Uganda | TechChange | The Institute for Technology and Social Change

It’s not every day that you get up from your desk, walk out of your office, and travel 8,353 miles to check in on a project. But in October that’s exactly what Delanie, Emily, and I did when we went to visit Malaria Consortium in Uganda.

As we walked out the office in Washington D.C., I started a timer on my phone to see what the door-to-door travel time would be. 26 hours later we were in the back of a hired car, dodging the mini-buses that barrel down the road between Entebbe and Kampala.

Why we returned to Kampala
We were in Uganda to check in on one of TechChange’s biggest projects: the “Diagnose and Treat Febrile Illnesses” eLearning course. Last year, we built a course for Malaria Consortium, one of the world’s leading non-profit organizations specializing in the prevention, control, and treatment of malaria. The course was meant to train private sector health workers and Rapid Diagnostic Testing sales representatives in Uganda and Nigeria.

In many malaria-endemic countries like Uganda and Nigeria, the disease has been prevalent for so long that pharmacists and doctors would give malaria treatment to any patient presenting symptoms of fever. Not only is this false diagnosis harmful for the patient, it also leads to the waste of costly treatments that don’t help the patient get better – in fact, their condition could become even more serious. Incorrect diagnoses can even be fatal: pneumonia is the leading cause of death for children under 5 in Sub-Saharan Africa, but it is often misdiagnosed as malaria.

An e-learning solution to train health workers
The goal of the elearning training is to reach roughly 5000 health professionals in both Uganda and Nigeria and provide in-depth training on how to diagnose diseases that can present fever-like symptoms, like malaria, pneumonia, typhoid, and others. The two-day training provides a hybrid learning experience with off-line elearning modules and in-person trainings, created with local content to make the training as culturally-relevant as possible.

The training teaches healthcare workers the basics of how the malaria parasite works, how to conduct a malaria Rapid Diagnostic Test (RDT), how to diagnose patients for other illnesses, and how to provide treatment depending on the results they find.

It’s been a year since the training was implemented, so we were curious to see how the training fared. Was a computer-based training actually useful to trainers? Did students enjoy the training? Were there better learning outcomes?

So, how is the training going so far?
We found that even with minor technical considerations, the training was a stunning success! Yes, there were certain drawbacks to having a computer-based training compared to a traditional lecture format. Among the biggest disadvantages were the possibility of power-outages, finding computers with adequate RAM and processing power to play the training, and also updating Adobe Flash (one of the requirements to run the training). However, with the help of an in-country technical setup team, these issues were controllable.

What do the trainers think?
Most importantly, trainers told us that the benefits of the blended learning style far outweighed any drawbacks caused by being dependent on computers. Students and trainers alike told us that the format allowed students to learn the content at their own pace, compared to a lecture where the instructor may move too quickly or slowly through content.

What do the students think?
Students also told us that the interactive format made the learning experience much better than a lecture accompanied by slides. The visual nature of the training came up again and again as an aspect of the training that helped students learn.

Students who had completed the pilot program took the training to heart. One pharmacist referred to the training as she told us about about her neighbor, who had recently come into her shop asking for antimalarials to treat his fever – but, his test result was negative, so she advised him to seek treatment at a health facility. After visiting the clinic, he stopped by the pharmacy to let her know that he had been diagnosed with Typhoid fever; if the pharmacist had misdiagnosed the fever and provided treatment for malaria, it would only have allowed his case of Typhoid to get worse.

This is just one anecdote of many. While concerns about electricity and infrastructure remain very real, it is exciting to see the training accomplishing it’s goals. We are excited to continue supporting and improving the delivery of this training with Malaria Consortium!

Is your organization looking to train your teams online? Besides online facilitated courses, we also also create custom offline computer trainings that can be used in settings where internet connectivity is a non-starter. See our different projects on our Enterprise page and feel free to reach out to us enterprise@techchange.org.

Filming of Malaria Consortium staff doctor counselling a client on proper treatment of malaria. Uganda. (Photo credit: Maddy Marasciulo-Rice, Malaria Consortium)

Malaria in Context

There is an undeniable malaria problem in the world today. According to the World Health Organization (WHO) in March 2014, half of the world’s population is at-risk, hundreds of millions of cases are reported each year, and hundreds of thousands die annually of this disease. Around 90% of these cases occur in Africa, with children under 5 years old making up the largest demographic affected.

