Empowering Nurses And Midwives through Information Technology (ENAMIT)
- ENAMIT (Empowering Nurses and Midwives through Information Technology) was designed in consultation with experts from WHO, RAFT and the Direction National de la Santé in Mali.
- A training program was developed introducing new technology such as e-learning to enable community health workers to perform first-line diagnostics and treatment in remote areas.
ENAMIT is an initiative by ADA aimed at Empowering Nurses and Midwives through Information Technology to improve global health by closing the knowledge-to-practice gap of rural community healthcare workers in developing nations. Pilot implementations of ENAMIT are currently being planned in Zambia, Sierra Leone, Mali and Equatorial Guinea.
The mission of ENAMIT is to maximize the potential empowerment that a health worker can achieve through the use of effective education and appropriate tools and ICT solutions to facilitate the health worker role.
Expected outcomes of the ENAMIT initiative include:
- Rural community workers will be able to overcome barriers to responding to emergencies and making referrals, thus improving health outcomes.
- Community health workers will have concise and well-structured learning briefs available in their own languages and accessible through different media.
- Fewer communication barriers between rural community health workers and their immediate supervisors.
- Supervisory and consulting skills of both supervisors and field practitioners will improve.
- Ongoing communication will reduce the isolation of rural community health workers.
ENAMIT aims to achieve long-term impacts covering improved knowledge, skills, empowerment of nurses and midwives; retention of empowered nurses and midwives in rural areas; and better health for women and children.
This project seeks to achieve these outcomes through empowering and connecting rural community health workers in Zambia, Sierra Leone, Mali, and Equatorial Guinea to each other and to their supervisors through an internet-based knowledge portal, linked to mobile information technology. This network will contribute to the formation of a life-long learning environment for community health workers through formal and informal learning strategies.
SPECIFIC GOALS AND OBJECTIVES OF THE ENAMIT INITIATIVE
I. To provide up-to-date, evidence-based information on priority reproductive health issues and essential surgical skills to health personnel that in turn improves the knowledge, training, skills and competencies of rural community health workers and their supervisors, which is reinforced through learning networks with links to knowledge portals and the use of mobile information technology.
ENAMIT will build the capacity of supervisors to use the internet and participate in virtual communities of practice designed to improve their skills and facilitate knowledge-sharing. A continuing education program will be designed and developed in collaboration with a local college or university in each location. This program will enhance the knowledge and skills of the supervisors to act as mentors and trainers for the community health workers they support. The supervisors will be part of a peer-to-peer network themselves and will mentor rural health workers.
Both supervisors and community health workers will be able to communicate with each other and their peers via cell phone, text messages and e-mail via their phones. Each group of supervisors and community health workers will have an electronic community of practice that will enable and support telephone communication, text responses and knowledge-sharing. These communities of practice will be designed to address the barriers affecting service delivery and help deal with health issues affecting providers and their clients in rural areas. Each supervisor will develop a knowledge enhancement program for each community health worker and hold regular weekly telephone discussions and send regular messages and e-mails with additional technical information targeted to their needs.
Mobile information technology will be adapted to provide health workers with access to a database that contains "frequently asked questions and answers" in crucial areas of health (maternal health, pregnancy, labor, delivery, postpartum, neonatal and early childhood health, adolescent sexual and reproductive health, and family planning). If an answer can't be found, then a text message can be sent to peers and/or supervisor requesting this information. Mobile information technology will store and transmit data such as performance reports, weekly statistics, community health maps, requests for supplies, logistics information and statistical reports.
The rural health workers and mentors will also have access to a Knowledge Center, an electronic communication tool designed to function in technically challenged countries to link with a virtual community of practice of experienced rural health workers and supervisors responsible for supporting community health workers. The community of practice will enable members to communicate regularly with each other and experts to discuss challenges and support the sharing and exchange of experience and information. Each supervisor will access this community of practice to receive regular technical updates and will be able to participate in e-based learning opportunities on technical issues, education and management. This will result in a network of experienced rural health workers, supervisors and content experts being established. The technology components will support this social structure and enable continuing formal and informal education to provide on-going educational opportunities to improve managerial and technical knowledge, supervisory skills, motivation and the quality of supervision and mentorship.
II. To improve the quality of maternal and neonatal health, adolescent sexual and reproductive health and family planning services in remote rural communities as well as essential surgical care.
Community health workers will have acquired skills that allow them to perform critical life saving procedures. They will be empowered with abilities that allow them to respond correctly against the frontline through the usage of mobile telephony access to a mentoring helpline for assistance in assessing situations, speeding up referrals to hospitals and clinics, and coordinating transportation for critically ill patients.
ENAMIT delivers a package of already existing and already tested impact-rich solutions by combining essential components into one solution. The components of ENAMIT include:
- RAFT alongside the pedagogy on Emergency Obstetric Neonatal Care (EMONC)
- Emergency and Essential Surgical Care (EESC)
- SEAL surgical skills training tools
- Knowledge Centers
- This package will be reinforced through a mentoring system facilitated by mobile phones.
These components are detailed further in the sections below. The package of solutions will be coordinated and put into effect by ADA.
COMPONENTS OF ENAMIT
The five main elements of the ENAMIT solution are detailed below.
