Creator: Shola Dele-Olowu, Deputy Director, Vaccines Program; Queensly Austin, Affiliate, Vaccines Program, & Akachi Mbogu, Supervisor Space Proprietor, Immunization Administration Methods and Capability
Introducing an e-learning platform for well being employees: The Immunization Academy in Nigeria
After an immunization session, Musa*, a well being employee in Kano State, Nigeria, usually emptied contents of his transportable vaccine provider into the photo voltaic direct-drive (SDD) freezer in his clinic with out a lot thought of sensitivities of the vaccines. In some instances, he saved diluents exterior the freezer. Unknown to Musa, this motion could cause vaccines to lose efficiency, probably rendering them ineffective. Though Musa has beforehand acquired in-person trainings on immunization, they weren’t focused to his particular talent gaps on vaccine administration. To worsen issues, refresher trainings happen sometimes, with both cumbersome or typically unavailable reference supplies.
A well being employee utilizing the photo voltaic direct-drive for vaccine storage
One yr after Musa was launched to the Immunization Academy (IA)—a CHAI-supported e-learning platform that makes use of a mix of demonstrational movies and skills-based on-line assessments to show and reinforce important immunization abilities—his information on vaccine storage and dealing with has improved; he’s now capable of differentiate between warmth and freeze delicate vaccines, together with the association of the vaccines and diluents within the photo voltaic direct-drive. Adebisi*, Musa’s supervisor, additionally discovered learn how to successfully conduct supportive supervision visits together with planning, on-the-job mentoring to well being employees, and successfully figuring out and bridging talent gaps.
Many well being employees and managers like Musa and Adebisi face limitations in successfully managing the day-to-day duties of the immunization program and thus, want a system for steady studying and efficiency enchancment.
Well being employees in Nigeria utilizing the Immunization Academy app
Introduction of IA in Nigeria
During the last decade, efforts by the Nationwide Major Healthcare Growth Company (NPHCDA) and its companions to strengthen well being employee capability have yielded outcomes. Between 2016 and 2018, well being employees had been evaluated throughout 4 immunization talent areas: vaccine dealing with, vaccine administration, communication and advocacy, and information administration. The outcomes discovered a mean enchancment of 21 and 12 share factors in Kano and Lagos states respectively.[1]
Regardless of these enhancements, abilities and information gaps persist throughout the nation, usually resulting from excessive prices related to standard in-person trainings, which are sometimes prolonged, didactic, and disruptive to main healthcare (PHC) companies. The COVID-19 pandemic additional highlighted the necessity for another strategy to well being employee coaching.
Responding to noticed challenges, CHAI started a partnership with the IA group in 2020 to allow steady enchancment of immunization information and abilities for managers and well being employees in Nigeria via e-learning and evaluation instruments. Over an 18-month interval, a collection of engagements and actions had been carried out by CHAI to help the profitable rollout of the IA e-learning suite in Nigeria.
Evaluating the effectiveness of e-learning
CHAI and the IA carried out a baseline evaluation[2] of the effectiveness of e-learning. A complete of 180 well being services had been chosen for the evaluation throughout 24 native authorities companies (LGAs) in Kano and Lagos states. The states had been chosen based mostly on their excessive inhabitants and variety reflective of many states within the nation. The evaluation concerned commentary of well being employee efficiency[3] throughout all chosen services; 537 structured interviews with well being employees and 24 focus group discussions had been carried out.
The well being employee efficiency observations confirmed vital enchancment from 2018[4] in abilities throughout all 4 domains, particularly vaccine dealing with and administration. Nonetheless, a deep dive revealed persistent capability gaps in crucial areas equivalent to temperature monitoring and vaccine administration, remembering the six key messages[5], in addition to efficient information use.
Fig 1: Measurement of well being employee observe throughout key immunization talent areas
The outcomes additionally revealed that just about 40 p.c of well being employees had taken an internet course, 99 p.c had been prepared to make use of e-learning for trainings, 94 p.c had smartphones, and 46 p.c consumed 1GB – 5GB of knowledge month-to-month. The main focus group discussions highlighted key motivators (authorities endorsed certificates, recognitions, and promotions at work), and limitations (information prices, community points, electrical energy, and workload) to the adoption of e-learning by well being employees.
