Learning and Action Network: Workforce Development and Remote Training during the COVID-19 Pandemic

The panel was moderated by Judd Staples. Speakers included: 

• Dr. Magaly Blas, Mamas del Rio
• Abhinav Girdhar, Bodhi Health Education
• David Scheiman, LifeNet International
• Cynthia Mckinney Drayton, Project Echo

Curated Evidence Database (3:01) 

• On July 13, IiH will release a curated evidence database to provide the innovator network with curated, valuable, and up-to-date evidence around COVID-19 in the hopes of synthesizing the breadth of available resources into a few manageable pages. The database, in the form of an Excel sheet, will be made available through Groups.io and the LAN newsletter and updated monthly. 
• Currently available information includes: severity and risk factors, transmission modalities and risk, transmission prevention, and risk communication. Upcoming information will include: prevention policies, diagnostics, treatment, collateral consequences on societies, and health systems. 
• The team welcomes suggestions of new topics and feedback, which can be given by emailing Katherine at katherine.flowers@duke.edu. 

Panel: Workforce Development and Remote Training during the COVID-19 Pandemic (15:15) 

• Dr. Magaly Blas is the Director and Founder of Mamas del Rio, which aims to improve maternal and child health in rural Peruvian Amazon communities through empowering healthcare workers. 
• Abhinav Girdhar is the Co-founder of Bodhi Health Education, which is a digital training and solutions platform currently serving healthcare providers and nursing institutions.  
• David Scheiman is the Vice President of LifeNet International, which works on workforce and financial management capacity building in Sub-Saharan African clinics. 
• Cynthia McKinney leads the Corporate and Foundations Relations of Project Echo, which leverages simple healthcare technology to train healthcare providers around the world.

• In the primary care delivery setting, how has workforce composition changed throughout COVID-19? Have you needed to extend or scale back in some areas? (21:12) 

o   Blas emphasized the critical role of community healthcare workers (CHWs) in her scope of work. Even before the pandemic, there was a severe inequity in the number of healthcare providers between Lima and the rest of the country. With the pandemic, many of these communities have been closed off and the MOH focuses on more crowded areas--so CHWs become the only point of contact for women. In this respect, CHWs are the direct link between the communities and the MOH. They report how the communities are dealing with the pandemic, whilst sharing prevention messaging and correcting misconceptions within the communities. 

o   For Scheiman, the most critical message was to protect existing workers. At LifeNet, they immediately purchased and disseminated PPE and employed emergency training. They then cross-trained staff to utilize each individual as flexibly as possible, triaging the tasks that were the most important. 

o   Similarly, McKinney stated that broadening the skillsets of providers through task-shifting is vital during this time, so that they may treat more patients than their previously specified specialty. She also noted that treatment must be done through an understanding of its complexity, being mindful of the different ways to treat someone depending upon the setting as well as the constantly changing information surrounding COVID-19. 

o   At Bodhi Health Education, Girdhar noted that a trend he saw was more healthcare providers going through their regular trainings to create backup as many providers shifted towards treating COVID-19 patients--but left behind a gap in available care for regular health services. 

• Can you speak about where to source and how to produce quality content for CHWs? How do you address potential technological difficulties? (33:05) 

o   Gridhar admitted that creating content during this time is extremely difficult, however, he spoke to the array of open sourced content from other organizations as well as the CDC and WHO that have made a strong effort to disseminate information. Furthermore, taking existing platforms on mobile applications enables Bodhi Health Education to make this information available in low bandwidth areas. 

o   Project ECHO partners with many of these content providers (WHO, AFRO WHO, CDC, etc) and has provided Zoom licensing for all of its partners, which has resulted in calls with nearly 9,000 participants all engaging in valuable trainings. The organization also generates case-based learning content themselves on a global resource library, so that healthcare providers can address particularly complex situations that arise from COVID-19. 

o   At LifeNet’s clinics that face low connectivity access, the organization uses mobile platforms based on regular phones (not smart phones), such as a platform bot on Whatsapp that pushes out various messages, diagnoses, and symptoms reports to CHWs. They also moved to Moodle, a teaching platform, to provide content on infectious disease. In some areas, downloading issues are solved by having drivers deliver flash drives with the content on it to the community. 

o   The low resource settings Mamas del Rio works in do not have cell phones, but their CHWs use tablets to receive and offer information. Unfortunately, little content is offered in Spanish, and most CHWs only have a primary level education. To address this, they have created engaging videos delivered on flash drives in addition to phone and radio communications to disseminate information. 

• What best practices have you found to be the most effective, and what other advice do you have for other innovators? (40:54) 

o   McKinney re-emphasized the importance of understanding local contexts at Project ECHO. They see their work as a community of practice, what they call ‘all teach all learn,’ to illustrate how technical experts learn from local experts. 

o   To Scheiman, the pandemic has been all about preparedness and collaboration. Organizations must be prepared before an emergency hits--for example, ready with a months-long supply of necessities as well as digital learning capacity. While the pandemic has caused great devastation, he believes there is also great opportunity to push necessary changes, and is excited by the amount of current collaboration between other NGOs and MOHs he is seeing. 

o   Similarly, Girdhar stated that actors must deeply understand the on-site issues as participants engage with their platform, as there are a plethora of issues that may arise beyond the software itself. He listed user behavior, bandwidth, and device issues as just a few. To address this, looking to local partners and resources are critical. 

o   Blas credits much of Mamas del Rio’s success to its early engagement with technology. It enabled them to communicate with CHWs, and for CHWs to continue providing services. She adds that the pandemic has led them to discover other, creative ways to provide support, such as through local radio programming. 

• How have you been able to keep your feedback channels open, and how do you encourage the two-way learning stream? (47:45) 

o   At Project ECHO, Zoom calls are often supplemented with a WhatsApp group so that CHWs can further engage with material and provide feedback. Furthermore, they view their material as telementoring, dynamic rather than stagnant training, to constantly adjust to the needs of CHWs specific to their settings and responsibilities. 

o   To Scheiman, recognizing those closest to the situation understand it most and come up with the best solutions. From this understanding, LifeNet has listened and supported various innovations from individuals in the field that have proven critical and effective.  

o   Bodhi Health Education also uses WhatsApp groups, which enables them to interact with users on a real time basis and therefore have a stronger connection with those developing the technology. In doing so, Bodhi has been able to adjust effectively and efficiently to meet communities’ needs. 

o   Blas reiterated how the communities she works with do not have access to mobile phones, and therefore rely on CHWs, radio, USBs, and even paper to disseminate information to community members. 

• At 56:25, Scheiman noted that organizations must also prepare for difficult financial issues, as many donors and governments pull out of their commitments or do not have the capacity to work as they once previously did. To adjust, LifeNet cut every budget with partners 10%, whilst eliminating or deferring services that were deemed non-essential. 

o   McKinney illustrated this point, as Project ECHO pivoted drastically to cover COVID-related issues but must now transition into covering both COVID in addition to its regular programming.