initiative to all World Vision area development programmes in Sierra Leone over the Summer of 2020. Discussions are also ongoing to deploy MOTS directly onto individuals phones at community and household level in addition to using CHWs to pass information to the community. The belief is that this programme will facilitate CHWs to feel more empowered to engage positively and knowledgably with their communities to provide life saving information and education about COVID-19 confidently, correctly and in a timely manner. If they can do this the current low death rates from COVID-19 in Africa and Sierra Leone will have a far better chance of being maintained into the future.