One of the main components of the ENAMIT program is the RAFT network, which is already proven successful. RAFT is an initiative from the Geneva Hospital that offers knowledge sharing for nurses and midwives, amongst others, via information and communication technology. RAFT enables the web-casting of interactive courses to health workers in remote areas. These sessions put the emphasis on knowledge sharing across health care professionals, usually in the form of presentations and dialogs between experts in different countries. The courses are also available for offline viewing anytime and through CD formats, according to the needs of the local contexts. The Department of Reproductive Health and Research (RHR) in WHO initiated its collaboration with RAFT in French in June 2006. RAFT in English started in October 2008 and RAFT in Arabic in 2009. The launch of RAFT in Spanish took place in 2011.
The range of topics in French include: maternal and newborn health; family planning; sexually transmitted infections; abortion; adolescents; gender; research; midwifery as a human resource; and many others.
2. SEAL AB SURGICAL SKILLS TRAINING PRODUCTS
In resource-scarce countries surgery courses are often provided with homemade training devices, frequently offering poor and uneven quality. In close cooperation with leading surgeons and clinical skills training centers, SEAL AB develops and produces clinical and surgical skills training models and equipment. These are valuable educational tools, which when combined with the education by RAFT, can help the health workers to master basic but critical life-saving surgical procedures. SEAL AB’s products are now increasingly being utilized both in resource-poor countries and in more affluent settings such as a large number of major hospitals in Sweden and Finland.
The tools produced by SEAL AB are simple to use and appropriately designed for use among both undergraduate medical students and other staff under training to become surgically competent mid-level providers of life-saving skills in countries where there are few faculty-trained physicians. The products are ideally suitable for improving the skills and capacities of rural health workers. SEAL AB also offers training materials specifically for midwives and obstetricians. Test surgery simulation materials produced by SEAL AB in the midwifery program are tailored for use among midwifery students, midwives and other staff under training to become surgically competent. Midwives who are appropriately trained are more likely to provide a consistent, high standard of perineal repair.
3. Emergency and Essential Surgical Care (EESC) Program
The EESC program, developed by the World Health Organization (WHO), focuses on ensuring efficacy, safety and equity in the provision of clinical procedures in surgery, anesthesia, obstetrics and orthopedics, particularly at rural hospitals, district hospitals, primary health care facilities, and health centers level. It was established to improve collaboration among organizations and institutions involved in reducing death and disability from road traffic accidents, burns, falls, pregnancy related complications, domestic violence, disasters and other emergency surgical conditions. 10-20% of deaths of young adults in developing countries are directly attributable to inadequate surgical knowledge therefore simple surgery skills make a difference.
The EESC also provides guidance on WHO recommendations for minimum standards on emergency and essential surgical care in surgery, trauma, obstetrics and anesthesia at first-referral level health care facilities.
4. Knowledge Centers for Better Health Care (WHO, GHWA)
The Global Health Workforce Alliance (GHWA) and the WHO have joined efforts to create Knowledge Centers, which act as a gateway for health professionals and community health workers and others to access health information, and health education material that aims to enhance the effectiveness of healthcare delivery to the public. The Knowledge Centers provide online and offline health information, and serve as a platform for delivering practical guides, interactive discussions, and training resources to help improve healthcare delivery at the district/community level.
Knowledge Centers will serve to bring new and innovative technologies to bear on addressing health issues of importance to health professionals and encourage the use of technology to help governments and individuals in scaling up knowledge and skills quickly and effectively. In this regard Knowledge Centers, in combination with the other components mentioned here, will support developing countries in transforming healthcare knowledge into practice. This will be provided to the proximities of rural health workers in order for them to have easy access.
5. Mentoring System to Support Health Workers
In addition to all the above mentioned components in this holistic solution, a mobile-based mentoring system will be implemented using mobile phones and applications to unite and support the rural health workers. Outstanding health workers will be offered the opportunity to act as “mentors” to other rural health workers. His/her role will be to assist and communicate with the other health workers, thereby enabling a system of quality control and a higher level of empowerment for the health workers. The mentors themselves will be offered a special compensation, in order to ensure reliability and dedication. Therefore, through the mentoring system the reach and the quality of treatment will be dramatically improved and retention of the health workers should be maximized.
- ADA: providing management, funding, identification of collaborators, coordination, evaluation, and dissemination
- Geneva University - RAFT: delivering courses through webcasting, on-line courses, and CDs in English, French, and eventually in Spanish; provide set of mentoring materials on mobile phones (http://raft.hcuge.ch)
- SEAL AB Ltd: Provision of the learning Simulation Materials (www.seal.se)
- WHO-AFRO: identifying the participating countries, schools, individuals, and developing curricula
- WHO-RHR: developing the curricula, identifying speakers, delivering course, and evaluation (http://www.who.int/reproductive-health/)
- WHO-EESC: developing the curricula, identifying speakers, delivering courses, and evaluation
- WHO-KMS: knowledge networking and IT solutions;
- WHO, GHWA: Knowledge Centres
- Malian Ministry of Health/ Direction National de la Santé
- Orange Mali
- National Agency for Telehealth and Medical Informatics (ANTIMA).
Photo above: CC Image courtesy of Allan Gichigi, Kenya/UNDP