Fig 2: Well being employee accessibility and expertise with eLearning
Fig 3: Challenges with accessing eLearning platform
Contextualization of the IA suite for Nigeria
CHAI labored with the federal government and Expanded Program on Immunization (EPI) companions on the state and nationwide ranges to co-design and information the rollout of the platform to over 2,200 well being employees and managers based mostly on findings from the wants evaluation. These inputs had been additionally utilized by IA to create a customized interactive device for Nigeria, known as IA Rating Nigeria (extra particulars in regards to the platform right here), which supplied a personalised coaching strategy to focus on and remediate particular person studying gaps.
This system additionally provided certification endorsed by NPHCDA upon attaining a passing rating of 70 p.c to inspire healthcare professionals to take part and full this system. Moreover, a dynamic dashboard was created to permit managers to assessment state, LGA, and particular person learner information. With this sensible dashboard, managers might simply see the place talent and information strengths and gaps existed. A leaderboard was additionally created to focus on immunization professionals in every LGA who had excessive scores and those that confirmed nice enchancment of their post-test scores.
Fig 4: Course of Circulation for using the IA Rating Nigeria[6]
Outcomes and influence
Following 15 months of growth and use of the IA platform by totally different well being employees, there was a 230 p.c enhance in enrolled customers from almost 10,000 earlier than implementation to over 37,000 after throughout the nation. Between November 2020 and July 2021, IA movies had been considered roughly20,000 occasions in Nigeria; and over 550 NPHCDA-endorsed certificates have been awarded to well being employees and managers via the IA rating platform with common rating enhancements of 13 p.c.
Using the platform additionally confirmed tangible enhancements in immunization practices amongst well being employees.
To evaluate the influence of IA on immunization service supply, CHAI labored with the states of Kano and Lagos to conduct an end-line evaluation.[7] In each states, well being employees in services with excessive uptake[8] of the IA platform had twice the development in immunization practices in comparison with these in low uptake services.[9] Well being employees in excessive uptake services had a 27 p.c enchancment in well being employee efficiency throughout 4 immunization areas in comparison with the baseline and people in low uptake services, who had a 13 p.c enchancment.
Fig 5: Excessive Uptake Services’ Baseline vs Endline Immunization Service Supply Efficiency[10]
Fig 6: Low Uptake Services’ Baseline vs Endline Immunization Service Supply Efficiency [11]
A constructive relationship (measured utilizing R2) [12] was additionally noticed between well being employees’ use of IA and enchancment of their general immunization practices. The very best general scores had been noticed amongst well being employees utilizing IA assets every day.
Fig 7: Comparability between the frequency of using IA reported by interviewees versus their general RI observe efficiency when graded utilizing the OSCE Software
Institutionalization and scale-up
Some key success elements for the introduction, institutionalization, and eventual scale-up of IA in Nigeria was its integration into present capability constructing processes of the federal government together with:
- Appointment of presidency focal individuals to drive uptake amongst well being employees.
- Deliberate well being employee trainings equivalent to new vaccines’ introduction.
- Peer-led studying.[13]
- Assessment conferences and supportive supervision utilizing outcomes from the efficiency dashboard.
- Coaching curriculum of the Group Well being Practitioners’ Registration Board (for pre-service establishments).
Conclusion
Revolutionary low-cost e-learning approaches are crucial for steady enchancment in well being employee observe. The profitable rollout of IA in Nigeria highlights alternatives to increase the scope of digital studying to incorporate the complete suite of main healthcare (PHC) companies to enhance well being system efficiency and in the end save thousands and thousands of lives.
This work was supported by funding from the Invoice & Melinda Gates Basis. We additionally acknowledge the profitable partnership with Immunization academy, which owns the e-learning instruments, and the Nationwide and State companies with out whom, we’d not have achieved the recorded outcomes.
Contributing authors:
Muhammad Sheriff, Assistant Program Officer, Vaccines Program; Isa Adamu, Senior Analyst, Vaccines Program; Dr. Owens Wiwa, EVP International Assets for Well being, West and Central Africa and Nation Director Nigeria