The burden of this disease on the health care systems of developing countries is immense: Uganda has the highest malaria incidence rate in the world with 478 cases per 1,000 population per year. Fully half of inpatient pediatric deaths in Uganda are caused by this disease and in Nigeria, the most populous African country, 97% of the population is at risk.

(Source: WHO 2013 Global Malaria Report)

How are the countries of Uganda and Nigeria addressing malaria?

While both Uganda and Nigeria have national malaria control and elimination programs, due to long waiting periods and frequent stock outs of the appropriate medications at local health facilities, individuals prefer to go to private clinics, pharmacies and local drug shops to solve their health needs. When these pharmacists―often untrained in accurately diagnosing febrile illnesses―see a client complaining of fever, they often presumptively prescribe antimalarial medicines. The reverse scenario is also a common problem: pharmacists do not always give out artemisinin-based combination therapy (ACTs) when it is actually needed.

Pharmacists in Uganda assist customers with recommending antimalarial medications (Photo credit: Maddy Marasciulo-Rice, Malaria Consortium)

Presumptive treatment ― the overuse of antimalarials greatly increases the chances that malaria parasite resistance will develop and spread. In the future we might have one less weapon in our arsenal against these parasites. This overuse also means that the medicine is put over

How can rapid diagnostic tests (RDTs) help treat malaria?

Fortunately, rapid diagnostic tests, or RDTs, allow malaria to be diagnosed quickly, accurately, and cheaply, using only a drop of blood and a few drops of a solution. The problem is―there is no official quality control within the private healthcare sector―the pharmacists who provide the RDT to the patient have no way to choose a good RDT from the many options on the market and the wrong choice could lead to inaccurate diagnosis. Furthermore, many of the RDT sales representatives haven’t been trained to properly explain their product to their clients.

Challenges of RDT Training for Malaria in Uganda and Nigeria

RDTs to test for malaria and drugs to treat the disease are currently available in the private healthcare sector. However, there are several challenges to scaling up RDTs in this sector in Uganda and Nigeria.

1. Lack of training with Rapid Diagnostic Testing Materials

The primary barrier to appropriate care is the lack of training among pharmacists and RDT sales providers about how to use the test and interpret the results correctly to effectively diagnose and treat a range of febrile illnesses.

Malaria Consortium, based in the UK, is one of the world’s leading non-profit organizations specializing in the prevention, control, and treatment of malaria and other tropical diseases. Their projects can be found across twelve countries in Africa and Southeast Asia. The organization strives to find effective and sustainable ways to control and manage malaria through research, implementation, and policy development. They came up with the design for a plan that could greatly help manage the disease in both Nigeria and Uganda:

If the RDT sales representatives and RDT providers can be trained to correctly use the RDTs and recognize the symptoms associated not only with malaria but with other common illnesses, then the burden of misdiagnosis and mistreatment can be greatly reduced. Furthermore, as the sales representatives travel and frequently interact with providers, they can act as trainers and further disseminate the knowledge and skills necessary to accurately diagnose and treat these diseases.

2. Prohibitively high costs

The costs associated with arranging such a training are enormous―between transporting the students and teachers to a centralized location, renting a venue, arranging lodging, and coordinating a schedule, the budget for a large-scale training would quickly be out of control. Additionally, pharmacy owners and other stakeholders working in the private sector would most likely have to assume a loss of revenue during their time away from their business while at a training.

3. Technical limitations

An eLearning platform is much more ideal for these circumstances―it’s flexible, participants don’t need to travel far, you need fewer instructors, and the information can be processed at the student’s pace and repeated when necessary. The information is also standardized and consistent, which means that a large number of people can benefit from a high quality training experience.

But how do you deliver an eLearning course when your audience has intermittent power and whose computers are not only often out-of-date, but lack the RAM, bandwidth, and software standards that such hi-tech learning platforms have come to expect?

eLearning Solutions for Reaching 3000+ Healthcare Providers for Malaria

Malaria Consortium partnered with TechChange to build a comprehensive digital course to train private sector health workers and RDT sales representatives in this context. This 11 module course includes around 400 slides for 6 hours of content takes participants through the biology behind the malaria parasite, discusses the medical philosophy behind diagnostic practices, and walks users through interactive scenarios for patients presenting a range of symptoms.

Sales representatives and drug store owners in Uganda testing eLearning modules designed by TechChange and Malaria Consortium on rapid diagnostic testing for malaria. (Photo credit: Catherine Shen, TechChange)

1. Offline access and Ease of Use

Despite significant benefits such as flexibility and scalability, e-learning courses also face challenges in the developing world. Lack of sufficient internet bandwidth, reliable computers, and computer skills can pose major barriers to a training’s effectiveness.

To troubleshoot the technical issues, this course is designed to require nothing more than a computer and headphones – it comes preloaded onto USB drives so not even an Internet connection is necessary, allowing health workers in even the most rural areas to access this training. A computer tutorial is also included for health workers with little to no prior experience with computers. Our tech team is also devoted to helping solve any other technical issues that arise due to out-of-date software and hardware malfunctions, working as a remote IT team as Malaria Consortium rolls out the project.

2. Localized content

In addition to including the relevant national laws, case studies, and local examples, the narration features Nigerian and Ugandan voice actors, art, and scenarios to make the training as culturally-relevant as possible.

3. Hybrid learning

Only one part of the training won’t be computer-based; participants will still practice actually conducting the RDT tests in a face-to-face session before they begin pricking patient’s fingers for diagnosis.

The course is designed to reach upwards of 3,000 healthcare providers in the two countries and build their capacity to effectively serve their community’s needs. We look forward to seeing the impact of this training in improving quality of care in Uganda and Nigeria hopefully in the near future.

To learn more about TechChange’s custom training solutions, please contact us at info@techchange.org.

Emily Fruchterman, Catherine Shen, & Charlie Weems contributed to this post.

By Nicole Emmett, graduate student, George Washington University

Imagine you’re a citizen in a country where over half of the population is under the age of 18 and few are over the age of 55. You enter the job market along with 400,000 other qualified youths, only to learn that you’re all competing for a meager 9,000 jobs. The prospects don’t look good. You’re frustrated. There are so many other problems your family and community are facing. A job and an income would help tremendously. You just want to be heard but you can’t find a voice. If only there was a way to be a part of the conversation with your local community, its leaders, and perhaps even Members of Parliament…

The country you were just imagining is real. Uganda has the world’s youngest population with the highest rate of youth unemployment at 62% in 2012. And that’s not the only problem the country is facing. Ugandans also worry about disease, adequate food supply, clean drinking water, health, and education among many, many other issues. But how can aid agencies or the government determine which of these many issues are important to the people they serve? Are the issues determined by demographics such as location, age, or gender? That’s where uReport comes in.

uReport is an SMS-based system that allows Ugandans (specifically youth) to speak out about what’s happening in their community. By texting the word JOIN to 8500 and providing additional information such as home district, age, and gender, any Ugandan can become a uReporter! UNICEF Uganda created the platform using the free, open-sourced software RapidSMS which allows the aid agency to quickly and easily push out information and polling questions to uReporters via SMS.

In the first year, 89,000 Ugandans became uReporters. Today there are more than 200,000! uReporters receive weekly SMS messages with information on topics such as female genital mutilation, disease awareness, safe water, early marriage, education, and health. In return, uReporters respond to survey questions with a simple yes or no, and have the option to provide more details via text. uReporters provide invaluable information to UNICEF, who then can share the information with other aid agencies and the Ugandan government, improving service delivery across the country.

UNICEF and other agencies have also begun to use uReport as an extension of their monitoring and evaluation system. uReport is a simple, inexpensive, and effective way to get real-time feedback on projects in the field and to ensure that aid programs are being targeted correctly. And because users provide demographic information at the time of registration, UNICEF can dissect the data and decide where to concentrate their resources and programs. This is so important at a time where every aid agency is working with limited resources and must get the most bang for their buck.

uReport has proven so successful in its first two years that even the Ugandan Parliament has joined in! Oleru Hude Abason, a Member of Parliament from the Yumbe district, was one of the first MPs to join uReport as a way to keep in touch with her constituents needs. Parliament has even created their own version of uReport – U Speak – to conduct constituent outreach. While it may have not been the original intent of the application, uReporters are now able to interact with government officials and hold them accountable like never before.

The success of uReport has been astounding. It’s innovation for information, improved service delivery, and real-time policy creation and has the potential to do so much more. It is Uganda’s next killer app!